Brazilian people's pain: discussing the use of opioids to manage pain in Brazil

EDITORIAL

Brazilian people's pain: discussing the use of opioids to manage pain in Brazil

Dear Revista Dor reader,

Exactly two years ago a group of physicians and health professionals, all experienced in the area of pain, got together, sponsored by the Brazilian Society for the Study of Pain - SBED with the primary objective of studying, reviewing, discussing and, if possible, outlining guidelines for the use of opioids, both to treat acute and chronic pain in Brazil. Attending that meeting were also representatives of the Anesthesiology, Palliative Care, Oncology and Orthopedics Medical Associations.

Among outlined goals for the use of opioids to control chronic and acute pain there were:

- Preparing recommendations for the use of opioids to control acute and chronic pain;

- Developing a practical guide to be used by pain specialists and non-specialists to control acute and chronic pain;

- Demystifying the idea of dependence/addiction and other opioid adverse effects as barriers to effective pain management with opioids;

- Disclosing available evidences with regard to the indication of opioids for the elderly, children, emergency, postoperative period, lactation, gestation, cancer patients, neuropathic and musculoskeletal pain;

- Spreading practical recommendations for the use of opioids in different clinical situations and populations;

- Encouraging research and knowledge in the area of pain, specifically related to opioids safety and effectiveness;

- Supplying subsidies so that painful patients with indication for the use of opioids are adequately managed.

Three more meetings followed and after a hard work the first results are being published in this Revista Dor edition as review article (Kraychete et al.).

There is no question about opioids efficacy to control acute pain; however there are controversies about their use for chronic pain, especially non-cancer pain. On the other hand, their risks are recognized, although there is huge unawareness of scientific evidences that clinical trials bring about such issues. It seems that there are two worldwide poles: on one side, developing countries where demand is higher than supply, and on the other developed countries where the debate about adverse effects points to a rational use considering risks and benefits. These issues also have to be discussed in our country at the light of our socioeconomic reality, our legislation, our public health policies and our huge regional differences. Unquestionably, this has been the first step.

To stress this issue let's remember what sweet Cândido said, that "it is necessary to cultivate our garden." So, SBED started analyzing available Brazilian epidemiological studies about pain - still few, but of high quality. Sixteen call the attention - some of them the most frequently referenced by the international scientific literature about pain epidemiology. They are:

Six on chronic pain: one in the Basic Health Attention (BHA) unit, where the prevalence was 30% (Barea et al. 1996; Gureje et al. 1998; Dellaroza et al. 2007; Sá et al. 2008; Moraes Vieira et al. 2012; Elzahaf et al. 2012).

Five on headache: one shows that it affects 10% of those looking for the BHA (Sanvito et al., 1996; Bigal et al., 2000; Benseñor et al., 2003; Traebert Peres, 2005; Queiroz et al., 2006).

Five about orofacial pain, being four about toothache: one shows that 17% of children below five years of age suffer and cry due to toothache; and that only 10% of them had dental treatment; ironically, in the country with the highest number of dentists and dentistry schools in the world (Goes et al., 2007; Moura-Leite et al., 2008; Bastos et al., 2008; Gonçalves et al., 2010; Siqueira et al, 2013). By law, the Brazilian state has to take care of our children. Many of them are still waiting. Current theme of the International Year Against Pain is exactly orofacial pain. These figures show that there is a lot to be done also in this area.

In general, these studies point that pain, regardless of its origin, is often associated to low income, lower education levels, alcohol abuse, female gender and mental health disorders. So, socioeconomic problems are the most important, regardless of pain being acute or chronic. The conclusion is obvious: pain is a public health issue also in our country. In addition, two studies (Moraes-Vieira et al., 2012; Siqueira et al., 2013) have data showing that although approximately 50% of evaluated people were medicated, most of them were unhappy with results. So, the series of articles starting with this edition about the use of opioids to manage pain becomes relevant.

So, on behalf of SBED, especially this year when we celebrate its 30^th anniversary, I congratulate this work group. Acknowledging their effort, I congratulate and greet it through its denoted coordinators, Drs. Durval Campos Kraychete e João Batista Santos Garcia. It is also our duty to acknowledge the ethical and exempt support of the private sector in making feasible such meetings.

I hope that the series of articles starting now will help pain clinicians in their difficult task of relieving human suffering. That the goals of spreading practical recommendations and demystifying the use of opioids to manage pain be met. I take this opportunity to wish Season Greetings and Happy 2014 to all. Always hoping for a Painless Brazil!

José Tadeu Tesseroli de Siqueira President

SBED

REFERENCES

• 1. Barea LM, Tannhauser M, Rotta NT. An epidemiologic study of headache among children and adolescents of southern Brazil. Cephalalgia. 1996;16(8):545-9.
• 2. Gonçalves DA, Dal Fabbro AL, Campos JA, Bigal ME, Speciali JG. Symptoms of temporomandibular disorders in the population: an epidemiological study. J Orofac Pain. 2010;24(3):270-8.
• 3. Moura-Leite FR, Ramos-Jorge ML, Bonanato K, Paiva SM, Vale MP, Pordeus IA. Prevalence, intensity and impact of dental pain in 5-year-old preschool children. Oral Health Prev Dent. 2008;6(4):295-301.
• 4. Bastos JL, Peres MA, Peres KG, Araujo CL, Menezes AM. Toothache prevalence and associated factors: a life course study from birth to age 12 yr. Eur J Oral Sci. 2008;116(5):458-66.
• 5. Sá KN, Baptista AF, Matos MA, Lessa I. Chronic pain and gender in Salvador population, Brazil. Pain. 2008;139(3):498-506.
• 6. Goes PS, Watt R, Hardy RG, Sheiham A. The prevalence and severity of dental pain in 14-15 year old Brazilian schoolchildren. Community Dent Health. 2007;24(4):217-24.
• 7. Dellaroza MS, Pimenta CA, Matsuo T. Prevalence and characterization of chronic pain among the elderly living in the community. Cad Saude Publica. 2007;23(5):1151-60.
• 8. Queiroz LP, Barea LM, Blank N. An epidemiological study of headache in Florianopolis, Brazil. Cephalalgia. 2006;26(2):122-7.
• 9. Benseñor IM, Tófoli LF, Andrade L. Headache complaints associated with psychiatric comorbidity in a population-based sample. Braz J Med Biol Res. 2003;36(10):1425-32.
• 10. Bigal ME, Bordini CA, Speciali JG. Etiology and distribution of headaches in two Brazilian primary care units. Headache. 2000;40(3):241-7.
• 11. Sanvito WL, Monzillo PH, Peres MF, Martinelli MO, Fera MP, Gouveia DA, et al. The epidemiology of migraine in medical students. Headache. 1996;36(5):316-9.
• 12. Gureje O, Von Korff M, Simon GE, Gater R. Persistent pain and well-being: a World Health Organization Study in Primary Care. JAMA. 1998;280(13):1142.
• 13. Elzahaf RA, Tashani OA, Unsworth BA, Johnson MI. The prevalence of chronic pain with an analysis of countries with a Human Development Index less than 0.9: a systematic review without meta-analysis. Curr Med Res Opin. 2012;28(7):1221-9.
• 14. de Moraes Vieira EB, Garcia JB, da Silva AA, Mualem Araújo RL, Jansen RC. Prevalence, characteristics, and factors associated with chronic pain with and without neuropathic characteristics in São Luís, Brazil. J Pain Symptom Manage. 2012;44(2):239-51.
• 15. de Siqueira SR, Vilela TT, Florindo AA. Prevalence of headache and orofacial pain in adults and elders in a Brazilian community: an epidemiological study. Gerodontology. 2013; doi: 10.1111/ger.12063 [Epub ahead of print]

Publication Dates

• Publication in this collection
  04 Feb 2014
• Date of issue
  Dec 2013