Factores asociados a uso inapropiado de opioides en dolor crónico no oncológico en una población de Bogotá

Objetivo: El dolor crónico no oncológico (DCNO) constituye un problema de salud pública. Su manejo con opioides ha crecido exponencialmente y consigo el uso inapropiado de opioides prescritos (UIOP). El objetivo primario fue identificar la prevalencia del riesgo de UIOP y los factores relacionados c...

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Autores Principales: Rondón Lizarazo, Maria Paula, Salazar Rodríguez, Diana Maritza
Otros Autores: Daza Vergara, José Alejandro
Formato: Tesis de maestría (Master Thesis)
Lenguaje:Español (Spanish)
Publicado: Universidad del Rosario 2019
Materias:
Acceso en línea:http://repository.urosario.edu.co/handle/10336/20102
id ir-10336-20102
recordtype dspace
institution EdocUR - Universidad del Rosario
collection DSpace
language Español (Spanish)
topic Opioides
Medicamentos bajo prescripción
Trastornos relacionados con opioides
Dolor crónico
Dolor nociceptivo
Dolor crónico no oncológico
Enfermedades
Dolor crónico
Opiáceos
Analgésicos opioides
Opioid
Prescription drugs
Opioid-related disorders
Chronic pain
Nociceptive pain
Chronic non-cancer pain
spellingShingle Opioides
Medicamentos bajo prescripción
Trastornos relacionados con opioides
Dolor crónico
Dolor nociceptivo
Dolor crónico no oncológico
Enfermedades
Dolor crónico
Opiáceos
Analgésicos opioides
Opioid
Prescription drugs
Opioid-related disorders
Chronic pain
Nociceptive pain
Chronic non-cancer pain
Rondón Lizarazo, Maria Paula
Salazar Rodríguez, Diana Maritza
Factores asociados a uso inapropiado de opioides en dolor crónico no oncológico en una población de Bogotá
description Objetivo: El dolor crónico no oncológico (DCNO) constituye un problema de salud pública. Su manejo con opioides ha crecido exponencialmente y consigo el uso inapropiado de opioides prescritos (UIOP). El objetivo primario fue identificar la prevalencia del riesgo de UIOP y los factores relacionados con este en un Hospital de IV nivel en Bogotá. Metodología: Se incluyeron 260 sujetos mayores de edad, en manejo con opioides por DCNO, en un periodo entre enero y abril de 2019. Se evaluó el riesgo del UIOP utilizando la escala SOAPP-®R (>18 puntos) y para detectar el abuso de otras sustancias la escala ASSIST. Luego se aplicó un cuestionario propio con variables que pudieran influir en el resultado de la escala SOAPP-®R. Mediante análisis estadístico descriptivo se identificó la prevalencia del riesgo. Para identificar factores relacionados al riesgo se usó una regresión logística ordinal. Resultados: La prevalencia encontrada fue de 56,5% y como factores relacionados a mayor riesgo se encontraron: la edad entre 50 y 60 años (IC95% 3,53-22,06), opioides potentes (IC95% 1,42-4,7), tiempo de evolución del dolor (superior a 24 meses, p=0,038), dolor craneofacial (IC95% 1,81-24,65), dependencia funcional (IC95% 1,97-5,93) y depresión (IC95% 1,79-6,13). Conclusiones: El riesgo de UIOP en la población expuesta es alto y tiene diversos factores que aumentan la probabilidad de presentar conductas aberrantes con su uso, por lo cual es importante implementar escalas de riesgo como SOAPP-®R y diseñar estrategias preventivas que contribuyan a mitigar la aparición del evento en la población del Hospital y eventualmente del país.
author2 Daza Vergara, José Alejandro
author_facet Daza Vergara, José Alejandro
Rondón Lizarazo, Maria Paula
Salazar Rodríguez, Diana Maritza
format Tesis de maestría (Master Thesis)
author Rondón Lizarazo, Maria Paula
Salazar Rodríguez, Diana Maritza
author_sort Rondón Lizarazo, Maria Paula
title Factores asociados a uso inapropiado de opioides en dolor crónico no oncológico en una población de Bogotá
title_short Factores asociados a uso inapropiado de opioides en dolor crónico no oncológico en una población de Bogotá
title_full Factores asociados a uso inapropiado de opioides en dolor crónico no oncológico en una población de Bogotá
title_fullStr Factores asociados a uso inapropiado de opioides en dolor crónico no oncológico en una población de Bogotá
title_full_unstemmed Factores asociados a uso inapropiado de opioides en dolor crónico no oncológico en una población de Bogotá
title_sort factores asociados a uso inapropiado de opioides en dolor crónico no oncológico en una población de bogotá
publisher Universidad del Rosario
publishDate 2019
url http://repository.urosario.edu.co/handle/10336/20102
_version_ 1712098608176693248
spelling ir-10336-201022021-08-14T06:01:01Z Factores asociados a uso inapropiado de opioides en dolor crónico no oncológico en una población de Bogotá Rondón Lizarazo, Maria Paula Salazar Rodríguez, Diana Maritza Daza Vergara, José Alejandro Isaza Narváez, Ana Milena Aguilera, Paula Pedraza Flechas, Ana Maria Opioides Medicamentos bajo prescripción Trastornos relacionados con opioides Dolor crónico Dolor nociceptivo Dolor crónico no oncológico Enfermedades Dolor crónico Opiáceos Analgésicos opioides Opioid Prescription drugs Opioid-related disorders Chronic pain Nociceptive pain Chronic non-cancer pain Objetivo: El dolor crónico no oncológico (DCNO) constituye un problema de salud pública. Su manejo con opioides ha crecido exponencialmente y consigo el uso inapropiado de opioides prescritos (UIOP). El objetivo primario fue identificar la prevalencia del riesgo de UIOP y los factores relacionados con este en un Hospital de IV nivel en Bogotá. Metodología: Se incluyeron 260 sujetos mayores de edad, en manejo con opioides por DCNO, en un periodo entre enero y abril de 2019. Se evaluó el riesgo del UIOP utilizando la escala SOAPP-®R (>18 puntos) y para detectar el abuso de otras sustancias la escala ASSIST. Luego se aplicó un cuestionario propio con variables que pudieran influir en el resultado de la escala SOAPP-®R. Mediante análisis estadístico descriptivo se identificó la prevalencia del riesgo. Para identificar factores relacionados al riesgo se usó una regresión logística ordinal. Resultados: La prevalencia encontrada fue de 56,5% y como factores relacionados a mayor riesgo se encontraron: la edad entre 50 y 60 años (IC95% 3,53-22,06), opioides potentes (IC95% 1,42-4,7), tiempo de evolución del dolor (superior a 24 meses, p=0,038), dolor craneofacial (IC95% 1,81-24,65), dependencia funcional (IC95% 1,97-5,93) y depresión (IC95% 1,79-6,13). Conclusiones: El riesgo de UIOP en la población expuesta es alto y tiene diversos factores que aumentan la probabilidad de presentar conductas aberrantes con su uso, por lo cual es importante implementar escalas de riesgo como SOAPP-®R y diseñar estrategias preventivas que contribuyan a mitigar la aparición del evento en la población del Hospital y eventualmente del país. Objective: Chronic non-cancer pain constitutes a worldwide public health problem. Sometimes it requires management with prescription opioids, which use can be associated with complications such as misuse/abuse of these drugs (POMA). The primary objective was to identify the risk prevalence and the risk factors associated with this kind of behaviors in the study population. Methodology: 260 subjects, who were assessed by pain services from Hospital Universitario due to CNCP, who fulfilled inclusion criteria, in a period of time between January and March 2019, were included. Subsequently, the SOAPP-®R, ASSIST scale and a questionnaire made by the PI were applied. With the results, by means of bivariate, multivariate and ordinal logistic linear regression analysis, the risk prevalence and the biopsychosocial factors that were associated with the relative risk of opioids misuse/abuse, were identified. Results: We found that the prevalence for the risk of POMA was 56.5% and as statistically significant factors associated with greater risk, we found: age between 50 and 60 years-old, strong opioids, the time of pain duration (more than 24 months), head and face pain/headache, functional dependence and depression. Conclusions: Acknowledging the risk prevalence and the factors associated with POMA for our Hospital population is very useful and important, given that it could help to generate/apply risk tools in the future, adjusted to the features of our population, in order to assess this risk and thus take further actions that reduce the risk of occurrence of these events and bring benefit to the patients. 2019-07-25 2019-08-13T21:44:15Z info:eu-repo/semantics/masterThesis info:eu-repo/semantics/acceptedVersion http://repository.urosario.edu.co/handle/10336/20102 spa Atribución-NoComercial-SinDerivadas 2.5 Colombia http://creativecommons.org/licenses/by-nc-nd/2.5/co/ info:eu-repo/semantics/openAccess application/pdf Universidad del Rosario Especialización en Medicina del Dolor y Cuidado Paliativo Escuela de Medicina y Ciencias de la Salud instname:Universidad del Rosario reponame:Repositorio Institucional EdocUR 1. Campbella, G., et al. The Pain and Opioids IN Treatment study: characteristics of a cohort using opioids to manage chronic non-cancer pain. Pain 2015; Feb;156(2):231-42. 2. Sehgal, N., Manchikanti, L., Smith, HS. Prescription Opioid Abuse in Chronic Pain: A Review of Opioid Abuse Predictors and Strategies to Curb Opioid Abuse. Pain Physician. 2012 Jul;15(3 Suppl):ES67-92. 3. Kaye, A.D. et al. Prescription Opioid Abuse in Chronic Pain: An Updated Review of Opioid Abuse Predictors and Strategies to Curb Opioid Abuse: Part 1. Pain Physician 2017; 20: S93-S109. 4. Airam, A., Hammam A., Gururau S. Prevention of Opioid Abuse in Chronic Non-Cancer Pain: An Algorithmic, Evidence Based Approach. Pain Physician 2012; 15:ES177-ES189. 5. Vogt MT, Kwoh CK, Cope DK, Osial TA, Culyba M, Starz TW. Analgesic usage for low back pain: impact on health care costs and service use. Spine. 2005;30:1075–1081. 6. Voon P, Karamouzian M, Kerr T.Chronic pain and opioid misuse: a review of reviews. Substance Abuse Treatment, Prevention, and Policy 2017; 12:36. 7. Palmer R.E, et al. The prevalence of problem opioid use in patients receiving chronic opioid therapy: computer-assisted review of electronic health record clinical notes. Pain 2015; Jul;156(7):1208-14. 8. Boyd, C., et al. Motives for Medical Misuse of Prescription Opioids Among Adolescent. J Pain. 2013 Oct; 14(10): 1208–1216. 9. Carter, J., et al. Factors predicting development of opioid use disorders among individuals who receive an initial opioid prescription: Mathematical modeling using a database of commercially-insured individuals. Drug Alcohol Depend. 2014 May 1;138:202-8. 10. Dart, RC., et al. Trends in abuse and misuse of prescription opioids among older. Drug Alcohol Depend. 2015 Apr 1;149:117-21. 11. Müller-Schwefe, G. Dynamic risk factors in the misuse of opioid analgesics. J Psychosom Res. 2012 Jun;72(6):443-51. 12. Volkow, N., McLellan, A.T. Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies. Engl J Med 2016; 374:1253-1263. 13. Guerrero A, Gómez P. VIII Estudio Nacional de Dolor 2014 - Prevalencia del dolor crónico en Colombia. Asociación Colombiana para el Estudio de Dolor. 2016. 14. Just J. et al. Risk of opioid misuse in chronic non-cancer pain in primary care patients - a cross sectional study. BMC Family Practice 2018; 19:92. 15. Gobierno Nacional de la República de Colombia. Estudio Nacional de Consumo de Sustancias Psicoactivas en Colombia. 2013. 16. Pagé, M.G., et al. Risk of Opioid Abuse and Biopsychosocial Characteristics Associated With This Risk Among Chronic Pain Patients Attending a Multidisciplinary Pain Treatment Facility. Clin J Pain. 2016 Oct;32(10):859-69. 17. Amsterdam J.V, Van den Brink W. The Misuse of Prescription Opioids: A Threat for Europe?. Current Drug Abuse Reviews 2015; 8: 3-14. 18. Ballantyne, JC. Opioids for the Treatment of Chronic Pain: Mistakes Made, Lessons Learned, and Future Directions. Anesth Analg 2017;125:1769–78. 19. Pergolizzi Jr, J. V., Gharibo, C., Passik, S., Labhsetwar, S., Taylor Jr, R., Pergolizzi, J. S., & Müller-Schwefe, G. Dynamic risk factors in the misuse of opioid analgesics. Journal of psychosomatic research 2012; 72(6): 443-451. 20. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub, 2013. 21. American College of Preventive Medicine. Use, Abuse, Misuse, and disposal of prescription pain medication time tool: A Resource from the American College of Preventive Medicine. 2011. Tomado de: http://www.acpm.org/?UseAbuseRxClinRef 22. Ballantyne, J.C, LaForge, K,S. Opioid dependence and addiction during opioid treatment of chronic pain. Pain 2007; 129: 235–255. 23. Johnson S, North R. Opioids excite dopamine neurons by hyperpolarization of local interneurons. J Neurosci. 1992; 12: 483–8. 24. Bonci A, Williams J. Increased probability of GABA release during withdrawal from morphine. J Neurosci. 1997; 17: 796–803. 25. Cami, J., Farre, M. Drug addiction. N Engl J Med 2003; 349: 975–86. 26. Hyman S, Malenka R. Addiction and the brain: the neurobiology of compulsion and its persistence. Nat Rev Neurosci. 2001; 2: 695–703. 27. Robinson T, Berridge K. Addiction. Annu Rev Psychol 2003; 54: 25–53. 28. Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, Dana T, Bougatsos C, Deyo RA. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health pathways to prevention workshop. Ann Intern Med. 2015;162:276–86. 29. Vowles K.E, McEntee M.L, Julnes P.S, et al. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain 2015;156:569-76. 30. Webster, L. R. Risk factors for opioid-use disorder and overdose. Anesthesia & Analgesia 2017; 125(5): 1741-1748. 31. McCabe SE, West BT, Boyd CJ. Motives for medical misuse of prescription opioids among adolescents. The Journal of Pain 2013:14: 1208-1216 32. Kirson, N. Y., Scarpati, L. M., Enloe, C. J., Dincer, A. P., Birnbaum, H. G., & Mayne, T. J. The economic burden of opioid abuse: updated findings. Journal of managed care & specialty pharmacy 2017; 23(4): 427-445. 33. Zedler BK, Saunders WB, Joyce AR, Vick CC, Murrelle EL. Validation of a screening risk index for serious prescription opioid-induced respiratory depression or overdose in a US Commercial Health Plan Claims Database. Pain Med. 2017 Mar 6 [Epub ahead of print]. 34. Klimas J, et al. Strategies to Identify Patient Risks of Prescription Opioid Addiction When Initiating Opioids for Pain. JAMA Network Open 2019; 2(5): e193365. 35. Grau, LE. Chronic pain, Addiction severity, and misuse of opioids in Cumberland County. Addict Behav. 2012 Mar;37(3):346-9. 36. Pletcher M.J, Kertesz S.G, Kohn M.A, Gonzales R. Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. Jama. 2008; 299: 70-78. 37. Lanier W.A., Johnson E.M., Rolfs R.T., Friedrichs M.D., Grey T.C. Risk Factors for Prescription Opioid-Related Death, Utah, 2008–2009. Pain Medicine 2012;13: 1580-1589. 38. Akbik H, et al. Validation and clinical application of the Screener and Opioid Assessment for Patients with Pain (SOAPP). J Pain Symptom Manage. 2006; 32(3):287-293. 39. Organización Mundial de la Salud . La prueba de detección de consumo de alcohol, tabaco y sustancias (ASSIST) - Manual para uso en la atención primaria, 2011. 40. Kanouse, A. B., & Compton, P. The epidemic of prescription opioid abuse, the subsequent rising prevalence of heroin use, and the federal response. Journal of pain & palliative care pharmacotherapy 2015; 29(2): 102-114. 41. Lee, Y. H., Brown, D. L., & Chen, H. Y. Current Impact and Application of Abuse-Deterrent Opioid Formulations in Clinical Practice 2017; 20(7):E1003-E1023. 1. Campbella, G., et al. The Pain and Opioids IN Treatment study: characteristics of a cohort using opioids to manage chronic non-cancer pain. Pain 2015; Feb;156(2):231-42. 2. Sehgal, N., Manchikanti, L., Smith, HS. Prescription Opioid Abuse in Chronic Pain: A Review of Opioid Abuse Predictors and Strategies to Curb Opioid Abuse. Pain Physician. 2012 Jul;15(3 Suppl):ES67-92. 3. Kaye, A.D. et al. Prescription Opioid Abuse in Chronic Pain: An Updated Review of Opioid Abuse Predictors and Strategies to Curb Opioid Abuse: Part 1. Pain Physician 2017; 20: S93-S109. 4. Airam, A., Hammam A., Gururau S. Prevention of Opioid Abuse in Chronic Non-Cancer Pain: An Algorithmic, Evidence Based Approach. Pain Physician 2012; 15:ES177-ES189. 5. Vogt MT, Kwoh CK, Cope DK, Osial TA, Culyba M, Starz TW. Analgesic usage for low back pain: impact on health care costs and service use. Spine. 2005;30:1075–1081. 6. Voon P, Karamouzian M, Kerr T.Chronic pain and opioid misuse: a review of reviews. Substance Abuse Treatment, Prevention, and Policy 2017; 12:36. 7. Palmer R.E, et al. The prevalence of problem opioid use in patients receiving chronic opioid therapy: computer-assisted review of electronic health record clinical notes. Pain 2015; Jul;156(7):1208-14. 8. Boyd, C., et al. Motives for Medical Misuse of Prescription Opioids Among Adolescent. J Pain. 2013 Oct; 14(10): 1208–1216. 9. Carter, J., et al. Factors predicting development of opioid use disorders among individuals who receive an initial opioid prescription: Mathematical modeling using a database of commercially-insured individuals. Drug Alcohol Depend. 2014 May 1;138:202-8. 10. Dart, RC., et al. Trends in abuse and misuse of prescription opioids among older. Drug Alcohol Depend. 2015 Apr 1;149:117-21. 11. Müller-Schwefe, G. Dynamic risk factors in the misuse of opioid analgesics. J Psychosom Res. 2012 Jun;72(6):443-51. 12. Volkow, N., McLellan, A.T. Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies. Engl J Med 2016; 374:1253-1263. 13. Guerrero A, Gómez P. VIII Estudio Nacional de Dolor 2014 - Prevalencia del dolor crónico en Colombia. Asociación Colombiana para el Estudio de Dolor. 2016. 14. Just J. et al. Risk of opioid misuse in chronic non-cancer pain in primary care patients - a cross sectional study. BMC Family Practice 2018; 19:92. 15. Gobierno Nacional de la República de Colombia. Estudio Nacional de Consumo de Sustancias Psicoactivas en Colombia. 2013. 16. Pagé, M.G., et al. Risk of Opioid Abuse and Biopsychosocial Characteristics Associated With This Risk Among Chronic Pain Patients Attending a Multidisciplinary Pain Treatment Facility. Clin J Pain. 2016 Oct;32(10):859-69. 17. Amsterdam J.V, Van den Brink W. The Misuse of Prescription Opioids: A Threat for Europe?. Current Drug Abuse Reviews 2015; 8: 3-14. 18. Ballantyne, JC. Opioids for the Treatment of Chronic Pain: Mistakes Made, Lessons Learned, and Future Directions. Anesth Analg 2017;125:1769–78. 19. Pergolizzi Jr, J. V., Gharibo, C., Passik, S., Labhsetwar, S., Taylor Jr, R., Pergolizzi, J. S., & Müller-Schwefe, G. Dynamic risk factors in the misuse of opioid analgesics. Journal of psychosomatic research 2012; 72(6): 443-451. 20. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub, 2013. 21. American College of Preventive Medicine. Use, Abuse, Misuse, and disposal of prescription pain medication time tool: A Resource from the American College of Preventive Medicine. 2011. Tomado de: http://www.acpm.org/?UseAbuseRxClinRef 22. Ballantyne, J.C, LaForge, K,S. Opioid dependence and addiction during opioid treatment of chronic pain. Pain 2007; 129: 235–255. 23. Johnson S, North R. Opioids excite dopamine neurons by hyperpolarization of local interneurons. J Neurosci. 1992; 12: 483–8. 24. Bonci A, Williams J. Increased probability of GABA release during withdrawal from morphine. J Neurosci. 1997; 17: 796–803. 25. Cami, J., Farre, M. Drug addiction. N Engl J Med 2003; 349: 975–86. 26. Hyman S, Malenka R. Addiction and the brain: the neurobiology of compulsion and its persistence. Nat Rev Neurosci. 2001; 2: 695–703. 27. Robinson T, Berridge K. Addiction. Annu Rev Psychol 2003; 54: 25–53. 28. Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, Dana T, Bougatsos C, Deyo RA. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health pathways to prevention workshop. Ann Intern Med. 2015;162:276–86. 29. Vowles K.E, McEntee M.L, Julnes P.S, et al. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain 2015;156:569-76. 30. Webster, L. R. Risk factors for opioid-use disorder and overdose. Anesthesia & Analgesia 2017; 125(5): 1741-1748. 31. McCabe SE, West BT, Boyd CJ. Motives for medical misuse of prescription opioids among adolescents. The Journal of Pain 2013:14: 1208-1216 32. Kirson, N. Y., Scarpati, L. M., Enloe, C. J., Dincer, A. P., Birnbaum, H. G., & Mayne, T. J. The economic burden of opioid abuse: updated findings. Journal of managed care & specialty pharmacy 2017; 23(4): 427-445. 33. Zedler BK, Saunders WB, Joyce AR, Vick CC, Murrelle EL. Validation of a screening risk index for serious prescription opioid-induced respiratory depression or overdose in a US Commercial Health Plan Claims Database. Pain Med. 2017 Mar 6 [Epub ahead of print]. 34. Klimas J, et al. Strategies to Identify Patient Risks of Prescription Opioid Addiction When Initiating Opioids for Pain. JAMA Network Open 2019; 2(5): e193365. 35. Grau, LE. Chronic pain, Addiction severity, and misuse of opioids in Cumberland County. Addict Behav. 2012 Mar;37(3):346-9. 36. Pletcher M.J, Kertesz S.G, Kohn M.A, Gonzales R. Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. Jama. 2008; 299: 70-78. 37. Lanier W.A., Johnson E.M., Rolfs R.T., Friedrichs M.D., Grey T.C. Risk Factors for Prescription Opioid-Related Death, Utah, 2008–2009. Pain Medicine 2012;13: 1580-1589. 38. Akbik H, et al. Validation and clinical application of the Screener and Opioid Assessment for Patients with Pain (SOAPP). J Pain Symptom Manage. 2006; 32(3):287-293. 39. Organización Mundial de la Salud . La prueba de detección de consumo de alcohol, tabaco y sustancias (ASSIST) - Manual para uso en la atención primaria, 2011. 40. Kanouse, A. B., & Compton, P. The epidemic of prescription opioid abuse, the subsequent rising prevalence of heroin use, and the federal response. Journal of pain & palliative care pharmacotherapy 2015; 29(2): 102-114. 41. Lee, Y. H., Brown, D. L., & Chen, H. Y. Current Impact and Application of Abuse-Deterrent Opioid Formulations in Clinical Practice 2017; 20(7):E1003-E1023.
score 12,111491