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Abstract(s)
Introdução: A dor crónica é um problema atual de saúde pública com altos custos individuais e sociais e que afeta uma percentagem considerável da população portuguesa. As principais causas de dor crónica são as patologias do foro osteoarticular e musculosquelético, que são particularmente frequentes nos cuidados de saúde primários. Os opióides são um pilar importante no tratamento da dor crónica não oncológica moderada a forte. No entanto, existe ainda alguma resistência à prescrição de opióides, o que pode levar ao subtratamento da dor e à diminuição da qualidade de vida dos pacientes.
Os objetivos desta dissertação são, através de uma revisão bibliográfica da literatura, perceber as crenças e atitudes dos médicos relativamente ao uso de opióides e identificar as razões que levam ao receio de os prescrever. O foco será nos cuidados de saúde primários, por serem os médicos de família os principais responsáveis pelo tratamento da dor crónica. Pretende-se também desmitificar algumas ideias incorretas que ainda existem relativamente à utilização de opióides no tratamento da dor crónica não oncológica.
Metodologia: Foi feita uma pesquisa bibliográfica na base de dados Pubmed, na revista DOR e nas plataformas online da Direção-Geral da Saúde, European Pain Federation e International Association for the Study of Pain. Os termos da pesquisa foram uma associação das palavras-chaves: “chronic pain”, “opioids”, “chronic non-cancer pain” e “primary health care”, “opióides”, “dor crónica” e “dor crónica não oncológica”. Foram excluídos os estudos que se focassem em especialidades que não os cuidados de saúde primários e que abordassem apenas dor crónica de etiologia oncológica.
Resultados: Nos últimos anos tem-se verificado um aumento global no consumo de opióides. No entanto, apesar das várias guidelines e recomendações existentes, ainda se observa uma grande relutância no uso de opióides para a dor crónica não oncológica, tanto por parte dos médicos, como dos pacientes. As principais razões referidas pelos médicos para a sua resistência na prescrição de opióides são a possível ocorrência de comportamentos abusivos e de adição, e a falta de formação e experiência prática. Esta insuficiente formação parece ser um problema que vem já da formação pré-graduada, pois a maioria das escolas médicas europeias tem um tempo insuficiente dedicado ao ensino sobre a dor no seu currículo.
Discussão e conclusão: É urgente o investimento na educação pré e pós graduada relativamente à dor crónica e o seu tratamento, com especial destaque para a prescrição de opióides. Existe ainda evidência fraca relativamente à eficácia e segurança do uso de opióides a longo prazo, sendo assim necessários mais estudos realizados a longo prazo.
Introduction: Chronic pain is a current public health problem with high individual and social costs that affects a considerable percentage of the Portuguese population. The leading causes of chronic pain are osteoarticular and musculoskeletal disorders, which are particularly frequent in primary health care. Opioids are an important pillar in the treatment of moderate to severe chronic non-cancer pain. However there is still some resistance to the prescription of opioids, which can lead to the undertreatment of pain and decrease of patients’ quality of life. The objectives of this dissertation are, through a bibliographical review of the literature, to understand the beliefs and attitudes of physicians regarding the use of opioids and to identify the reasons that lead to the fear of prescribing them. The focus is on primary health care, as family doctors are the primary care providers for the treatment of chronic pain. It is also intended to demystify some incorrect ideas that still exist regarding the use of opioids in the treatment of chronic non-cancer pain. Methodology: A literature search was made in Pubmed database, in the journal DOR and the online platforms of Direção-Geral da Saúde, European Pain Federation and International Association for the Study of Pain. The terms of the survey were an association of keywords: "chronic pain", "opioids", "chronic non-cancer pain" and "primary health care", "opióides", "dor crónica" and "dor crónica não oncológica". Studies that focused on specialties other than primary health care and which addressed only chronic pain with oncological etiology were excluded. Results: In recent years there has been an overall increase in opioid consumption. However, in spite of several guidelines and recommendations, there is still a great reluctance to use opioids for chronic non-cancer pain, both by physicians and patients. The main reasons cited by physicians for their resistance to opioid prescription are the possible occurrence of abusive and addictive behaviors and lack of training and practical experience. This insufficient training seems to be a problem that comes from pre-graduate education, since most European medical schools have insufficient time dedicated to pain education in their curriculum. Discussion and conclusion: There is an urgent need to invest in pre and postgraduate education regarding chronic pain and its treatment, with special emphasis on the prescription of opioids. There is also weak evidence regarding the efficacy and safety of long-term use of opioids, and further long-term studies are therefore needed.
Introduction: Chronic pain is a current public health problem with high individual and social costs that affects a considerable percentage of the Portuguese population. The leading causes of chronic pain are osteoarticular and musculoskeletal disorders, which are particularly frequent in primary health care. Opioids are an important pillar in the treatment of moderate to severe chronic non-cancer pain. However there is still some resistance to the prescription of opioids, which can lead to the undertreatment of pain and decrease of patients’ quality of life. The objectives of this dissertation are, through a bibliographical review of the literature, to understand the beliefs and attitudes of physicians regarding the use of opioids and to identify the reasons that lead to the fear of prescribing them. The focus is on primary health care, as family doctors are the primary care providers for the treatment of chronic pain. It is also intended to demystify some incorrect ideas that still exist regarding the use of opioids in the treatment of chronic non-cancer pain. Methodology: A literature search was made in Pubmed database, in the journal DOR and the online platforms of Direção-Geral da Saúde, European Pain Federation and International Association for the Study of Pain. The terms of the survey were an association of keywords: "chronic pain", "opioids", "chronic non-cancer pain" and "primary health care", "opióides", "dor crónica" and "dor crónica não oncológica". Studies that focused on specialties other than primary health care and which addressed only chronic pain with oncological etiology were excluded. Results: In recent years there has been an overall increase in opioid consumption. However, in spite of several guidelines and recommendations, there is still a great reluctance to use opioids for chronic non-cancer pain, both by physicians and patients. The main reasons cited by physicians for their resistance to opioid prescription are the possible occurrence of abusive and addictive behaviors and lack of training and practical experience. This insufficient training seems to be a problem that comes from pre-graduate education, since most European medical schools have insufficient time dedicated to pain education in their curriculum. Discussion and conclusion: There is an urgent need to invest in pre and postgraduate education regarding chronic pain and its treatment, with special emphasis on the prescription of opioids. There is also weak evidence regarding the efficacy and safety of long-term use of opioids, and further long-term studies are therefore needed.
Description
Keywords
Cuidados de Saúde Primários Dor Crónica Dor Crónica Não Oncológica Opióides