Impacto cognitivo do uso crônico de opioides
DOI:
https://doi.org/10.5281/zenodo.7942941Palavras-chave:
opioides, narcóticos, conhecimento, disfunção cognitiva, doença crônica, abuso, substânciasResumo
Introdução: o impacto do uso crônico de opioides tem sido relacionado a uma ampla gama de distúrbios cognitivos, desde pequenas deficiências nas habilidades cognitivas até problemas em habilidades como atenção, aprendizado, memória e funções executivas.
Objetivo: realizar uma revisão sistemática para investigar o impacto cognitivo em pacientes que fazem uso crônico de opioides e avaliar a gravidade desse impacto.
Método: ensaios clínicos randomizados, estudos de caso-controle, coortes prospectivas e retrospectivas foram avaliados em duas bases de dados: PubMed e Cochrane Central, usando os seguintes termos em sua busca: "analgesic opioids", "cognitive dysfunção", "cognitive impairments", "doença crônica" e "abuso, substância". A busca foi em inglês, espanhol e português para estudos conduzidos em humanos adultos sobre o uso crônico de opioides e seu impacto cognitivo.
Resultados: foram selecionados 7 estudos, 5 dos quais os pacientes usaram tramadol e foi verificado o impacto cognitivo negativo, um estudo com o uso de tapentadol com impacto positivo na cognição e um estudo com o uso de hidrocodona com impacto positivo na neurocognição de pacientes.
Conclusões: apesar das limitações encontradas, como conclusão considera-se que o tramadol tem impacto negativo na neurocognição, o que não ocorre em relação ao tapentadol e hidrocodona, que apresentarão melhora na qualidade de vida e cognição dos pacientes.
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Roberts D, Wolfarth A, Sanchez C, Pehrson AL. Chapter 5 - Frontal cortex dysfunction as a target for remediation in opiate use disorder: Role in cognitive dysfunction and disordered reward systems. Prog Brain Res [Internet]. 2018 [citado 13 Feb 2023]; 239:179-227. DOI: https://doi.org/10.1016/bs.pbr.2018.07.001
Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EKB, et al. Assessment of pain. Br J Anaesth [Internet]. 2008 Jul [citado 13 Feb 2023]; 101(1):17-24. DOI: https://doi.org/10.1093/bja/aen103
Pergolizzi J, Böger RH, Budd K, Dahan A, Erdine S, Hans G, et al. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract [Internet]. 2008 Ago [citado 13 Feb 2023]; 8(4):287-313. DOI: https://doi.org/10.1111/j.1533-2500.2008.00204.x
Toledo-Fernández A, Brzezinski-Rittner A, Roncero C, Benjet C, Salvador-Cruz J, Marín-Navarrete R. Assessment of neurocognitive disorder in studies of cognitive impairment due to substance use disorder: A systematic review. J Subst Use [Internet]. 2018 Sep [citado 13 Feb 2023]; 23(5):535-50. DOI: https://doi.org/10.1080/14659891.2017.1397208
Bassiony MM, Youssef UM, Hassan MS, Salah El-Deen GM, El-Gohari H, Abdelghani M, et al. Cognitive Impairment and Tramadol Dependence. J Clin Psychopharmacol [Internet]. 2017 Feb [citado 13 Feb 2023]; 37(1):61-6. DOI: https://doi.org/10.1097/jcp.0000000000000617
Aharonovich E, Campbell ANC, Shulman M, Hu MC, Kyle T, Winhusen T, et al. Neurocognitive Profiling of Adult Treatment Seekers Enrolled in a Clinical Trial of a Web-delivered Intervention for Substance Use Disorders. J Addict Med [Internet]. 2018 Feb [citado 13 Feb 2023]; 12(2):99-106. DOI: https://doi.org/10.1097/adm.0000000000000372
Kristek G, Radoš I, Kristek D, Kapural L, Nešković N, Škiljić S, et al. Influence of postoperative analgesia on systemic inflammatory response and postoperative cognitive dysfunction after femoral fractures surgery: a randomized controlled trial. Reg Anesth Pain Med [Internet]. 2019 Ene [citado 13 Feb 2023]; 44(1):59-68. DOI: https://doi.org/10.1136/rapm-2018-000023
Jamison RN, Schein JR, Vallow S, Ascher S, Vorsanger GJ, Katz NP. Neuropsychological effects of long-term opioid use in chronic pain patients. J Pain Symptom Manage [Internet]. 2003 Oct [citado 13 Feb 2023]; 26(4):913-21. DOI: https://doi.org/10.1016/S0885-3924(03)00310-5
Els C, Jackson TD, Kunyk D, Lappi VG, Sonnenberg B, Hagtvedt R, et al. Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database Syst Rev [Internet]. 2017 Oct. [citado 13 Feb 2023]; 10(10):CD012509. DOI: https://doi.org/10.1002/14651858.cd012509.pub2
Mercadante S. Opioid Analgesics Adverse Effects: The Other Side of the Coin. Curr Pharm Des [Internet]. 2019 [citado 13 Feb 2023]; 25(30):3197-202. DOI: https://doi.org/10.2174/1381612825666190717152226
Dublin S, Walker RL, Gray SL, Hubbard RA, Anderson ML, Yu O, et al. Prescription Opioids and Risk of Dementia or Cognitive Decline: A Prospective Cohort Study. J Am Geriatr Soc [Internet]. 2015 Ago [citado 13 Feb 2023]; 63(8):1519-26. DOI: https://doi.org/10.1111/jgs.13562
Kosten T, Aharonovich E, Nangia N, Zavod A, Akerman SC, Lopez-Bresnahan M, et al. Cognitive performance of patients with opioid use disorder transitioned to extended-release injectable naltrexone from buprenorphine: Post hoc analysis of exploratory results of a phase 3 randomized controlled trial. Addict Behav [Internet]. 2020 Dic [citado 13 Feb 2023]; 111:106538. DOI: https://doi.org/10.1016/j.addbeh.2020.106538
Babul N, Noveck R, Chipman H, Roth SH, Gana T, Albert K. Efficacy and safety of extended-release, once-daily tramadol in chronic pain: a randomized 12-week clinical trial in osteoarthritis of the knee. J Pain Symptom Manage [Internet]. 2004 Jul [citado 13 Feb 2023]; 28(1):59-71. DOI: https://doi.org/10.1016/j.jpainsymman.2003.11.006
Sjogren P, Thomsen AB, Olsen AK. Impaired neuropsychological performance in chronic nonmalignant pain patients receiving long-term oral opioid therapy. J Pain Symptom Manage [Internet]. 2000 Feb [citado 13 Feb 2023]; 19(2):100-8. DOI: https://doi.org/10.1016/S0885-3924(99)00143-8
Mullican WS, Lacy JR, TRAMAP-ANAG-006 Study Group. Tramadol/acetaminophen combination tablets and codeine/acetaminophen combination capsules for the management of chronic pain: a comparative trial. Clin Ther [Internet]. 2001 Sep [citado 13 Feb 2023]; 23(9):1429-45. DOI: https://doi.org/10.1016/S0149-2918(01)80118-1
Lee JH, Lee CS, Ultracet ER Study Group. A randomized, double-blind, placebo-controlled, parallel-group study to evaluate the efficacy and safety of the extended-release tramadol hydrochloride/acetaminophen fixed-dose combination tablet for the treatment of chronic low back pain. Clin Ther [Internet]. 2013 Nov [citado 13 Feb 2023]; 35(11):1830-40. DOI: https://doi.org/10.1016/j.clinthera.2013.09.017
Hale ME, Zimmerman TR, Ma Y, Malamut R. Evaluation of Quality of Life, Functioning, Disability, and Work/School Productivity Following Treatment with an Extended-Release Hydrocodone Tablet Formulated with Abuse-Deterrence Technology: A 12-month Open-label Study in Patients with Chronic Pain. Pain Pract [Internet]. 2017 Feb [citado 13 Feb 2023]; 17(2):229-38. DOI: https://doi.org/10.1111/papr.12433
Tarsitano A, Cortese M, Barile M, Scarpelli P. Tapentadol prolonged release and the long-term management of chronic musculoskeletal pain in the elderly - focus on anxiety, depression, cognitive status and life quality: the TaPE study. Eur Rev Med Pharmacol Sci [Internet]. 2019 Nov [citado 13 Feb 2023]; 23(4 Suppl):35-9. DOI: https://doi.org/10.26355/eurrev_201911_19374
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Copyright (c) 2023 Lara Macedo-Soares, Marcelo Adrián Estrin
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
