Sertaç KETENCİ, Birzat Emre GÖLBOYU, Ender SALBAŞ, Bora UZUNER, Bahadır ÇİFTÇİ

Türk hekimlerinin fibromiyalji tedavisindeki tutumları; pregabalinofobi ağrı tedavisinin yeni gerçeği mi?

Amaç: Bu çalışma, fibromiyalji tedavisi ile ilgilenen hekimlerin tedavi tercihlerini belirlemek ve pregabalin reçetelemek konu- sundaki tereddütlerini araştırmayı amaçlamaktadır. Gereç ve Yöntem: Anket çalışmamız 5 Şubat 2021–20 Şubat 2021 tarihleri arasında gerçekleştirildi. Fiziksel tıp ve rehabilitas- yon, algoloji ve romatoloji hekimlerinden oluşan 1569 kişinin bilinen e-posta adreslerine ve telefon numaralarına anket form- ları gönderildi. Anketlere verilen yanıtlar olası yeniden gönderimler açısından kontrol edildi. Veri havuzu SPSS 22.0 istatistik paket programı ile değerlendirildi. Frekans dağılımları hesaplandı ve n, % olarak sunuldu. Bulgular: Dört yüz altı fiziksel tıp ve rehabilitasyon, romatoloji ve algoloji uzmanı çalışma formlarını tamamladı. Hekimlerin %59’u fibromiyalji tedavisinde birinci basamak ajan olarak duloksetin tercih ettiklerini belirtti. Pregabalin, hekimlerin fibromi- yalji için ilk tercihinin sadece %6'sıydı. Çalışmaya katılan hekimlerin %35'i fibromiyalji hastalarının fiziksel tıp ve rehabilitasyon bölümlerinde takip edilmesi gerektiğini belirtti. Katılımcıların %44,3’ü fibromiyalji hastalarını, fibromiyalji tedavisi ile ilgilenen ve fibromiyalji hastalarını takip etmek isteyen diğer bölümlere sevk ettiklerini belirtti. Katılımcıların %81'i pregabalinin ba- ğımlılığa neden olduğunu kabul etti. Katılımcıların %36,7'si fibromiyalji hastalarının en az %20'sinin pregabalini kötüye kullanabileceğini belirtti. Hekimlerin %97,8'i mahkumlara pregabalin reçete edilmesi konusunda ön yargılı olduğunu belirtti. Üç hekimden yaklaşık ikisi hastanelerinde pregabalin reçete edilmesi ile ilgili bir şiddet olayına maruz kaldığını belirtti. Sonuç: Bu veriler “pregabalinofobi”nin kabul edilmesi gerektiğini göstermektedir. Bu durum, yalnızca ilacın güvenilmezliğin- den değil, hekimin can güvenliği endişeleriyle de ilişkilidir. Görünüşe göre doktorlarda bu ön yargının oluşmasında geçerli nedenler vardır.

The attitudes of Turkish physicians in the treatment of fibromyalgia; is “Pregabalinophobia” the new reality of pain medicine?

Objectives: This study aims to determine the treatment preferences of physicians interested in fibromyalgia treatment and to investigate their hesitations about prescribing pregabalin. Methods: Our survey study was conducted between February 5 and 20, 2021. The survey forms were sent to the known email addresses and phone numbers of 1569 physical medicine and rehabilitation (PMR), algology, and rheumatology physicians. The replies to the surveys were checked for possible resubmissions. The pooled data were evaluated with the SPSS 22.0 statis- tical package program. Frequency distributions were calculated and presented as n, %. Results: Four hundred and six PMR, rheumatology, and algology specialists fulfilled the study forms. About 59.0% of physi- cians stated that they prefer duloxetine as the first-line agent of fibromyalgia syndrome (FMS) treatment. Pregabalin was only 6.0% of the physicians’ first choice for FMS. About 35.0% of the participating physicians stated that the PMR department should follow up FMS patients. About 44.3% of the participants noted that they refer FMS patients to other departments which interested in FMS treatment and do not want to follow-up FMS patients. About 81% agreed that pregabalin causes addiction. About 36.7% stated that at least 20% of the patients could abuse pregabalin and 97.8% of physicians stated that they were prejudiced about prescribing pregabalin to prisoners. Approximately two of the three physicians experienced an act of vio - lence in their hospital regarding pregabalin prescribing. Conclusion: These data showed that the “Pregabalinophobia” should be accepted. This condition is associated with life safety concerns of the physician not only from unreliability of the drug. It seems that the doctors have valid reasons to develop this prejudice.

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