Factores psicológicos asociados a la adherencia al tratamiento analgésico en pacientes con dolor crónico: Revisión sistemática de la literatura

Introduction: The lack of adherence is frequent in chronic pain (CP) patients and the influence of psychological factors may play a relevant role. The aim of this study was to analyze the psychological factors related to the adherence to analgesic treatment in patients with CP. Methodology: A systematic review was carried out, including original articles published in English and Spanish between June-2009 and June-2019 included in Pudmed, Scopus, Web of Science and PsycINFO. Articles with cross-sectional and longitudinal design were included, carried out in a population >18 years with chronic non-oncological pain (CNOP) and that analyzed any psychological variable in relation to adherence to analgesic treatment. The search terms were “adherence”, “compliance”, “misuse”, “analgesic”, “chronic pain” and “psychology”. The quality of the articles included was analysed through the Critical Appraisal Checklist for Analytical Cross-sectional studies of Joanna Briggs Institute for cross-sectional studies and the Newcastle-Ottawa Quality Assessment Form for Cohort Studies for the longitudinal studies. Results: A total of 1184 articles were initially identified, and 14 were finally selected. Depression was the most studied variable, being included in 11 articles, followed by anxiety, that appeared in 6. Both depression and anxiety were repeatedly associated with lower adherence to analgesic treatment, and the same was true in two of the articles that measured jointly the relationship of anxiety and depression on analgesic adherence (high negative affect 39.1 % vs. low negative affect 8,3 %, p = 0.013). Active coping strategies were found to be associated with underuse (OR = 1.132, 95 % CI: 1.027-1.249, p = 0.013) and poor coping strategies were associated with opioid misuse (p = 0.01). The association between catastrophizing and analgesic adherence was addressed in 5 articles, and although it was found that catastrophizing was related to low adherence (r = 0.45, p = 0.01), this result was no longer significant when evaluated alongside anxiety and depression. Conclusion: The identification and control of psychological factors in patients suffering from CP is necessary, as it could serve to improve adherence to analgesic treatment in these patients.