Prevalência do uso e prescrição de analgésicos opioides para idosos com dor crônica não oncológica: uma revisão sistemática com meta-análise

Abstract

Background: Chronic non-cancer pain is a common problem among older people. Opioids are among the treatment options for chronic non-cancer pain, this medication only provides limited benefits. This medication is also associated with a high risk of serious harms (e.g., overdoses) specially in older people. This review estimated the proportion of opioid use and prescription among older adults with chronic non-cancer pain. Methods: Searches were performed by identifying eligible studies included in two published systematic reviews, performing backward citations and updating the searches from October 2018 until June 2024. Observational studies investigating the proportion of opioid use and prescriptions in a representative sample of older adults (60 years or older) with chronic non-cancer pain were included. Risk of bias was assessed using a tool developed for epidemiological studies. Meta-analysis was performed using random effect models to obtain the pooled prevalence and their 95% confidence intervals. The overall quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Nine studies (476,140 older people) were included in this review. Six (66.6%) were classified as having a low risk of bias. The rate of opioid prescription among older people with chronic non-cancer pain was 35.6% (95% CI: 27.8% to 44.2%), while the proportion of opioid use was 26.4% (95% CI: 16.6% to 39.3%). The overall quality of evidence was moderate according to GRADE (downgraded for inconsistency). Conclusion: Approximately one-third of older people with chronic non-cancer pain are prescribed opioids and one-quarter reported their use. Given the limited benefits and increased risk of harm associated with opioid use, strategies to reduce the overuse of opioids among older people with chronic noncancer pain are needed.