Abstract
In chronic non-cancer pain (CNCP), evidence of the effectiveness of strong opioids (SO) is very limited. Despite this, their use is increasingly common. To examine SO prescriptions, we designed a descriptive, longitudinal, retrospective population-based study, including patients aged ≥15 years prescribed SO for ≥3 months continuously in 2013–2017 for CNCP in primary care in Catalonia. Of the 22,691 patients included, 17,509 (77.2%) were women, 10,585 (46.6%) were aged >80 years, and most had incomes of <€18,000 per year. The most common diagnoses were musculoskeletal diseases and psychiatric disorders. There was a predominance of transdermal fentanyl in the defined daily dose (DDD) per thousand inhabitants/day, with the greatest increase for tapentadol (312% increase). There was an increase of 66.89% in total DDD per thousand inhabitants/day for SO between 2013 (0.737) and 2017 (1.230). The mean daily oral morphine equivalent dose/day dispensed for all drugs was 83.09 mg. Transdermal fentanyl and immediate transmucosal release were the largest cost components. In conclusion, there was a sustained increase in the prescription of SO for CNCP, at high doses, and in mainly elderly patients, predominantly low-income women. The new SO are displacing other drugs.
Highlights
The World Health Organization (WHO) recognizes pain as a major public health problem
Pain is the second cause of primary care (PC) consultation and >50% of appointments are related to chronic pain [3]
More pain drugs are consumed than any other class of drug [5], including strong opioids (SO)
Summary
The World Health Organization (WHO) recognizes pain as a major public health problem. The main causes of chronic non-cancer pain (CNCP) are musculoskeletal diseases, one of the primary causes of chronic disease (first in women and second in men). Spanish surveys conducted in 2017 and 2020 [1,2] found that 25% of the population had chronic pain, and the prevalence was higher the lower the social class. Pain is the second cause of primary care (PC) consultation and >50% of appointments are related to chronic pain [3]. Widespread chronic pain worsens the quality of life, mental health and the cardiovascular risk, and increases health spending [4]. More pain drugs are consumed than any other class of drug [5], including strong opioids (SO)
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