Abstract

RIBERA, Mª V.; GALVEZ, R.  and  VIDAL, M. A.. Patrones de uso de los opioides mayores en el dolor de origen neuropático. Rev. Soc. Esp. Dolor [online]. 2007, vol.14, n.4, pp.266-273. ISSN 1134-8046.

Introduction: Neuropathic pain exerts a great impact upon patients. It is one of the most complex pain syndromes, and has a diverse origin. The clinical manifestations of neuropathic pain are typically described as burning, pulsing, sharp or itching pain, etc., that may be accompanied by hyperalgesia or allodynia. The pain is usually associated to altered mood states and even depression, with an important impact upon patient social and occupational activity, and a marked worsening of quality of life. Treatment is difficult, and the condition is often refractory to conventional management. The efficacy of opioids has been the subject of controversy, though recent studies show them to be effective in application to neuropathic pain. Objectives: To determine the patterns of major opioid use in the management of neuropathic pain. Material and methods: A cross-sectional, multicenter, descriptive epidemiological study conducted by 107 specialists from Pain Units throughout Spain, in patients with neuropathic pain. The study comprised a questionnaire for the collection of demographic data, the reason for consultation, the background disease of pain, the time elapsed from diagnosis, treatment, and pain intensity as scored by a visual analog scale (VAS). Demographic data on the investigators were also collected, together with their experience and occupational setting. Quantitative variables are reported as the mean and standard deviation (SD), while qualitative variables are expressed as percentages. Statistical significance was considered for p<0.05. Results: A total of 107 specialists from all over Spain participated in the study. Of these, 97.9% had specific training in pain management, and 92.1% worked in public hospitals. Each specialist included an average of 10.1 patients. A total of 1077 patients were included. Of these, 38.5% suffered pain for over three months, while in 46.3% the pain had been present for over a year. In those situations where a change in opioid proved necessary, fentanyl TTS was introduced in 75.3% of cases. In 61.9% of cases, the reason for the change was inefficacy of the previous treatment. As regards the rest of treatments, 76.7% of the patients were receiving antiseizure drugs, 64.6% used antidepressants, and 96.1% received analgesics. Of the latter, 43.6% were prescribed minor opioids, of which tramadol accounted for 95.5%, while 36.9% were receiving major opioids. A total of 77.3% of the patients receiving tramadol used doses in excess of 150 mg/day. In this study, 47.2% of the patients presented a pain VAS score of over. Conclusions: The treatment of neuropathic pain follows a multimodal scheme in which antiseizure drugs and antidepressants play an important role. However, major opioids, particularly fentanyl TTS, are seen as a first line treatment for pain of this kind.

Keywords : Neuropathic pain; Opioids; TTS Fentanyl; Anticonvulsants; Antidepressants.

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