1. Évaluation de la prescription des antalgiques de palier II chez la personne âgée de 75 ans en médecine générale
- Author
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Sofia Da Silva, Maurice Giroud, Adrien Brocard, Alain Putot, Patrick Manckoundia, université de Bourgogne, CAPS, Service de médecine gériatrique (CHU de Dijon - Centre gériatrique de Champmaillot - EHPAD), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Service de Neurologie générale, vasculaire et dégénérative (CHU de Dijon), Cognition, Action, et Plasticité Sensorimotrice [Dijon - U1093] ( CAPS ), and Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM )
- Subjects
Male ,medicine.medical_specialty ,Constipation ,Nausea ,Analgesic ,[ SDV.MHEP.GEG ] Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology ,Drug Prescriptions ,personne âgée ,Ambulatory care ,General Practitioners ,medicine ,Humans ,Pain Management ,Medical prescription ,Adverse effect ,Biological Psychiatry ,Aged ,Aged, 80 and over ,Analgesics ,[SDV.MHEP.GEG] Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology ,business.industry ,Chronic pain ,medicine.disease ,Drug Utilization ,médecine générale ,Neuropsychology and Physiological Psychology ,Health Care Surveys ,antalgiques de palier II ,Vomiting ,Physical therapy ,Female ,France ,Neurology (clinical) ,Chronic Pain ,Geriatrics and Gerontology ,medicine.symptom ,business - Abstract
Although step-2 analgesics (S2A) are recommended when step-1 analgesics (S1A) are ineffective or in cases of moderate to severe pain, their efficacy varies. This study evaluated the place attributed by general practitioners (GPs) to S2A in the treatment of nociceptive pain in elderly persons (EP). Descriptive, transversal and declarative study conducted among GPs in Burgundy. In total, 115 GPs took part in the survey. Among these, 60.8% had at least one consultation/day for pain. After paracetamol, which was systematically preferred, 56.4% prescribed S2A for EP. The reasons for prescribing S2A included pain not relieved by S1A in 93% of cases, another medical treatment or not (42.6%), or the existence of moderate to severe pain (31.3%). The use of S2A was more frequent in acute pain (79.1%) than in chronic pain (53%). Among GPs, 77.4% initially prescribed the minimal effective dose. GPs were reluctant to prescribe S2As for the following reasons: poor tolerance (78.3%) and the fear of severe adverse effects (57.4%). The most frequently cited adverse effects were nausea/vomiting and constipation by 66.1% of GPs. Nonetheless, 73.9% thought that S2As were necessary for EPs requiring outpatient care. Although the benefit/risk ration of S2As is controversial and their analgesic efficacy seems to be more variable than that of low-dose morphine, they have an important place in the therapeutic arsenal of GPs to treat pain in EP.
- Published
- 2017
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