Terapias mente-corpo podem melhorar dor e diminuir uso de opióides

 

 

Pergunta clínica: Qual o efeito das terapias mente-corpo, como por exemplo a meditação, a hipnose, o relaxamento, a sugestão terapêutica e a terapia cognitivo-comportamental, na dor e utilização de opioides em adultos medicados com estes fármacos?

Desenho do estudo: Revisão sistemática e meta-análise. Foram realizadas pesquisas de ensaios clínicos aleatorizados e revisões sistemáticas escritos em inglês na MEDLINE, Embase, Emcare, CINAHL, PsycINFO e Cochrane até Março 2018. Foram selecionados os ensaios clínicos aleatorizados que avaliavam o uso de terapia mente-corpo em adultos com prescrição de opioides para a dor. Dois revisores procederam à selecção de citações, extracção de dados e avaliação do risco de viés de modo independente. O marcador primário foi a intensidade da dor. Os marcadores secundários foram: dose de opioides, uso inapropriado de opioides, “craving” de opioide, incapacidade ou função.

Resultados: Foram incluídos 60 ensaios clínicos aleatorizados, com um total de 6404 participantes, avaliando diferentes terapêuticas: meditação (n=5), hipnose (n=25), relaxamento (n=14), sugestão terapêutica (n=6), terapêutica cognitivo-comportamental (n=7) e “imaginação guiada” (n=7). A maioria dos estudos foi avaliado com baixo risco de viés. As terapias mente-corpo associaram-se a redução da dor (Cohen d = −0.51; intervalo de confiança (IC) 95%, −0.76 a −0.27) e a redução da dose de opioides (Cohen d = −0.26; IC 95%, −0.44 a −0.08). De entre as diferentes terapias, as que demonstraram efeitos na redução da dor foram a meditação (Cohen d = −0.70), a hipnose (Cohen d = −0.54), a sugestão (Cohen d = −0.68) e a terapia cognitivo-comportamental (Cohen d = −0.43). A meditação (n=4 [80%]), a terapia cognitivo-comportamental (n=4 [57%]) e a hipnose (n=12 [63%]) demonstraram melhorar os marcadores relacionados com os opioides.

Comentário: Os resultados desta revisão sistemática e meta-análise demonstraram que as terapias mente-corpo estão associadas a uma redução moderada da dor e pequenas reduções na dose de opioides. Podem, portanto, constituir uma opção, alvo de decisão partilhada. Como limitações, de realçar a elevada heterogeneidade dos estudos e, ainda, o possível viés de publicação (devido a não publicação de resultados sem benefício das terapias), o que pode ter amplificado o benefício encontrado.

Artigo original: JAMA Intern Med

Por Maria Gonçalves, USF Garcia de Orta  

 

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