Browsing by Author "Dittborn, Mariana"

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    Opioid analgesics prescribing in Latin America: systematic review and meta-analysis
    (2025) Leiva Vásquez, Ofelia Paz; Dittborn, Mariana; Turrillas, Pamela; Chukwusa, Emeka; Nkhoma, Kennedy; Adejoke Obirenjeyi Oluyase; Padilla Pérez, Oslando; Pastrana, Tania
    Background Improving access to opioids in Latin America requires better understanding of prescription patterns in palliative care.Aim To describe opioid prescribing patterns, including types and doses in morphine equivalent daily dose (MEDD), among patients receiving palliative care, including patients with cancer and non-cancer conditions in Latin America.Design Systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sources We searched MEDLINE, EMBASE, PubMed, LILACS and SciELO from inception to January 2025. Quantitative studies reporting opioid prescriptions in adult patients receiving palliative care were included. Two reviewers independently screened, extracted data and assessed methodological quality using the Effective Public Health Practice Project tool. A narrative synthesis and descriptive statistics were conducted. Meta-analysis of MEDD was performed post hoc using random-effects models.Results Of 2855 records, 51 studies from seven countries met inclusion criteria. Most were observational (75%), with 8641 patients analysed. Cancer pain was the main indication (98%). Morphine (61%) and tramadol (15%) were the most frequently prescribed opioids. A meta-analysis of 48 studies (8433 patients) yielded a pooled mean MEDD of 98.06 mg (95% CI 77.07 to 119.05), with substantial heterogeneity (I²=100%). Most studies were rated as low to moderate quality.Conclusions This review provides a regional synthesis of opioid prescribing patterns for palliative care in Latin America. Although morphine is the most used opioid, data show limited dosing variability and a scarcity of high-quality studies. Strengthening research capacity is essential to inform clinical guidelines and policy for equitable and adequate pain management in palliative care across the region.
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    Opioid prescribing for cancer pain in Latin America: systematic review
    (2024) Leiva, Ofelia; Chukwusa, Emeka; Nkhoma, Kennedy; Dittborn, Mariana; Turrillas, Pamela; Pastrana, Tania
    Objective To explore opioid prescribing patterns for cancer pain in Latin America (LA).Methods A systematic review was conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Relevant databases, including MEDLINE, EMBASE, PubMed, LILACS and Scielo, were searched from inception to June 2023. Empirical studies of opioid prescription patterns in adult palliative care patients with cancer pain were included. Methodological quality was assessed using the Effective Public Health Practice Project tool. Data were analysed using narrative synthesis. Descriptive statistical analyses were conducted using SPSS V.28 (IBM). Categorical variables were summarised using frequencies and percentages and continuous variables as means or medians.Results Seventeen studies from six countries were included. Ten were observational, while seven were experimental, including five randomised controlled trials (RCT) and two non-RCT. Most were low or moderate methodological quality. Out of 7809 patients, morphine (54%) and tramadol (18%) were the most prescribed opioids. The median of morphine equivalent daily dose was 26 mg (IQR 26-41).Conclusion Latin America shows lower opioid consumption rates compared with high-income countries for control pain management (CPM). More rigorous research on CPM in LA is needed. Additionally, a comprehensive review of opioid prescription patterns, including non-cancer diagnoses, is necessary.