Morphine myths and realities: Experience in two Paraguayan centers
DOI:
https://doi.org/10.18004/anales/2020.053.03.71Keywords:
Pain, Morphine, Knowledge, ParaguayAbstract
Introduction: Morphine is an alkaloid obtained from opium. Its knowledge and applications are unknown in daily medical practice. The inefficient use of analgesics causes pain to be refractory. Among doctors there are reluctance to use opioids such as morphine for several myths that we must deny. Objectives: To evaluate the knowledge of doctors of various specialties at INCAN (National Cancer Institute) and HRE (Regional Hospital of Encarnación) about morphine, as its forms of presentation, indications, contraindications and price in the free market of Paraguay. Materials and methods: Descriptive cross-sectional study, data were collected through a self-administered anonymous survey. The number was 41, between INCAN and HRE doctors. The Chi2 statistical test was used for statistical analysis. SPSS 20 was used. Results: 46.3% were INCAN doctors, 53.7% were HRE doctors. Mean age was 30.17 years SD ± 5.56. The statistical analysis with Chi2 crossing center variables and number of correct answers of the members was not significant. The results regarding doses, indications and side effects were negative for both entities, reinforcing a low level of knowledge about the generalities. The vast majority of doctors report that its use causes addictions and respiratory depression. Conclusion: It is shown that there is ignorance about the use of morphine that makes it impossible to properly treat pain due to myths and fear of side effects.
References
1. Lacy C, Amstrong L, Glodman M, Lance L, editors. Drug Information Handbook: A Comprehensive Resource for All Clinicians and Healthcare Professionals. 24th ed. Vol. 1. U.S.A.: APhA; 2015. 2052 p.
2. Evans H, Steele SM, Nielsen KC, Tucker MS, Klein SM. Peripheral Nerve Blocks and Continuous Catheter Techniques. Anesthesiol Clin North America . 2005 Mar;23(1):141–62.
3. Costantini M, Ripamonti C, Beccaro M, Montella M, Borgia P, Casella C, et al. Prevalence, distress, management, and relief of pain during the last 3 months of cancer patients’ life. Results of an Italian mortality follow-back survey. Ann Oncol . Jan 2009 ;20(4):729–35.
4. Deandrea S, Montanari M, Moja L, Apolone G. Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol . Jul 2008 ;19(12):1985–91.
5. Stockler MR, Wilcken NRC. Why is management of cancer pain still a problem? J Clin Oncol . Jun 2012;30(16):1907–8.
6. De Lima L, Bruera E, Joranson DE, Vanegas G, Cepeda S, Quesada L, et al. Opioid availability in Latin America: the Santo Domingo report progress since the Declaration of Florianopolis. J Pain Symptom Manage. Abr 1997 ;13(4):213–9.
7. Goodman LS (Louis S, Brunton LL, Chabner B, Knollmann BC. Goodman & Gilman’s pharmacological basis of therapeutics. McGraw-Hill; 2011. 2084 p.
8. Nicholson B. Responsible Prescribing of Opioids for the Management of Chronic Pain. Drugs. 9 Jan 2003;63(1):17–32.
9. Geppetti P, Benemei S. Pain Treatment with Opioids. Clin Drug Investig. Jun 2009 ;29(Suplemento 1):3–16.
10. De Lima L, Bonilla P, Diaz P, Gonzalez M. Uso de Opioides en tratamiento del DOLOR Manual para Latinoamérica. 1era Edición. Venezuela; 2011 .
11. Bandieri E, Romero M, Ripamonti CI, Artioli F, Sichetti D, Fanizza C, et al. Randomized Trial of Low-Dose Morphine Versus Weak Opioids in Moderate Cancer Pain. J Clin Oncol . Feb 2016 ;34(5):436–42.
12. Grass JA. Patient-controlled analgesia. Anesth Analg . Nov 2005(Suplemento 5):S44-61.
13. Romero J, Gálvez R, Ruiz S, Soc Esp Dolor R. ¿Se sostiene la Escalera Analgésica de la OMS? [Internet]. 2008 [citado 15 Dic 2019]. Disponible: http://www.facmed.unam.mx/deptos/familiar/cp/lecturas/EcaleraAnalgesicaOMS.pdf
14. Cady J. Understanding opioid tolerance in cancer pain. Oncol Nurs Forum [Internet]. [citado 13 Mar 2019];28(10):1561-8; quiz 1569-70. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/11759304
15. Definitions Related to the Use of Opioids for the Treatment of Pain: Consensus Statement of the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine American Society of Addiction Medicine . Disponible en: https://www.asam.org/docs/default-source/public-policy-statements/1opioid-definitions-consensus-2-011.pdf
16. Organización Mundial de la Salud, editor. Glosario de términos de alcohol y drogas . Solana e Hijos, A.G; 1994
17. Reid CM, Gooberman-Hill R, Hanks GW. Opioid analgesics for cancer pain: symptom control for the living or comfort for the dying? A qualitative study to investigate the factors influencing the decision to accept morphine for pain caused by cancer. Ann Oncol . 6 Sep 2007 ;19(1):44–8.
18. Fairchild A. Under-treatment of cancer pain. Curr Opin Support Palliat Care . Mar 2010;4(1):11–5.
19. Mercadante S, Bruera E. Methadone as a First-Line Opioid in Cancer Pain Management: A Systematic Review. J Pain Symptom Manage . Mar 2018;55(3):998–1003.
20. Charalambous H, Protopapa E, Gavrielidou D, Avgousti V. Physicians’ prescribing habits for cancer pain in Cyprus. Ann Oncol . Abr 2012 ;23(suplemento 3):79–83.
21. Kim M, Park H, Park EC, Park K. Attitude and Knowledge of Physicians About Cancer Pain Management: Young Doctors of South Korea in Their Early Career. Jpn J Clin Oncol. Jun 2011 ;41(6):783–91.
22. Jacobsen R, Sjøgren P, Møldrup C, Christrup L. Physician-related barriers to cancer pain management with opioid analgesics: a systematic review. J Opioid Manag ;3(4):207–14.
23. Caglevic M, Anabalón R, Baeza R. Manejo del dolor oncológico en un hospital público de Santiago de Chile. Rev Chil Cancerol y Hematol. 2008;1:21–6.
24. Vester JM, Rodríguez-Riveros MI. Conocimiento y experiencias de estudiantes de enfermería en la administración de principales opioides en el tratamiento del dolor. Memorias del Inst Investig en Ciencias la Salud . Ago 2017 ;15(2).
25.Loeser JD, Treede R-D. The Kyoto protocol of IASP Basic Pain Terminology. Pain Jul 2008;137(3):473–7.
26. Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, Blum RH, Stewart JA, et al. Pain and Its Treatment in Outpatients with Metastatic Cancer. N Engl J Med . Mar 1994 ;330(9):592–6.
27. Ferguson J, Gilroy D, Puntillo K. Dimensions of pain and analgesic administration associated with coronary artery bypass grafting in an Australian intensive care unit. J Adv Nurs. Dic 1997 ;26(6):1065–72.
28. Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med . Ene 2002 ;30(1):119–41.
29. Watson CPN. Bonica’s Management of Pain, 4th Edition. J Pain Symptom Manage . Aug 2010 ;40(2):315–9.
30. Puntillo KA. Dimensions of procedural pain and its analgesic management in critically ill surgical patients. Am J Crit Care. Mar 1994;3(2):116–22.
31. Flórez J, Armijo JA, Mediavilla A. Farmacologia humana. 241 p.
32. Cristancho RA, Vecino AI, Misas JD. Cost/effectiveness evaluation of three fixed combinations of acetaminophen and opioids in the management of acute pain in Colombia. Colomb J Anesthesiol. Ene 2015 ;43(1):87–94.
33. Jaschek C, D’Arcangelis S. ¿Mitos o prejuicios de la morfina? MEDPAL,Interdisciplina y Domic. 2009 ;año 1, no. 2.
34. Organization GH. Cancer pain relief : with a guide to opioid availability. 2nd ed. 1996. 63 p.
35. Bennett MI, Flemming K, Closs SJ. Education in cancer pain management. Curr Opin Support Palliat Care Mar 2011 ;5(1):20–4.
36. Sociedad Española del Dolor. D, González Ortiz JC, Mohar Betancourt A, Meneses García A. Revista de la Sociedad Española del Dolor. . Vol. 18, Revista de la Sociedad Española del Dolor. Editorial Garsi; 2011. 118-134 p.
37. Álvarez GP, Estragó V. Dolor oncológico: un problema no resuelto. Rev. Méd. Urug. 2004 ; 20(1):32-43
38. Dahan A, Aarts L, Smith TW. Incidence, Reversal, and Prevention of Opioid-induced Respiratory Depression. Anesthesiology . Jan 2010 ;12(1):226–38.
39. Swarm R, Benedetti C, CD B, Boston B, et al. Adult cancer pain. J Natl Compr Cancer Netw Aug 2010;8(9):1046–1086 41p.
40. Højsted J, Sjøgren P. Addiction to opioids in chronic pain patients: A literature review. Eur J Pain . Jul 2007 ;11(5):490–518.
41. Ogboli-Nwasor E, Makama J, Yusufu L. Evaluation of knowledge of cancer pain management among medical practitioners in a low-resource setting. J Pain Res . 2013;6:71–7.
42. Santisteban Lic L, Gastaldo Dra B, Pistani Dra M, Dreos S. Artículo de comunicación Fundación Dolor . Vol. 63, Rev. Arg. Anest. 2005
43. Galloso M. Octubre CMDE, Curso DEL. TERMINAL EN LA CARRERA DE MEDICINA FACULTAD DE. 2007;XII(5):23–32.
