Tratamiento analgésico y adecuación terapéutica en los pacientes con enfermedad crónica avanzada. Oportunidades de mejora

Objectives

To describe the analgesic treatment of patients with advanced chronic disease (ACD), to determine pain management, and to detect opportunities for improvement.

Design

Observational, descriptive, cross-sectional, multicentre study.

Location

Three primary care teams, one intermediate care hospital and five nursing homes in Catalonia.

Participants

Patients 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 measurements

Place 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.

Results

The 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.

Conclusions

In 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.