Tratamiento del dolor oncológico con múltiples opioides potentes al final de la vida
Managing cancer pain at the end of life with multiple strong opioids: a population-based retrospective cohort study in primary care.
Gao W, Gulliford M, Bennett MI, Murtagh FE, Higginson IJ.
PLoS One. 2014 Jan 27;9(1):e79266. doi: 10.1371/journal.pone.0079266. eCollection 2014.
BACKGROUND: End-of-life cancer patients commonly receive more than one type of strong opioid. The three-step analgesic ladder framework of the World Health Organisation (WHO) provides no guidance on multiple opioid prescribing and there is little epidemiological data available to inform practice. This study aims to investigate the time trend of such cases and the associated factors. METHODS: Strong opioid prescribing in the last three months of life of cancer patients were extracted from the General Practice Research Database (GPRD). The outcome variable was the number of different types of prescribed non-rescue doses of opioids (1 vs 2-4, referred to as a complex case). Associated factors were evaluated using prevalence ratios (PR) derived from multivariate log-binomial model, adjusting for clustering effects and potential confounding variables. ….. CONCLUSION: These findings suggest that prescribing behaviour, rather than patient factors, plays an important role in multiple opioid prescribing at the end of life; highlighting the need for training and education that goes beyond the well-recognised WHO approach for clinical practitioners.