• Atencion primaria · Nov 2024

    [Analgesic treatment and pain management in patients with advanced chronic disease. Opportunities for improvement].

    • Àngels Ballarín Castany, Jordi Casanovas Font, Thaïs Serrà Rigol, Anna Formiguera Macià, Ramon Oller Piqué, and Xavier Gómez-Batiste.
    • Equip d'Atenció Primària Vic, Vic, Barcelona, España. Electronic address: aballarin@eapvic.org.
    • Aten Primaria. 2024 Nov 16; 57 (5): 103135103135.

    ObjectivesTo describe the analgesic treatment of patients with advanced chronic disease (ACD), to determine pain management, and to detect opportunities for improvement.DesignObservational, descriptive, cross-sectional, multicentre study.LocationThree primary care teams, one intermediate care hospital and five nursing homes in Catalonia.ParticipantsPatients with ACD and pain according to the Brief Pain Inventory (Short Form) scale (or Pain Assessment in Advanced Dementia scale, in case of advanced dementia).Main MeasurementsPlace of care (home, nursing home, hospital), end of life (EOL) trajectory (organ failure, cancer, dementia, multimorbidity), type of analgesic treatment and pain management according to the Pain Management Index scale.ResultsThe study included 183 patients. The most frequent EOL trajectory was dementia, followed by organ failure, multimorbidity and cancer. The most commonly used analgesic was paracetamol, while weak opioids were testimonial. Analgesic use differed according to EOL trajectory and place of care, with the use of strong opioids prevailing in cancer and hospital, respectively. Almost half of patients had negative PMI, and none non-pharmacological intervention for pain control was recorded.ConclusionsIn patients with ACD and palliative needs, the use of strong opioids continues to prevail in the hospital setting and oncological disease, although pain is highly prevalent in all EOL trajectories and places of care. The high percentage of negative PMI reveals the opportunity for an individualised analgesic ladder stepping for better pain control. Also, incorporating non-pharmacological approaches could help improve pain in these patients.Copyright © 2024 The Authors. Publicado por Elsevier España S.L.U. All rights reserved.

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