RESUMO

Introducción: El dolor es uno de los síntomas que más sufrimiento produce en cualquier enfermedad y constituye un problema básico de salud en todo el mundo, con frecuencia infra tratado, sobre todo en el área de la Pediatría, con especial déficit en la prescripción de analgésicos opioides. Objetivo: Caracterizar los conocimientos sobre analgésicos opioides y su prescripción por profesionales de la Pediatría. Material y Métodos: Se aplicó un cuestionario construido ad hoc y validado por el método Delphi, a 43 profesionales de la pediatría de tres Hospitales de la provincia La Habana durante el periodo comprendido entre marzo 2017 a marzo 2018. Resultados: Los conocimientos sobre Farmacología de los analgésicos opioides fueron insuficientes en un 81,3 por ciento, regular en un 13 por ciento y buenos en el 5,7 por ciento. Las barreras en la prescripción de opioides más frecuentes fueron el temor a la depresión respiratoria (71,9 por ciento), la escasez de opioides en el Cuadro Básico de Medicamentos (56,3 por ciento) y el temor a la dependencia (36,3 por ciento). Se prescriben opioides sólo en el 39,5 por ciento de los casos, la codeína y el tramadol son los más frecuentemente prescritos. En el 55,8 por ciento de los participantes la formación y superación en analgesia fue insuficiente, en el 28 por ciento regular y solo en el 16,2 por ciento se consideró buena. Conclusiones: Los conocimientos farmacológicos deficientes relativos a los opioides y la baja disponibilidad de estos fármacos son los factores que más influyen en el manejo deficiente del dolor en Pediatría(AU)

Introduction: Pain is one of the symptoms that causes more suffering in any disease. It also constitutes a basic health problem all over the world, which is frequently under-diagnosed mostly in the area of Pediatrics with a special deficit in the prescription of opioid analgesics. Objective: To characterize the knowledge of opioid analgesics and their prescription made by pediatric health professionals. Material and Method: An ad hoc questionnaire, which was validated by the Delphi Method, was applied to 43 pediatricians of three Hospitals in Havana province from March 2017 to March 2018. Results: The knowledge of the pharmacology of opioid analgesics was insufficient in 81.3 percent, regular in 13 percent, and good in 5,7 percent. The most frequent barriers in the prescription of opioids were the fear to respiratory depression (71,9 percent), scarcity of opioids in the Basic Drugs Chart (56,3 percent), and the fear to addiction (36,3 percent). Opioids are prescribed only in 39,5 percent of the cases, being codeine and tramadol the ones that are more frequently prescribed. In 55.8 percent of the inquired cases, the formation and updating in analgesia was insufficient, in 28 percent it was fairly good, and only in 16.2 percent it was considered good. Conclusions: The insufficient pharmacologic knowledge of opioids and the poor availability of these drugs are the factors that most influence on the inadequate management of pain in Pediatrics in our study(AU)

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RESUMO

Pain is highly prevalent among the adult Latin American population. However, many patients with moderate to severe pain do not have access to effective pain management with opioids due to limited access to healthcare, overuse of nonopioid analgesics, regulatory barriers and lack of appropriate information about opioids. There is scarce training on use of opioids among physicians and other healthcare providers, which leads to misconceptions, mainly related to a fear of prescribing opioids. Although opioids are safe and effective drugs for the treatment of moderate to severe chronic pain, the use of opioids in Latin American nations is clearly below standards compared with developed countries.

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RESUMO

A dor é um problema de saúde pública cujo manejo tem apresentado diversas deficiências. Esta pesquisa avalia a percepção e conhecimento de profissionais de saúde a respeito do tema dor e aspectos relacionados à utilização de medicamentos opióides, como legislação, efeitos colaterais, crenças, medo e preconceito. A pesquisa realizada foi exploratória qualitativa, aplicada na forma de entrevistas focais. A amostra estudada foi estratificada, aleatória, composta por trinta profissionais farmacêuticos, médicos e enfermeiros. Observou-se nesse trabalho a necessidade de os profissionais da saúde se familiarizarem mais com o tema, independente de terem demonstrado conhecimento em alguns aspectos. Foi observado conhecimento mais evidente com relação aos efeitos colaterais nas classes farmacêutica e médica, enquanto que na enfermagem o conhecimento maior foi relacionado com as escalas analgésicas. Foram detectados alguns aspectos subjetivos relacionados ao uso de medicamentos opióides, como indícios de medo e preconceito, que podem estar contribuindo para subutilização destes fármacos. Há a necessidade indiscutível da atuação de uma equipe multidisciplinar de saúde bem consolidada para o manejo da dor e melhora da qualidade de vida do paciente.

Pain is a public health problem whose management shows a series of deficiencies. This study evaluates both perception and knowledge of pharmacists, physicians and nurses about pain management and aspects related to utilization of opioids such as legislation, side effects, creeds, fear and prejudice. This exploratory qualitative study was conducted by means of focal interviews of a stratified random sample composed by thirty pharmacists, physicians and nurses. The results show that the health professionals, although being familiar with some aspects, need to acquire more knowledge about this subject. Pharmacists and physicians showed more knowledge about side effects while nurses knew more about analgesic scales. Some subjective aspects regarding opioid utilization observed in the study, among others fear and prejudice, might be contributing to the under-utilization of these drugs. There is an undeniable need for a multi-disciplinary approach of health professionals for managing pain and improving the quality of life of the patients.

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