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Uso inadecuado de opioides en pacientes con dolor oncológico: revisión sistemática integradora de la literatura
Opioid misuse in patients with cancer pain: an integrative systematic review of the literature

Rev. Soc. Esp. Dolor. 2020; 27(5): 306-315 / DOI: 10.20986/resed.2020.3801/2020

María Labori, Rosa Hernández, Josep Porta

RESUMEN

Introducción: Los opioides son ampliamente utilizados para el control del dolor oncológico y no oncológico. Existe mucha información sobre el uso inadecuado de opioides (UIO) en pacientes no oncológicos, sin embargo en pacientes oncológicos existe menos evidencia.
Objetivos: Identificar, analizar y sintetizar la evidencia disponible sobre la epidemiología, los factores de riesgo, instrumentos clínicos y evolución del UIO en pacientes con dolor oncológico.
Material y métodos: Revisión sistemática integradora de la literatura con extracción de datos y síntesis narrativa. Las fuentes utilizadas para buscar artículos publicados hasta el 31 de diciembre de 2017 fueron las bases de datos PubMed, Web of Science y PsychINFO. Se eligieron aquellos artículos que siguieran los siguientes criterios de inclusión: 1) publicados en lengua inglesa, española o francesa, y 2) que incluyesen información sobre la prevalencia o incidencia del UIO en pacientes con dolor oncológico, o/y 3) que aportasen información sobre factores de riesgo, mortalidad, duración del UIO y su remisión.
Resultados: De la búsqueda surgieron 3520 artículos, de los cuales 40 cumplieron los criterios de inclusión. Se identificaron cuatro áreas temáticas: 1) epidemiología, 2) factores de riesgo, 3) opinión de pacientes y profesionales, y 4) políticas específicas. Los resultados obtenidos fueron muy heterogéneos, identificándose una prevalencia que oscila entre el 0 y el 26 % en el UIO y entre el 12 y el 85 % en las conductas aberrantes relacionadas con opioides. Se identificaron diferentes factores de riesgo de UIO, destacando la edad joven y la presencia de antecedentes psiquiátricos o de abuso de sustancias, y se describieron diferentes instrumentos dirigidos a la evaluación del riesgo o bien al diagnóstico del UIO. En cuanto a la opinión de los profesionales, parece haber un incremento de la sensibilización al respecto, pero las políticas de los centros en relación con esta problemática suelen ser casi inexistentes.
Conclusiones: A pesar de que existe una mayor sensibilización de los profesionales acerca del UIO en pacientes oncológicos, la información de que disponemos es muy heterogénea y no nos permite extraer conclusiones claras. Por esta razón será necesaria la realización de nuevos estudios intentando homogeneizar criterios y establecer mejores protocolos y políticas de detección e intervención frente al UIO.

ABSTRACT

Background: Opioids are widely used for the treatment of cancer pain and non-malignant pain. There is a lot of information about opioid misuse (OM) in patients with non-malignant pain, however in cancer patients there is less evidence.
Objectives: To identify, appraise and synthesize existing evidence about epidemiology, risk factors, clinical tools and evolution of OM in patients with cancer pain.
Methods: Integrative systematic review with data extraction and narrative synthesis. PubMed, Web of Science y PsychINFO databases were searched for articles published through 31 December 2017. Study inclusion criteria were as follows: 1) published in English, Spanish or French language; and 2) containing data on the prevalence or incidence of OM in patients with cancer pain; or/and 3) providing information about OM risk factors, mortality, duration and remission.
Results: The search yielded 3520 articles, of which 40 met the inclusion criteria. Four themes were identified: 1) epidemiology, 2) risk factors, 3) patient’s and professional’s opinion, and 4) specific policies. The obtained results were very heterogeneous; the prevalence of OM varied from 0 up to 26 % and the prevalence of opioid-associated aberrant behaviours from 12 to 85 %. Different risk factors for OM were identified, highlighting young age and history of psychiatric disorders or substance abuse, and different tools for risk assessment or diagnosis of OM were described. Regarding professional’s opinion, it seems to be more awareness about OM but nevertheless policies regarding this problem are scarce.
Conclusions: Even though there is a greater awareness among professionals about OM in cancer patients, the current information is very heterogeneous and does not allow clear conclusions. For this reason, it will be necessary to carry out new studies trying to standardize criteria and establish better protocols and policies for detection and management of OM.

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Labori M, Hernández R, Porta J. Uso inadecuado de opioides en pacientes con dolor oncológico: revisión sistemática integradora de la literatura. Rev Soc Esp Dolor 2020; 27(5): 306-315 / DOI: 1020986/resed20203801/2020

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Año 2020 / Volumen 27 / Número 5
English version