Rev. Soc. Esp. Dolor. 2021; 28(4): 181-193 / DOI: 10.20986/resed.2021.3922/2021
Jenifer Palomo, Helena De Sola, Jose A. Moral, María Dueñas, Alejandro Salazar, Inmaculada Failde
ABSTRACT
Introduction: The lack of adherence is frequent in chronic pain (CP) patients and the influence of psychological factors may play a relevant role. The aim of this study was to analyze the psychological factors related to the adherence to analgesic treatment in patients with CP.
Methodology: A systematic review was carried out, including original articles published in English and Spanish between June-2009 and June-2019 included in Pudmed, Scopus, Web of Science and PsycINFO. Articles with cross-sectional and longitudinal design were included, carried out in a population >18 years with chronic non-oncological pain (CNOP) and that analyzed any psychological variable in relation to adherence to analgesic treatment. The search terms were “adherence”, “compliance”, “misuse”, “analgesic”, “chronic pain” and “psychology”. The quality of the articles included was analysed through the Critical Appraisal Checklist for Analytical Cross-sectional studies of Joanna Briggs Institute for cross-sectional studies and the Newcastle-Ottawa Quality Assessment Form for Cohort Studies for the longitudinal studies.
Results: A total of 1184 articles were initially identified, and 14 were finally selected. Depression was the most studied variable, being included in 11 articles, followed by anxiety, that appeared in 6. Both depression and anxiety were repeatedly associated with lower adherence to analgesic treatment, and the same was true in two of the articles that measured jointly the relationship of anxiety and depression on analgesic adherence (high negative affect 39.1 % vs. low negative affect 8,3 %, p = 0.013). Active coping strategies were found to be associated with underuse (OR = 1.132, 95 % CI: 1.027-1.249, p = 0.013) and poor coping strategies were associated with opioid misuse (p = 0.01). The association between catastrophizing and analgesic adherence was addressed in 5 articles, and although it was found that catastrophizing was related to low adherence (r = 0.45, p = 0.01), this result was no longer significant when evaluated alongside anxiety and depression.
Conclusion: The identification and control of psychological factors in patients suffering from CP is necessary, as it could serve to improve adherence to analgesic treatment in these patients.
RESUMEN
Introducción: La falta de adherencia terapéutica es frecuente en pacientes con dolor crónico (DC) y la influencia de factores psicológicos sobre ella puede ser relevante. El objetivo del estudio es analizar los factores psicológicos relacionados con la adherencia al tratamiento analgésico en paciente con DC.
Metodología: Se realizó una revisión sistemática donde se incluyeron artículos originales publicados en inglés y castellano entre junio de 2009 y junio de 2019 incluidos en Pudmed, Scopus, Web of Science y PsycINFO. Se incluyeron artículos con diseño transversal y longitudinal, llevados a cabo en una población > 18 años con dolor crónico no oncológico (DCNO) y que analizaban cualquier variable psicológica en relación con la adherencia al tratamiento analgésico. Los términos de búsqueda fueron “adherence”, “compliance”, “misuse”, “analgesic”, “chronic pain” y “psychology”. La calidad de los artículos incluidos se analizó mediante la Critical Appraisal Checklist for Analytical Cross-sectional studies de Joanna Briggs Institute para los estudios transversales y Newcastle-Ottawa Quality Assessment Form for Cohort Studies para los longitudinales.
Resultados: Se identificaron 1184 artículos, de los cuales 14 fueron finalmente seleccionados. La depresión fue la variable más estudiada, incluida en 11 artículos, seguida de la ansiedad, que apareció en 6. Tanto la depresión como la ansiedad se asociaron de manera constante y significativa con una menor adherencia al tratamiento analgésico, y lo mismo fue cierto en dos de los artículos que miden conjuntamente la relación de ansiedad y depresión en la adherencia analgésica (efecto negativo alto 39,1 % vs. efecto negativo bajo 8,3 %, p = 0,013). Se encontró que las estrategias de afrontamiento activas se asociaban con infrauso (OR = 1,132, IC 95 %: 1,027-1,249, p = 0,013) y las pobres estrategias de afrontamiento se relacionaron con un mal uso de los opioides (p = 0,01). La asociación entre catastrofismo y adherencia analgésica se abordaba en 5 artículos, y aunque se encontró que el catastrofismo se relacionaba con una baja adherencia (r = 0,45, p < 0,01), este resultado dejó de ser significativo cuando se evaluaba junto a la ansiedad y a la depresión.
Conclusiones: La identificación y control de los factores psicológicos en los enfermos que sufren DC es necesario, ya que podría servir para mejorar la adherencia al tratamiento analgésico en estos pacientes.
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