Trastornos del sue?o e incidencia de ansiedad y depresión en pacientes con dolor crónico no maligno tratados con opioides potentes

摘要

Introduction: accompanying pain, other biologically important functions are present which are not always well recognized and which are usually called "co morbidities". One of them is sleep, although it has also been shown some correlation between the state of mood and nociception, being both states the most studied and considered as relevant in relation to chronic pain, anxiety and depression. Objective: the main objective is to evaluate the quality of sleep in patients with chronic nonmalignant pain (CNMP) treated with potent opioids. As secondary objectives: To analyze the incidence of anxiety and depression in these patients and to compare the quality of sleep and incidence of anxiety-depression with different variables: type of opioid, gender, sex and type of pain. Material and methods: we considered the study universe CNMP patients treated with the same strong opioid for at least three months and were seen at the Pain Management Unit between September 2009 and march 2010. Excluded were patients younger than 18 years, those who would not cooperate, diagnosed with fibromyalgia and those who were in psychiatric treatment. As an assessment tool of sleep we used the Oviedo Sleep Questionnaire (COS) and in measuring the degree of anxiety-depression we used the Test Hospital Anxiety and Depression (HAD) on its overall assessment. Statistical analysis for qualitative variables was performed using the Pearson χ2. Quantitative variables were compared with a Student test. Values with a p-value less than 0.05 were accepted as significant (95% confidence interval). We used the statistical package for Windows SPSS.15. Results: in the assessment of sleep disorders there were significant differences according to the type of opioid consumed, being the group treated with Hydromorphone the one with the best results made in the three subscales tested: COS's subjective assessment, objective subscale of insomnia and those who consumed fewer drugs to sleep. We also found differences in the incidence of anxiety / depression, statistically significant, depending on the type of opioid, again being the group treated with Hydromorphone the one with lower incidence of psychological impact. No significant differences were found in sleep disorders and in the prevalence of anxiety-depression in terms of the other variables: type of pain, or sex. Conclusions: in our study, patients who consumed Hydromorphone showed better sleep quality, less use of hypnotics and a lower rate of developing an anxiety-depressive picture. It is true, perhaps, that to corroborate these results and avoid elements that distort them, there will in future works be necessary to assess the presence of other variables.