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Kinouani S, Vielle C, Lambert C, Dupouy J, Laporte C. [Misuse of paracetamol in primary care: Cross-sectional study in a French rural context]. Therapie 2024; 79:429-433. [PMID: 38246801 DOI: 10.1016/j.therap.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/25/2023] [Accepted: 11/17/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To estimate the prevalence of the paracetamol use for a reason other than pain (qualitative misuse) during the last 12 months in patients consulting their general practitioner, as well as the reasons for this misuse. METHODS Descriptive cross-sectional analysis, with gender weighting to estimate the prevalence of paracetamol misuse. RESULTS In total, data from 209 patients were included in the analysis. Among them, 11 patients declared having taken paracetamol for a reason other than pain, i.e., a gender-weighted prevalence of 5.7% (95% CI: 3.0 to 10.4). Nearly two-thirds of these patients said they had done it to feel better. CONCLUSIONS The paracetamol misuse is rare but real in general practice. Further studies are needed to better understand it, especially qualitative studies.
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Affiliation(s)
- Shérazade Kinouani
- Inserm, Bordeaux Population Health Research Center, Team HEALTHY, UMR 1219, université de Bordeaux, 33000 Bordeaux, France; Département de médecine générale, université de Bordeaux, 33000 Bordeaux, France.
| | - Claire Vielle
- Département de médecine générale, université de Bordeaux, 33000 Bordeaux, France
| | - Céline Lambert
- Unité de biostatistiques, DRCI, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Julie Dupouy
- Département universitaire de médecine générale, faculté de santé, université Toulouse III Paul-Sabatier, 31062 Toulouse, France; Inserm, CERPOP, UMR 1295, université Paul-Sabatier, 31000 Toulouse, France
| | - Catherine Laporte
- Clermont-Auvergne INP, CNRS, institut Pascal, CHU de Clermont-Ferrand, université Clermont-Auvergne, 63000 Clermont-Ferrand, France; Département de médecine générale, université Clermont-Auvergne, 63001 Clermont-Ferrand, France
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Rogger R, Bello C, Romero CS, Urman RD, Luedi MM, Filipovic MG. Cultural Framing and the Impact On Acute Pain and Pain Services. Curr Pain Headache Rep 2023; 27:429-436. [PMID: 37405553 PMCID: PMC10462520 DOI: 10.1007/s11916-023-01125-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE OF REVIEW Optimal treatment requires a thorough understanding of all factors contributing to pain in the individual patient. In this review, we investigate the influence of cultural frameworks on pain experience and management. RECENT FINDINGS The loosely defined concept of culture in pain management integrates a predisposing set of diverse biological, psychological and social characteristics shared within a group. Cultural and ethnic background strongly influence the perception, manifestation, and management of pain. In addition, cultural, racial and ethnic differences continue to play a major role in the disparate treatment of acute pain. A holistic and culturally sensitive approach is likely to improve pain management outcomes, will better cover the needs of diverse patient populations and help reduce stigma and health disparities. Mainstays include awareness, self-awareness, appropriate communication, and training.
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Affiliation(s)
- Rahel Rogger
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Corina Bello
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carolina S. Romero
- Anesthesia, Critical Care and Pain Department, Hospital General Universitario de Valencia, Universitad Europea de Valencia, Valencia, Spain
| | - Richard D. Urman
- Department of Anaesthesiology, The Ohio State University, Columbus, OH USA
| | - Markus M. Luedi
- Department of Anaesthesiology and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Mark G. Filipovic
- Department of Anaesthesiology and Pain Medicine, Pain Center, Inselspital Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
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3
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Ge P, Li Q, Dong M, Niu Y, Han X, Xiong P, Bao Y, Min H, Liu D, Wang S, Zhang J, Zhang Z, Yu W, Sun X, Yu L, Wu Y. Self-medication in Chinese residents and the related factors of whether or not they would take suggestions from medical staff as an important consideration during self-medication. Front Public Health 2022; 10:1074559. [PMID: 36620260 PMCID: PMC9814121 DOI: 10.3389/fpubh.2022.1074559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate the status of Chinese residents' self-medication behavior and the important factors to consider when purchasing OTC drugs, and to explore the related factors of the possibility that Chinese residents take medical staff's suggestions as important factors to consider when purchasing OTC drugs. Study design A cross-sectional survey. Methods A questionnaire was developed for exploring the sociodemographic characteristics of the respondents, their self-medication status, and important considerations. The questionnaire includes several scales including Health Literacy Scale-Short Form (HLS-SF), EQ-5D Visual Analog Scale (EQ-5D-VAS), Big Five Inventary-10 Items (BFI-10), and New General Self Efficacy Scale (NGSES). After carrying out a multi-stage sampling method, the questionnaire was conducted nationwide from July 10 to September 15, 2021. Next, descriptive statistics were conducted to analyze the general features. Logistic regression was then used to analyze the related factors of the possibility that the respondents took the suggestions of medical staff as an important consideration when purchasing OTC drugs. Results Nine thousand two hundred fifty-six qualified questionnaires were received. 99.06% of Chinese adults had self-medication behaviors. The types of OTC drugs purchased most by the respondents were NSAIDs (5,421/9,256 people, 58.57%) and vitamins/minerals (4,851/9,256 people, 52.41%). 86.2% of the respondents took the suggestions of medical staff as an important consideration when purchasing OTC drugs. The results of multi-factor logistic regression showed that women, those living in the central and western regions of China, those suffering from chronic diseases, those with high agreeableness, high conscientiousness, high neuroticism and openness, high health literacy, high EQ-5D-VAS, and those with high self-efficacy are more likely to take medical staff's suggestions as important factors to consider. Conclusion The vast majority of Chinese adults have self-medication behavior. Important considerations when purchasing OTC drugs include medical staff's suggestions, drug safety and drug efficacy. Whether residents take the suggestions of medical staff as an important consideration is related to their sociological characteristics, agreeableness, conscientiousness, neuroticism, openness, health literacy, self-assessment health status, and self-efficacy. When purchasing and using OTC drugs, residents should carefully listen to the suggestions from medical staff. They should also carefully consider their own conditions before buying OTC drugs.
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Affiliation(s)
- Pu Ge
- Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China
| | - Qiyu Li
- School of Humanities and Health Management, Jinzhou Medical University, Jinzhou, China
| | - Murong Dong
- Faculty of Education, University of Malaya, Kuala Lumpur, Malaysia
| | - Yuyao Niu
- Faculty of Arts and Humanities, University of Macau, Taipa, Macao SAR, China
| | - Xiao Han
- Department of Pharmacy, The Fifth Affiliated Hospital of Sun Yat-sat University, Zhuhai, China
| | - Ping Xiong
- Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China
| | - Yuhan Bao
- Health Clinic, Changzhou Institute of Technology, Changzhou, China
| | - Hewei Min
- School of Public Health, Peking University, Beijing, China
| | - Diyue Liu
- International School of Public Health and One Health, Hainan Medical University, Haikou, China
| | - Suqi Wang
- School of Philosophy, Anhui University, Hefei, China
| | - Jinzi Zhang
- School of Humanities and Social Sciences, Harbin Medical University, Harbin, China
| | - Ziwei Zhang
- School of Public Health, Peking University, Beijing, China
| | - Wenli Yu
- School of Foreign Languages, Weifang University of Science and Technology, Weifang, China
| | - Xinying Sun
- School of Public Health, Peking University, Beijing, China
| | - Lian Yu
- School of Public Health, Xi'an Jiaotong University, Xi'an, China,*Correspondence: Lian Yu ✉
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China,Yibo Wu ✉
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Mayoral V. An overview of the use and misuse/abuse of opioid analgesics in different world regions and future perspectives. Pain Manag 2022; 12:535-555. [PMID: 35118876 DOI: 10.2217/pmt-2021-0094] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Opioids are an important therapeutic option for severe resistant chronic pain but, in the absence of proper oversight, their use has risks. The level of prescription opioid misuse/abuse differs among countries, due to differences in healthcare systems and pain management approaches. However, evaluating the true dimension of prescription opioid misuse/abuse is complicated by statistical reporting which often does not differentiate between prescription and illicit opioid use, or between prescription opioid use by patients and nonpatients, highlighting a need for greater uniformity. Parallel efforts to educate patients and the general public about opioid risks, facilitate appropriate analgesic prescribing and identify alternative formulations or options to use instead of or with opioids, may contribute to optimizing prescription opioid use for pain management.
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Affiliation(s)
- Victor Mayoral
- Pain Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Patterson TG, Beckenkamp P, Ferreira M, Turner J, Gnjidic D, Chen Y, Mesa Castrillion CI, Ferreira P. Deprescribing paracetamol in pain conditions: A scoping review. Res Social Adm Pharm 2021; 18:3272-3283. [PMID: 34911668 DOI: 10.1016/j.sapharm.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/02/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine evidence on deprescribing paracetamol in pain conditions and inform future strategies for paracetamol deprescription. DESIGN Scoping review. PARTICIPANTS Adults with pain conditions, taking paracetamol. RESULTS After two independent teams of reviewers screening for titles, abstracts, and then full texts, 16 original articles were included. Deprescribing strategies were grouped into 5 categories: (1) Pharmacological, (2) Psychological, (3) Physiological, (4) Policy, and (5) Combination. We found strategies were predominately consumer-focused, conducted in community settings and involved individuals experiencing musculoskeletal pain (such as low back pain and osteoarthritis). A total of twelve studies investigated interventions targeting dose reduction and four studies examined interventions focusing on discontinuation of paracetamol. The most common strategies used to deprescribe paracetamol in pain conditions were physiological strategies, followed by psychological strategies. All included studies demonstrated some level of effectiveness to deprescribe paracetamol in a pain conditions through dose reduction or discontinuation, although the effectiveness of deprescribing strategies were highly variable, ranging from the majority of participants discontinuing their paracetamol use, to less than 10% reducing their paracetamol use upon the latest follow-up. CONCLUSIONS There are clear opportunities for prospective trials to be designed more purposely and primarily focused to influence reduction and cessation of paracetamol for specific pain conditions where deprescription is appropriate.
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Affiliation(s)
| | - Paula Beckenkamp
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Manuela Ferreira
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Justin Turner
- Faculty of Pharmacy, University of Montreal, Quebec, Canada.
| | - Danijela Gnjidic
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Yanyu Chen
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | | | - Paulo Ferreira
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
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DeJulius CR, Gulati S, Hasty KA, Crofford LJ, Duvall CL. Recent Advances in Clinical Translation of Intra-Articular Osteoarthritis Drug Delivery Systems. ADVANCED THERAPEUTICS 2021; 4:2000088. [PMID: 33709019 PMCID: PMC7941755 DOI: 10.1002/adtp.202000088] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Indexed: 12/12/2022]
Abstract
Osteoarthritis (OA) is a degenerative disease of the joints and a leading cause of physical disability in adults. Intra-articular (IA) therapy is a popular treatment strategy for localized, single-joint OA; however, small-molecule drugs such as corticosteroids do not provide prolonged relief. One possible reason for their lack of efficacy is high clearance rates from the joint through constant lymphatic drainage of the synovial tissues and synovial fluid and also by their exchange via the synovial vasculature. Advanced drug delivery strategies for extended release of therapeutic agents in the joint space is a promising approach to improve outcomes for OA patients. Broadly, the basic principle behind this strategy is to encapsulate therapeutic agents in a polymeric drug delivery system (DDS) for diffusion- and/or degradation-controlled release, whereby degradation can occur by hydrolysis or tied to relevant microenvironmental cues such as pH, reactive oxygen species (ROS), and protease activity. In this review, we highlight the development of clinically tested IA therapies for OA and highlight recent systems which have been investigated preclinically. DDS strategies including hydrogels, liposomes, polymeric microparticles (MPs) and nanoparticles (NPs), drug conjugates, and combination systems are introduced and evaluated for clinical translational potential.
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Affiliation(s)
- Carlisle R DeJulius
- Department of Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Nashville, TN 37232, United States
| | - Shubham Gulati
- Department of Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Nashville, TN 37232, United States
| | - Karen A Hasty
- Department of Orthopedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, 1211 Union Ave. Suite 520, Memphis, TN 38104, United States
| | - Leslie J Crofford
- Department of Medicine, Division of Rheumatology and Immunology, Vanderbilt University Medical Center, 1161 21 Ave. S., Nashville, TN 37232, United States
| | - Craig L Duvall
- Department of Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Nashville, TN 37232, United States
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Verthein U, Buth S, Daubmann A, Martens MS, Schulte B. Trends in risky prescriptions of opioid analgesics from 2011 to 2015 in Northern Germany. J Psychopharmacol 2020; 34:1210-1217. [PMID: 32674662 PMCID: PMC7605054 DOI: 10.1177/0269881120936544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Due to their euphoric and sedative effects, opioid analgesics have high potential for abuse and dependence. In the last decade in the USA and many Western European Countries the prescription rates of opioid analgesics have steadily increased. OBJECTIVE This study describes 5-year trends in the prescription of opioid analgesics and risk indicators such as duration, dose and 'doctor shopping' in Northern Germany. METHODS The annual rates of opioid analgesic prescriptions have been analysed for patients with statutory health insurance processed by the North German Pharmacy Data Center for the years 2011-2015. A distinction was made between non-cancer patients and cancer patients, and different groups according to prescription duration and dose level. RESULTS Between 2011 and 2015, the annual number of patients with opioid analgesic prescriptions increased from 500,000 to 550,000. About half of non-cancer-patients (85% of the total sample) and cancer patients received opioid analgesics for 90 days or less. The rates for long-term prescriptions (⩾9 months) ranged between 6-7% for non-cancer patients and 7-8% for cancer patients. Between 1.2-1.8% received opioid analgesics in doses of more than two defined daily doses. The majority of non-cancer patients with opioid analgesic prescriptions were female. The average age of non-cancer patients was 66 years. About 80% of non-cancer patients with first opioid analgesic prescription received World Health Organization step II medication. CONCLUSION For the first time, this study provides comprehensive patient-related analyses of opioid analgesic prescriptions in Germany over a 5-year period. Despite a slight increase in the overall number of opioid analgesic prescriptions, an epidemic spread of opioid analgesics cannot be observed.
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Affiliation(s)
- Uwe Verthein
- Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Buth
- Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Daubmann
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcus-Sebastien Martens
- Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Schulte
- Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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8
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Nguyen TNM, Laetsch DC, Chen LJ, Haefeli WE, Meid AD, Brenner H, Schöttker B. Pain severity and analgesics use in the community-dwelling older population: a drug utilization study from Germany. Eur J Clin Pharmacol 2020; 76:1695-1707. [PMID: 32648116 PMCID: PMC7661425 DOI: 10.1007/s00228-020-02954-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/03/2020] [Indexed: 01/23/2023]
Abstract
Purpose Chronic pain is common in the older population and a significant public health concern. However, comprehensive studies on analgesics use in this age group from Germany are scarce. This study aims to give a comprehensive overview on the use of the most common therapeutic groups of analgesics in community-dwelling older adults from Germany. Methods A cross-sectional study was carried out using data from a German cohort of 2038 community-dwelling adults aged 63–89 years. Descriptive statistics and logistic regression models were applied to assess the utilization of analgesics by age, sex, pain severity, pain duration, and locations. Results One out of four study participants was suffering from high-intensity or disabling pain. Approximately half of those taking analgesics still reported to suffer from high-intensity or disabling pain. Among analgesics users, occasional non-steroidal anti-inflammatory drugs (NSAIDs) use was the most frequent pain therapy (in 43.6% of users), followed by metamizole (dipyrone) use (16.1%), regular NSAIDs use (12.9%), strong opioids use (12.7%), and weak opioids use (12.0%). In multivariate logistic regression models, higher age, higher pain severity, longer pain duration, abdominal pain, and back pain were statistically significantly associated with opioids use. Metamizole use was also statistically significantly associated with higher pain severity but inversely associated with pain duration. Conclusions A significant number of older German adults are affected by high-intensity and disabling chronic pain despite receiving analgesics. Long-term studies are needed to compare the effectiveness and safety of different treatments for chronic pain in older adults. Electronic supplementary material The online version of this article (10.1007/s00228-020-02954-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thi Ngoc Mai Nguyen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Dana Clarissa Laetsch
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Li-Ju Chen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas D Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.
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Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective, widely used analgesics. For the past 2 decades, considerable attention has been focused on their cardiovascular safety. After early studies indicating an association between NSAID use and increased risks of heart failure and elevated blood pressure, subsequent studies found a link between NSAID use and an increased risk of thrombotic events. Selective cyclooxygenase 2 (COX2) inhibitors (also known as coxibs) have been associated with the greatest risk of adverse vascular effects but concern also relates to non-selective NSAIDs, especially those with strong COX2 inhibition such as diclofenac. Although NSAID use is discouraged in patients with cardiovascular disease, pain-relief medication is often required and, in the absence of analgesics that are at least as effective but safer, NSAIDs are frequently prescribed. Furthermore, non-prescription use of NSAIDs, even among people with underlying cardiovascular risks, is largely unsupervised and varies widely between countries. As concern mounts about the disadvantages of alternatives to NSAIDs (such as opioids) for pain management, the use of NSAIDs is likely to rise. Given that the pharmaceutical development pipeline lacks new analgesics, health-care professionals, patients and medicine regulatory authorities are focused on optimizing the safe use of NSAIDs. In this Review, we summarize the current evidence on the cardiovascular safety of NSAIDs and present an approach for their use in the context of holistic pain management.
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The Trends in Opioid Use in Castile and Leon, Spain: A Population-Based Registry Analysis of Dispensations in 2015 to 2018. J Clin Med 2019; 8:jcm8122148. [PMID: 31817357 PMCID: PMC6947376 DOI: 10.3390/jcm8122148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 01/19/2023] Open
Abstract
Opioids are driving-impairing medicines (DIM). To assess the evolution and trends of opioid analgesics use between 2015 and 2018 in Castile and Leon (Spain), a population-based registry study was conceived. The length of opioid use and its concomitant use with other DIMs were studied. Analyses were done considering age and gender distributions. Adjusted consumption for licensed drivers is also presented. Of the 5 million dispensations recorded between 2015 and 2018, opioid analgesics were dispensed to 11.44% of the general population and 8.72% of vehicle drivers. Increases among daily users (2.6 times higher) and chronic users (1.5% higher) were noted, supporting the overall increase in opioid use (1.5%). The use of multiple drugs including other DIMs was a common finding (mean ± SD, 2.54 ± 0.01). Acute use (5.26%) and chronic use (3.20%) were also frequent. Formulations combining opioid analgesics with nonopioid analgesics were preferred. The use of opioids increased in Spain between 2015 and 2018. Concomitant use with other DIMS especially affects women and the elderly. Frequent use of opioid analgesics with other DIMs is a serious problem for drivers and increases the risk of accidents. Promoting safe driving should be a main objective of health authorities, to be achieved by developing and implementing educational activities for healthcare professionals and patients.
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11
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Opioid prescription patterns in Germany and the global opioid epidemic: Systematic review of available evidence. PLoS One 2019; 14:e0221153. [PMID: 31461466 PMCID: PMC6713321 DOI: 10.1371/journal.pone.0221153] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/30/2019] [Indexed: 01/10/2023] Open
Abstract
Introduction Opioids are one of the most important and effective drug classes in pain medicine with a key role in most medical fields. The increase of opioid prescription over time has led to higher numbers of prescription opioid misuse, abuse and opioid-related deaths in most developed OECD (Organisation for Economic Co-operation and Development) countries around the world. Whilst reliable data on the prevalence of opioid treatment is accessible for many countries, data on Germany specifically is still scarce. Considering Germany being the largest country in the European Union, the lack of evidence-based strategies from long-term studies is crucial. The aim of this work is to review and summarise relevant published literature on the prevalence of opioid prescription in Germany to adequately inform health policy strategies. Methods A systematic review of the epidemiology of opioid prescription in Germany was conducted, searching PubMed and Web of Science. Eligibility criteria were defined prior to conducting the search. Literature concerning Germany, published in English and German was included and the search was replicated by three independent researchers. Two levels of screening were employed. Disagreement was resolved by face-to-face discussion, leading to a consensus judgement. Results Our electronic search yielded 735 articles. Reviewing titles and abstracts yielded 19 relevant articles. Three authors examined each article’s full text more closely and determined that twelve papers should be included. Of the twelve identified studies—with publication dates ranging from 1985 to 2016—six were retrospective cross-sectional studies and six were retrospective repeated-measures cross-sectional studies. Sample sizes ranged from 92,842 to ≈ 11,000,000 participants. Data sources of included studies showed vast heterogeneity. The reviewed literature suggested an increase in the number of patients with opioid prescriptions and defined daily doses of opioids per recipient in Germany over time. The majority of opioid prescriptions was used for patients with non-cancer pain. Opioid use was more common in older people, women and in the north of Germany. Fentanyl was shown to be the most prescribed strong opioid in outpatient settings in Germany, despite not being the first-line choice for chronic pain conditions. All data published before 2000—but none of the more recent studies—suggested an insufficient treatment of pain using opioids. There were no signs for a current opioid epidemic in Germany. Conclusions Despite some limitations of the review and the heterogeneity of studies, it can be stated that the number of opioid prescriptions overall as well as the number of people receiving opioid treatment have increased over time. Most prescriptions were found to be for strong opioids and patients with non-cancer pain. Even though patterns of opioid prescription follow trends observed in other developed countries, there are no signs of an opioid epidemic in Germany. Therefore, this review could currently not find a need for urgent health policy interventions regarding opioid prescription practices. However, critical gaps in the literature remain and more research is needed to make more reliable judgements.
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12
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Ushida T, Matsui D, Inoue T, Yokoyama M, Takatsuna H, Matsumoto T, Takita A, Kurusu T, Sakoda H, Okuizumi K. Recent prescription status of oral analgesics in Japan in real-world clinical settings: retrospective study using a large-scale prescription database. Expert Opin Pharmacother 2019; 20:2041-2052. [PMID: 31422709 DOI: 10.1080/14656566.2019.1651840] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: Information on prescriptions of oral analgesics for the treatment of pain is beneficial. However, there have been few reports on the prescription status of oral analgesics from a nation-wide, large-scale prescription database in Japan. Research design and methods: The authors analyzed the prescription data of 2,042,302 patients prescribed oral analgesics in 2017. The numbers/proportions of patients prescribed oral analgesics, adherence with approved doses, co-prescription patterns, dose changes, drug adherence, and treatment-discontinuation rates were evaluated. Results: Loxoprofen was prescribed to 32.5% of the patients, followed by celecoxib, prescribed to 16.0% of patients. Acetaminophen and pregabalin were prescribed to 10.5% and 9.4% of patients, respectively. Many analgesics were prescribed at lower doses than the approved doses. The most frequently used concomitant medication was pregabalin. For duloxetine and pregabalin, high proportions of patients were prescribed these drugs for > 90 days. Conclusions: Loxoprofen was the most prescribed of the non-steroidal anti-inflammatory drugs in Japan. The information obtained provides an overview of prescribed oral analgesics in Japan and could be useful for potential research into prescribed oral analgesics in the future.
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Affiliation(s)
- Takahiro Ushida
- Multidisciplinary Pain Center, Aichi Medical University , Aichi , Japan
| | - Daiju Matsui
- Medical Affairs Division, Medical Science Department, Daiichi Sankyo Co., Ltd ., Tokyo , Japan
| | - Teruyoshi Inoue
- Medical Affairs Division, Medical Science Department, Daiichi Sankyo Co., Ltd ., Tokyo , Japan
| | - Mizuka Yokoyama
- Medical Affairs Division, Medical Science Department, Daiichi Sankyo Co., Ltd ., Tokyo , Japan
| | - Hiroshi Takatsuna
- Medical Affairs Division, Medical Science Department, Daiichi Sankyo Co., Ltd ., Tokyo , Japan
| | - Takuyuki Matsumoto
- Quality & Safety Management Division, Safety and Risk Management Department, Daiichi Sankyo Co., Ltd ., Tokyo , Japan
| | - Atsushi Takita
- R&D Division, Biostatistics & Data Management Department, Daiichi Sankyo Co., Ltd ., Tokyo , Japan
| | - Takao Kurusu
- Rx Group, Data Solution Division, Japan Medical Information Research Institute, Inc ., Tokyo , Japan
| | - Hiroshi Sakoda
- Medical Affairs Division, Medical Science Department, Daiichi Sankyo Co., Ltd ., Tokyo , Japan
| | - Kaoru Okuizumi
- Medical Affairs Division, Medical Science Department, Daiichi Sankyo Co., Ltd ., Tokyo , Japan
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Zin CS, Nazar NI, Rahman NS, Alias NE, Ahmad WR, Rani NS, Cardosa MS, Ng KS, Ye FL. Trends and patterns of analgesic prescribing in Malaysian public hospitals from 2010 to 2016: tramadol predominately used. J Pain Res 2018; 11:1959-1966. [PMID: 30288090 PMCID: PMC6160284 DOI: 10.2147/jpr.s164774] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose To examine the trends of analgesic prescribing at public tertiary hospital outpatient settings and explore the patterns of their utilization in nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol, and opioid patients. Patients and methods This cross-sectional study was conducted from 2010 to 2016 using the prescription databases of two tertiary hospitals in Malaysia. Prescriptions for nine NSAIDs (ketoprofen, diclofenac, celecoxib, etoricoxib, ibuprofen, indomethacin, meloxicam, mefenamic acid, and naproxen), tramadol, and five other opioids (morphine, fentanyl, oxycodone, dihydrocodeine, and buprenorphine) were included in this study. Annual number of patients and prescriptions were measured in repeat cross-sectional estimates. Descriptive statistics and linear trend analysis were performed using Stata version 13. Results A total of 192,747 analgesic prescriptions of the nine NSAIDs, tramadol, and five other opioids were given for 97,227 patients (51.8% NSAIDs patients, 46.6% tramadol patients, and 1.7% opioid patients) from 2010 to 2016. Tramadol (37.9%, n=72,999) was the most frequently prescribed analgesic, followed by ketoprofen (17.5%, n=33,793), diclofenac (16.2%, n=31,180), celecoxib (12.2%, n=23,487), and other NSAIDs (<4.5%). All the analgesics were increased over time except meloxicam, indomethacin, and mefenamic acid. Opioids, primarily morphine (2.2%, n=4,021) and oxycodone (0.5%, n=1,049), were prescribed the least, but the rate of increase was the highest. Conclusion Tramadol was the most frequently prescribed analgesic in hospital outpatient settings in Malaysia. Opioids were prescribed the least, but noted the highest increase in utilization.
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Affiliation(s)
- Che Suraya Zin
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia,
| | - Nor Ilyani Nazar
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia,
| | - Norny Syafinaz Rahman
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia,
| | - Nor Elina Alias
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia,
| | - Wan Rohaidah Ahmad
- Department of Anaesthesiology and Intensive Care, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Nurul Sahida Rani
- Department of Pharmacy, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Mary Suma Cardosa
- Department of Anaesthesiology and Intensive Care, Hospital Selayang, Batu Caves, Malaysia
| | - Kim Swan Ng
- Department of Anaesthesiology and Intensive Care, Hospital Selayang, Batu Caves, Malaysia
| | - Felicia Loh Ye
- Department of Pharmacy, Hospital Selayang, Batu Caves, Malaysia
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Wastesson JW, Martikainen JE, Zoëga H, Schmidt M, Karlstad Ø, Pottegård A. Trends in Use of Paracetamol in the Nordic Countries. Basic Clin Pharmacol Toxicol 2018. [DOI: 10.1111/bcpt.13003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Jonas W. Wastesson
- Aging Research Center; Karolinska Institutet & Stockholm University; Stockholm Sweden
| | | | - Helga Zoëga
- Centre of Public Health Sciences; Faculty of Medicine; University of Iceland; Reykjavík Iceland
- Medicines Policy Research Unit; Centre for Big Data Research in Health; University of New South Wales; Sydney NSW Australia
| | - Morten Schmidt
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
| | - Øystein Karlstad
- Department of Pharmacoepidemiology; Norwegian Institute of Public Health; Oslo Norway
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy; Department of Public Health; University of Southern Denmark; Odense Denmark
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15
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Hider-Mlynarz K, Cavalié P, Maison P. Trends in analgesic consumption in France over the last 10 years and comparison of patterns across Europe. Br J Clin Pharmacol 2018. [PMID: 29514410 DOI: 10.1111/bcp.13564] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS The aims of the present study were to describe the consumption trends of three groups of analgesics (non-opioids, and mild and strong opioids) between 2006 and 2015 in France, and compare this pattern of use with six European countries in 2015. METHODS Annual drugs sales were extracted from the French national authority's consumption database, and from the IMS Multinational Integrated Data Analysis System and national databases for European countries. RESULTS The use of mild opioids in France was found to have decreased by 53% over the past 10 years, owing to the declining use of dextropropoxyphene combinations, along with an increase in the use of non-opioids and strong opioids (from 72 to 93, and 2 to 2.8 defined daily doses/1000 inhabitants/day, respectively). Paracetamol, the most consumed analgesic, increased over this period, particularly for the adult high dose (+140%). The use of tramadol and codeine combinations also increased, by 62% and 42%, respectively. Morphine remained the most used strong opioid, although there were also large increases in the consumption of oxycodone (+613%) and fentanyl (+263% and +72% for transmucosal and transdermal forms, respectively). A comparison of the patterns of use in Europe in 2015 showed a higher consumption of mild and strong opioids in the UK. France ranked first and third place, respectively, for paracetamol and mild opioid consumption, whereas its use of strong opioids was among the lowest. CONCLUSIONS Paracetamol consumption is clearly highest in France, whereas its use of strong opioids is among the lowest in Europe, although its consumption of oxycodone has increased significantly. Further studies are required specifically to monitor these drugs.
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Affiliation(s)
- Karima Hider-Mlynarz
- French National Agency for Medicines and Health Products Safety, Surveillance Division, Saint-Denis, France
| | - Philippe Cavalié
- French National Agency for Medicines and Health Products Safety, Surveillance Division, Saint-Denis, France
| | - Patrick Maison
- French National Agency for Medicines and Health Products Safety, Surveillance Division, Saint-Denis, France
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Kostev K, Von Vultée C, Usinger DM, Reese JP. Tramadol prescription patterns in patients followed by general practitioners and orthopedists in Germany in the year 2015. Postgrad Med 2017; 130:37-41. [PMID: 29157058 DOI: 10.1080/00325481.2018.1407205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The aim of this study was to analyze tramadol prescription patterns in acute pain patients followed by general practitioners and orthopedists in Germany. METHODS This study included patients ≥18 years diagnosed with acute pain who received at least one tramadol prescription each in one of 1,129 general or 179 orthopedic practices in Germany between January and December 2015 (index date). Patients were excluded if they had received a prescription for another analgesic in the year prior to the index date, had a follow-up of less than 15 months after the index date, or were prescribed tramadol for a period of more than three months. The main outcome of this retrospective study was the share of patients receiving tramadol in combination therapy. Combination therapy was defined as the prescription of tramadol in conjunction with at least one other analgesic during the same medical visit. RESULTS The present study included a total of 8,766 individuals. Overall, 1,492 (22.0%) of tramadol patients seen by general practitioners and 370 (18.7%) of those seen by orthopedists received tramadol in combination with other analgesics. Although this proportion was similar throughout the different subgroups in orthopedic practices, it was considerably higher in patients >80 years and in those with private health insurance coverage in general practices. CONCLUSIONS Approximately one of five tramadol patients was prescribed tramadol in combination therapy. Further research is needed to gain a better understanding of the demographic and clinical factors that have an effect on tramadol prescription patterns in Germany.
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Affiliation(s)
- Karel Kostev
- a Epidemiology , QuintilesIMS , Frankfurt am Main , Germany
| | | | | | - Jens-Peter Reese
- d Institute of Health Service Research and Clinical Epidemiolgy and Coordinating Center for Clinical Trials , Philipps-University , Marburg , Germany
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