Journal of Pain Research (Oct 2021)
An Italian Expert Consensus on the Use of Opioids for the Management of Chronic Non-Oncological Pain in Clinical Practice: Focus on Buprenorphine.
Abstract
Consalvo Mattia,1,2 Livio Luongo,3,4 Massimo Innamorato,5 Luca Melis,6 Michele Sofia,7 Lucia Zappi,8 Filomena Puntillo9,10 1Department of Medical and Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, Rome, Italy; 2Anesthesia, Intensive Care and Pain Unit, ICOT-Polo Pontino, Latina, Italy; 3Department of Experimental Medicine, Division of Pharmacology, University of Campania “L. Vanvitelli”, Naples, Italy; 4NEUROMED, Pozzilli, Italy; 5Pain Therapy Unit, AUSL Romagna, S.M.Croci Hospital Ravenna, Ravenna, Italy; 6Poliste, Cagliari, Italy; 7Department of Palliative Care and Pain Therapy, ASST Rodhense, Garbagnate Milanese, Itlay; 8UOC Antalgic Therapy, Emergency and Acceptance Department, San Martino Polyclinic Hospital, Genoa, Italy; 9Department of Interdisciplinary Medicine, “Aldo Moro” University of Bari, Bari, 70124, Italy; 10Anesthesia, Intensive Care and Pain Unit, Policlinico Hospital of Bari, Bari, 70124, ItalyCorrespondence: Consalvo MattiaDepartment of Medical and Surgical Science, University Sapienza, Corso della Repubblica, 79, Latina, 04100, ItalyTel +39 0773 6511Email [email protected]: The aim of the present work was to evaluate the knowledge and prescriptive habits of clinicians involved in the management of chronic non cancer pain (CNCP), with a special focus on the use of opioids.Methods: A Delphi method was used. A Board of specialists elaborated and discussed a series of statements, based on available literature and personal clinical expertise, about particularly controversial topics on pain pathophysiology and treatment. A Panel of experts in the field of pain management, selected by the Board, was invited to vote the proposed statements, indicating the level of agreement on a 5-point Likert scale (1: strongly disagree; 2: disagree; 3: partially agree; 4: agree; 5: strongly agree). The threshold for consensus was set at minimum 66.6% of the number of respondents with a level of agreement ≥ 4 (Agree or Strongly agree).Results: The Board included 5 pain therapists, 1 pharmacologist and 1 methodology expert and drew up a total of 36 statements (for a total of 40 requested answers)”. A total of 100 clinicians were included in the Expert Panel. Respondents were 89 (89%). Consensus was achieved for 32 out of 40 answers. Most of the lack of consensus was recorded for statements regarding opioids use, and resulted from a low level of agreement (3 on the Likert scale), suggesting a neutral position deriving from a lack of knowledge rather than a strong contrary opinion.Conclusion: Most of the proposed items reached consensus, suggesting a generally homogeneous approach to CNCP management. However, the lack of consensus recorded for several items regarding opioid use confirms the need to fill important gaps in the knowledge of available agents. A clear explanation of the peculiar pharmacological properties of drugs associated with potential clinical advantages (such as buprenorphine) will help optimize pain treatment in both primary care and hospital settings and improving pain control in CNCP patients.Keywords: pain, chronic, non-oncological, strong opioids, buprenorphine, Delphi survey
