Documento de consenso sobre el uso de la combinación paracetamol/tramadol en pacientes con dolor moderado-intenso

espanolObjetivos Desarrollar recomendaciones sobre el uso de la combinacion paracetamol/tramadol (P/T) en pacientes con dolor moderado-intenso, basadas en la mejor evidencia y experiencia. Metodos Se siguio la metodologia de grupos nominales y Delphi apoyados por una revision sistematica de la literatura (RSL). Se selecciono un panel multidisciplinar de 12 expertos en el manejo del dolor. En la primera reunion de grupo nominal se definio el objetivo, alcance, usuarios, apartados del documento de consenso, asi como recomendaciones generales preliminares. Para la RSL se definieron los criterios de inclusion y exclusion, y las estrategias de busqueda. Dos revisores seleccionaron y analizaron los articulos. Esta evidencia se discutio en una segunda reunion de grupo nominal y se generaron las recomendaciones definitivas. Para cada recomendacion, el nivel de evidencia y el grado de recomendacion se clasificaron segun el modelo de Oxford, y el grado de acuerdo por tecnica Delphi. Se definio acuerdo si al menos el 70% de los participantes contestaron ≥ 7 en cada recomendacion (1 = total desacuerdo a 10 = total acuerdo). Resultados Se generaron 20 recomendaciones que cubren aspectos generales, como la evaluacion del dolor, y especificos del manejo de P/T. Estos ultimos abarcan la indicacion de la combinacion P/T (perfil de paciente, dosificacion, pauta, formulaciones), gestion del riesgo (contraindicaciones, precauciones, interacciones, uso concomitante con otras medicaciones, seguimiento, situaciones especiales) y la educacion del paciente. Conclusiones Estas recomendaciones pretenden resolver algunos interrogantes clinicos habituales y facilitar la toma de decisiones respecto al uso de la combinacion P/T en pacientes con dolor moderado-intenso. EnglishObjectives To present recommendations on the use of the paracetamol/tramadol (P/T) combination in patients with moderate-intense pain based on best evidence and experience. Methods The method of nominal groups and Delphi was followed, and supported by a systematic literature review (SLR). A multidisciplinary panel of 12 experts in pain management was selected. In the first nominal group meeting, the aim, scope, users, and sections of the consensus document, were defined, along with the preliminary general recommendations. For the SLR, the inclusion and exclusion criteria, as well as the search strategies, were defined. Two reviewers selected and analysed the articles. This evidence was discussed in a second nominal group meeting, and definitive recommendations were developed. For each recommendation, the evidence levels and grade of recommendation grades were classified according to the Oxford model, and the grade according to the Delphi technique. It was defined as an agreement if at least 70% of the participants scored ≥ 7 for each recommendation (1 = total disagreement to 10 = total agreement). Results A total of 20 recommendations were produced, which covered general aspects, such as the assessment of pain, and those specific to P/T management. These latter included the indications of the P/T combination (patient profile, dosing, prescription, formulations), risk management (contraindications, precautions, interactions, concomitant use with other medications, follow-up, special situations), and patient education. Conclusions These recommendations attempt to resolve any of the routine clinical questions, and help in the making of decisions on the use of the P/T combination in patients with moderate-intense pain.