Sampaio Rute, Azevedo Luís Filipe, Dias Cláudia Camila, Castro Lopes José M
Departamento de Biomedicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal.
Patient Prefer Adherence. 2020 Feb 19;14:321-332. doi: 10.2147/PPA.S232577. eCollection 2020.
Pharmacological interventions remain the cornerstone of chronic pain treatment; however, nearly 40% of the prescription medicines are not taken as prescribed. The present study aims at understanding and describing non-adherence from the perspective of chronic pain patients during a 1-year follow-up study.
A cohort of 950 consecutive patients referred to a first consultation in Multidisciplinary Chronic Pain Clinics was followed with a standardized protocol for 1 year. This included assessment of pain characteristics; prescribed medication; therapeutic adherence; effectiveness of treatment, non-adherence and its perceived reasons; clinical outcomes and quality of life. We used a mixed methods approach, including qualitative and quantitative analyses.
Forty-nine percent of the 562 patients who responded to all assessments during follow-up were adherent after 1 year of chronic pain treatment. The core associations between each "non-adherence reason" and Anatomical Therapeutic Chemical Code (ATC) group were perceived side effects (=0.019) and delayed start (=0.022) for narcotic analgesics (opioids); perceived non-efficacy (=0.017) and delayed start (=0.004) for antiepileptics and anticonvulsants; perceived low necessity (=0.041) and delayed start (=0.036) for analgesics antipyretics; change in prescriptions because of a new clinical condition for antidepressants (=0.024); high concerns (=0.045) and change in prescriptions because of a new clinical condition (<0.001) for non-steroidal anti-inflammatory drugs; delayed start (=0.016) and financial constraints (=0.018) for other medications.
This study emphasizes the patient's perspective regarding non-adherence to pharmacological treatment of chronic pain, providing valuable and novel information to be used in future interventions to help patients make an informed choice about their adherence behavior.
药物干预仍然是慢性疼痛治疗的基石；然而，近40%的处方药未按规定服用。本研究旨在通过一项为期1年的随访研究，从慢性疼痛患者的角度理解和描述不依从情况。
对950名连续转诊至多学科慢性疼痛诊所进行首次咨询的患者，采用标准化方案进行为期1年的随访。这包括疼痛特征评估；处方药；治疗依从性；治疗效果、不依从及其感知原因；临床结果和生活质量。我们采用了混合方法，包括定性和定量分析。
在随访期间对所有评估做出回应的562名患者中，49%在接受1年慢性疼痛治疗后依从。每种“不依从原因”与解剖治疗化学代码（ATC）组之间的核心关联为：麻醉性镇痛药（阿片类药物）的感知副作用（=0.019）和开始延迟（=0.022）；抗癫痫药和抗惊厥药的感知无效（=0.017）和开始延迟（=0.004）；解热镇痛药的感知必要性低（=0.041）和开始延迟（=0.036）；抗抑郁药因新的临床状况导致处方改变（=0.024）；非甾体抗炎药的高度关注（=0.045）和因新的临床状况导致处方改变（<0.001）；其他药物的开始延迟（=0.016）和经济限制（=0.018）。
本研究强调了患者对慢性疼痛药物治疗不依从的观点，为未来干预提供了有价值的新信息，以帮助患者对其依从行为做出明智选择。
