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PLoS One. 2017 Jan 3;12(1):e0168987. doi: 10.1371/journal.pone.0168987. eCollection 2017.

Chronic Pain: How Challenging Are DDIs in the Analgesic Treatment of Inpatients with Multiple Chronic Conditions?

Author information

1
Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.
2
Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland.
3
Research Center for Medical Informatics, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland.
4
Maennedorf Hospital, Department of Internal Medicine, Canton Zurich, Switzerland.
5
Horten Center, University Hospital Zurich, Zurich, Switzerland.
6
Institute of Complementary and Integrative Medicine, University Hospital Zurich, Zurich, Switzerland.
7
Cantonal Hospital, Internal Medicine, Olten, Switzerland.
8
University Research Priority Program 'Dynamics of Healthy Aging,' University of Zurich, Zurich, Switzerland.

Abstract

BACKGROUND:

Chronic pain is common in multimorbid patients. However, little is known about the implications of chronic pain and analgesic treatment on multimorbid patients. This study aimed to assess chronic pain therapy with regard to the interaction potential in a sample of inpatients with multiple chronic conditions.

METHODS AND FINDINGS:

We conducted a retrospective study with all multimorbid inpatients aged ≥18 years admitted to the Department of Internal Medicine of University Hospital Zurich in 2011 (n = 1,039 patients). Data were extracted from the electronic health records and reviewed. We identified 433 hospitalizations of patients with chronic pain and analyzed their combinations of chronic conditions (multimorbidity). We then classified all analgesic prescriptions according to the World Health Organization (WHO) analgesic ladder. Furthermore, we used a Swiss drug-drug interactions knowledge base to identify potential interactions between opioids and other drug classes, in particular coanalgesics and other concomitant drugs. Chronic pain was present in 38% of patients with multimorbidity. On average, patients with chronic pain were aged 65.7 years and had a mean number of 6.6 diagnoses. Hypertension was the most common chronic condition. Chronic back pain was the most common painful condition. Almost 90% of patients were exposed to polypharmacotherapy. Of the chronic pain patients, 71.1% received opioids for moderate to severe pain, 43.4% received coanalgesics. We identified 3,186 potential drug-drug interactions, with 17% classified between analgesics (without coanalgesics).

CONCLUSIONS:

Analgesic drugs-related DDIs, in particular opioids, in multimorbid patients are often complex and difficult to assess by using DDI knowledge bases alone. Drug-multimorbidity interactions are not sufficiently investigated and understood. Today, the scientific literature is scarce for chronic pain in combination with multiple coexisting medical conditions and medication regimens. Our work may provide useful information to enable further investigations in multimorbidity research within the scope of potential interactions and chronic pain.

PMID:
28046033
PMCID:
PMC5207693
DOI:
10.1371/journal.pone.0168987
[Indexed for MEDLINE]
Free PMC Article

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