| Santos Garcia et al.1010 Santos Garcia JB, Lech O, Campos Kraychete D, Rico MA, Hernández-Castro JJ, Colimon F, Guerrero C, Sempértegui Gallegos M, Lara-Solares A, Flores Cantisani JA, Amescua-Garcia C, Guillén Núñez MDR, Berenguel Cook MDR, Jreige Iskandar A, Bonilla Sierra P. The role of tramadol in pain management in Latin America: a report by the Change Pain Latin America Advisory Panel. Curr Med Res Opin. 2017;33(9):1615-21.
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74 articles selected with the objective of discussing the main indications, pharmacological characteristics, safety, tolerability, availability, and impact on pain control provided by tramadol. |
Tramadol is used to treat a broad spectrum of non-oncologic pain conditions (such as post-surgical, musculoskeletal, post-traumatic, neuropathic, fibromyalgia) as well as oncologic pain. Its relevance when treating special patient groups (e.g. the seniors) is recognized. Main reasons for tramadol’s high importance as a treatment option are: its broad efficacy, a discrete safety profile, and its availability, considering that access to strong analgesics - mainly controlled drugs (classical opioids) - is highly restricted in some countries. |
| García et al.1111 García CA, Santos Garcia JB, Rosario Berenguel Cook MD, Colimon F, Flores Cantisani JA, Guerrero C, Rocío Guillén Núnez MD, Hernández Castro JJ, Kraychete DC, Lara-Solares A, Lech O, Rico Pazos MA, Gallegos MS, Marcondes L P. Undertreatment of pain and low use of opioids in Latin America. Pain Manag. 2018;8(3):181-96.
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34 articles, found by searching Medline, LILACS, Scielo and EMBASE databases, with the key words “Latin America” and “pain”, and by manual search following recommendations of experts on the subject. |
In Latin America, undertreatment of pain seems to be frequent, and a substantial number of patients feel that their pain is not adequately controlled. There is a scarcity of data related to pain management and opioid use in Latin America. Many chronic pain patients do not have access to effective opioid treatment. A variety of reasons lead to undertreatment of pain, including opioid-ignorance and opiophobia, use of nonsteroidal anti-inflammatory drugs (NSAIDs) and other non-opioid analgesics in patients with moderate to severe pain, limited access to health care, and regulatory barriers. |
| Krawczyk et al.11 Krawczyk N, Greene MC, Zorzanelli R, Bastos FI. Rising trends of prescription opioid sales in contemporary Brazil, 2009-2015. Am J Public Health. 2018;108(5):666-8.
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Data from registered pharmacies throughout Brazil on the legal sale of opioids between 2009 and 2015, collected in ANVISA’s Sistema Nacional de Gerenciamento de Produtos Controlados (National Controlled Products Management System). |
Opioid sales increased nationwide from 1,601,043 prescriptions in 2009 to 9,045.945 prescriptions in 2015, corresponding to a 465% increase in 6 years. The largest absolute increase was for codeine products, accounting for over 98% of prescriptions in both years. Oxycodone had the largest relative increase, and fentanyl products had the smallest absolute and relative increase. |
| Silva et al.99 da Silva Dal Pizzol T, Turmina Fontanella A, Cardoso Ferreira MB, Bertoldi AD, Bof Borges R, Serrate Mengue S. Analgesic use among the Brazilian population: results from the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM). PLoS One. 2019;14(3):e0214329.
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41,433 people of all ages in Brazilian urban regions. The majority of the population was represented by women between 20 and 59 years old, with 1 to 8 years of schooling. |
The majority of individuals were female (52.8%), aged between 20 and 59 years (57.2%), with 1 to 8 years of education (45.6%). The overall prevalence of analgesic use was 22.8%. The use of analgesics was significantly higher among women, adults and seniors (20 years or more), individuals with high schooling and respondents who reported: diagnosis of one or more chronic diseases, use of three or more drugs, with health insurance and with one or more admissions for emergency care or hospitalizations in the last year. Non-opioid analgesics were the most commonly used agents (18.5% of the sample), followed by NSAIDs (6.9%) and opioid analgesics (0.5%). The most commonly used drugs were metamizole (37.8% of all analgesics), paracetamol (25.3%), and diclofenac (10.7%). |
| Lino et al.77 Lino PA, Sohn W, Singhal A, Martins MAP, Silva MESE, Abreu MHNG. A national study on the use of opioid analgesics in dentistry. Braz Oral Res. 2019;33:e076.
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141,161 opioid prescriptions by 36,929 dentists. |
A total of 141,161 opioid analgesics prescriptions were made by 36,929 dentists. The frequency of opioid type prescriptions was codeine associated with paracetamol n=117,493 (83.2%), tramadol n=13,562 (9.6%), codeine and other non-opioid analgesics n=4,308 (3.1%). |
| Avelar et al.66 Avelar LPP, Castilho LS, Abreu MHNG, Vilaça EL, Resende VLS, Silva MES. A prescrição de medicação psicotrópica e o conhecimento da portaria regulatória brasileira por cirurgiões-dentistas. Cad Saúde Colet. 2019;27(3):338-44.
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15,250 questionnaires were sent to Brazilian dentists about the prescriptions of psychotropics. 969 were answered. |
257 professionals prescribe psychotropic drugs and 223 know the legislation. A worrying percentage of professionals prescribing these drugs do not know the content of the Administrative Rule 344/1998. Opioid analgesics are the most prescribed drugs. The specialists are the ones who prescribe the most psychotropic drugs, and those who prescribe anxiolytics know the legislation more often. Oral and maxillofacial surgeons and temporomandibular joint disorder specialists are the most familiar with the legislation and prescribe psychotropic drugs. Intense pain and fear are the two main reasons for prescription. |
| Krawczyk et al.88 Krawczyk N, Silva PLDN, De Boni RB, Mota J, Vasconcellos M, Bertoni N, Coutinho C, Bastos FI. Non-medical use of opioid analgesics in contemporary Brazil: Findings from the 2015 Brazilian National Household Survey on Substance Use. Glob Public Health. 2020;15(2):299-306.
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16,273 residents in Brazil, with data extracted from the 2015 Brazilian Household Survey on Substance Use (BHSU-3). |
The prevalence in Brazil of non-medical use of opioid analgesics throughout life, in the last year, and in the last month was 2.9, 1.4, and 0.6, respectively. Considering those who responded having used the drug in the last year, the prevalence was lower among males, individuals between 12 and 24 years old, people with monthly family income above $286.00, and unemployed. |
| Barros et al.22 Barros GAM, Calonego MAM, Mendes RF, Castro RAM, Faria JFG, Trivellato SA, Cavalcante RS, Fukushima FB, Dias A. Uso de analgésicos e o risco da automedicação em amostra de população urbana: estudo transversal. Rev Bras Anestesiol. 2019;69(6):529-36.
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416 participants from an urban Brazilian population. 190 had chronic pain, with the majority being women. Of those with chronic pain, 149 were self-medicating with analgesics. 145 participants used non-steroidal anti-inflammatory drugs and only 4 used weak opioids. |
Self-medication with analgesics is practiced by 78.4% of chronic pain patients. The most common analgesic treatment currently consists of nonsteroidal anti-inflammatory drugs (dipyrone and paracetamol). Weak opioids are rarely used and only 2.6% of individuals with chronic pain were taking these analgesics. None of the individuals were taking potent opioids. |
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Source: Prepared by the authors