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Non-Adherence to Pharmacotherapy: A Prospective Multicentre Study About Its Incidence and Its Causes Perceived by Chronic Pain Patients

Authors Sampaio R, Azevedo LF, Dias CC, Castro Lopes JM

Received 30 September 2019

Accepted for publication 17 December 2019

Published 19 February 2020 Volume 2020:14 Pages 321—332


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Rute Sampaio, 1, 2 Luís Filipe Azevedo, 3– 5 Cláudia Camila Dias, 4, 5 José M Castro Lopes 1–3

1Departamento de Biomedicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; 2Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal; 3Centro Nacional de Observação em Dor - OBSERVDOR, Porto, Portugal; 4Departamento de Medicina da Comunidade, Informação e Decisão em Saúde, Faculdade de Medicina da Universidade do Porto (MEDCIDS), Porto, Portugal; 5Centro de Investigação Em Tecnologias e em Serviços de Saúde (CINTESIS), Porto, Portugal

Correspondence: Rute Sampaio
Faculty of Medicine of Porto University, Department of Biomedicine – 5 th Floor, Alameda Hernani Monteiro, Porto 4200-319, Portugal

Objective: Pharmacological interventions remain the cornerstone of chronic pain treatment; however, nearly 40% of the prescription medicines are not taken as prescribed. The present study aims at understanding and describing non-adherence from the perspective of chronic pain patients during a 1-year follow-up study.
Methods: A cohort of 950 consecutive patients referred to a first consultation in Multidisciplinary Chronic Pain Clinics was followed with a standardized protocol for 1 year. This included assessment of pain characteristics; prescribed medication; therapeutic adherence; effectiveness of treatment, non-adherence and its perceived reasons; clinical outcomes and quality of life. We used a mixed methods approach, including qualitative and quantitative analyses.
Results: Forty-nine percent of the 562 patients who responded to all assessments during follow-up were adherent after 1 year of chronic pain treatment. The core associations between each “non-adherence reason” and Anatomical Therapeutic Chemical Code (ATC) group were perceived side effects (p=0.019) and delayed start (p=0.022) for narcotic analgesics (opioids); perceived non-efficacy (p=0.017) and delayed start (p=0.004) for antiepileptics and anticonvulsants; perceived low necessity (p=0.041) and delayed start (p=0.036) for analgesics antipyretics; change in prescriptions because of a new clinical condition for antidepressants (p=0.024); high concerns (p=0.045) and change in prescriptions because of a new clinical condition (p< 0.001) for non-steroidal anti-inflammatory drugs; delayed start (p=0.016) and financial constraints (p=0.018) for other medications.
Discussion: This study emphasizes the patient’s perspective regarding non-adherence to pharmacological treatment of chronic pain, providing valuable and novel information to be used in future interventions to help patients make an informed choice about their adherence behavior.

Keywords: chronic pain, pharmacological treatment, non-adherence, patient’s perspective

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