Impact of potential inappropriate NSAIDs use in chronic pain.
Pain remains one of the main reasons for medical consultation worldwide: moderate- to severe-intensity pain occurs in 19% of adult Europeans, seriously affecting the quality of their social and working lives. Nonsteroidal anti-inflammatory drugs (NSAIDs) are not recommended for long-term use and a careful surveillance to monitor for toxicity and efficacy is critical. This study aims to assess: 1) the pattern of use of NSAIDs and opioids in a population covered by a cloud-based pharmacovigilance surveillance system; and 2) potential inappropriate use. A retrospective 18-months systematic analysis on patients' pain treatment was performed. The primary endpoint was evaluating the prevalence of NSAIDs and opioids use and the duration of therapy regimen. The secondary endpoint was to investigate the prevalence of NSAIDs taken for >21 consecutive days concomitant with drugs for peptic ulcer and gastroesophageal reflux disease (GORD) or antiplatelet drugs. The yearly cost for individual users of concomitant NSAIDs for more than 21 consecutive days and of GORD medications has been estimated. A total of 3,050 subjects with chronic pain were enrolled; 97% of them took NSAIDs for >21 consecutive days; about one-fourth of these users also received drugs for peptic ulcer and GORD (Anatomical Therapeutic Chemical code A02B). The yearly cost foran individual who uses NSAIDs for >21 consecutive days as well as concomitant GORD medications is 61.23 euros. In total, 238 subjects (8%) using NSAIDs for >21 days also received one antiplatelet agent. About 11% of subjects received opioids at least once and only 2% of them carried on the therapy for more than 90 consecutive days. In evaluating the escalation in dosage as a proxy of dependence risk, this study shows no dosage escalation in our cohort of chronic pain population - that is to say we show no risk of dependence.
Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy ; Sbarro Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, USA.
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Ussai
Department of Anesthesiology and Intensive Care Medicine, University Hospital of Udine, Bassa Friulana, Italy.
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Miceli
Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Bassa Friulana, Italy.
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Pisa
Department of Palliative Care and Pain Medicine, Health Company n.5, Bassa Friulana, Italy.
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Bednarova
Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy ; Sbarro Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, USA.
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Giordano
Department of Anesthesiology and Intensive Care Medicine, University Hospital of Udine, Bassa Friulana, Italy.
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Della Rocca
School of Management, Santa Clara University, Santa Clara, CA, USA.
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Petelin
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy* / Q000191:economics; D015331:Cohort Studies; D016527:Drug Costs; D004363:Drug Utilization; D023381:Endpoint Determination; D005260:Female; D005764:Gastroesophageal Reflux / Q000139:chemically induced / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D057970:Inappropriate Prescribing; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000139:chemically induced / Q000188:drug therapy / Q000453:epidemiology; D060735:Pharmacovigilance; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D015995:Prevalence; D012189:Retrospective Studies
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D010975:Platelet Aggregation Inhibitors
dependence; economic impact; pain therapy