Keywords
opioids
chronic non-cancer pain.
Abstract
Introduction: The treatment of chronic non-cancer pain (CNCP) is complex and requires a multidisciplinary approach. Opioids are powerful analgesics used for moderate-severe pain. The Delphi methodology in our study allows us to reach a consensus on the reasons and opinions of the use of opioid analgesics in patients with CNCP. The objective of the study is to know the opioid prescription habits of physicians who regularly prescribe them in CNCP, identify barriers and propose recommendations to improve their use. Material and methods: A Delphi study focused on the reasons why physicians prescribe opioids in a certain way. The survey was conducted in two rounds spaced one month, between the months of December 2022 and January 2023. The Opioid Task Force of the Spanish Society of Pain (GTSED Opioides) promoted the initiative and generated the questions. Consensus was defined with 75 % of responses as "strongly agree" or "strongly disagree". Results: In relation to the beginning of treatment and indications, the panelists strongly agreed that in treatment it is important to have continuity of care between Hospital Care and Primary Care. There was also consensus that we strongly disagreed with combining different major opioids in the same patient. Participants strongly agreed that, when rotating one opioid to another, a dose reduction should be calculated based on the equianalgesic dose, but also taking into account individual factors. The item that obtained the highest degree of consensus throughout the study was that the panelists when prescribing an opioid, took into consideration some situations of renal, hepatic, respiratory and / or cardiac impairment. During the withdrawal of opioids, the panelists give a clear guideline on how to perform it and how to act in the face of withdrawal symptoms, also leaving open a channel of communication with the patient, individualize the withdrawal of opioids and have an Addiction Unit to refer patients of difficult management in the withdrawal of opioids. Conclusions: Barriers and areas for improvement were identified: the need for a multidisciplinary, effective communication and improvement of inter-level continuity of care, training of prescribers and identification of patients at risk of opioid abuse in CNCP. Recommendations for overcoming barriers to optimal opioid treatment were also proposed.References
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