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dc.contributor.advisorEggen, Anne Elise
dc.contributor.authorSamuelsen, Per-Jostein
dc.date.accessioned2016-08-19T08:23:53Z
dc.date.available2016-08-19T08:23:53Z
dc.date.issued2016-08-19
dc.description.abstractBackground: Analgesics are commonly used drugs but we are lacking knowledge of trends, persistence, high-risk use and the association with pain sensitivity at a population-level. Purpose: To describe the use of analgesics, particularly persistent analgesic use, in a general population (30+ years), including change over time, contraindications and drug interactions, risk factors, and associations with pain sensitivity. Methods: The Tromsø Study, including Tromsø 5 (2001-02, n = 8,030) and Tromsø 6 (2007-08, n = 12, 981), with the latter further linked with the Norwegian Prescription Database (2004-13). Main results: The age-adjusted prevalence of analgesic use increased from 53.7% to 59.6% in women and from 29.1% to 36.7% in men between 2001 and 2008, due to an increase in the use of non-prescription analgesics. Several areas of potential high-risk use of analgesics were identified. The prevalence of persistent prescription analgesic use was 4.3% in general and 10.2% among those reporting chronic pain, while the incidence rate was 21.2 per 1,000 person-years; risk factors were chronic pain, increasing age, female sex, lower education level and most likely lower levels of physical activity. Analgesic use was associated with increased pain sensitivity; regular opioid users were more pain sensitive than regular users of non-opioid analgesics. Increased pain sensitivity was a risk factor for future persistent analgesic in the crude analysis. Conclusions: The use of analgesics increased from 2001 to 2008. The extent of use of non-steroidal anti-inflammatory drugs in the presence of chronic kidney disease, gastrointestinal ulcers, cardiovascular disease and interacting drugs increasing the bleeding risk was a particular cause for concern. The prevalence of persistent analgesic use was relatively low, also among those reporting chronic pain, perhaps indicative of limited effectiveness. Analgesic use is associated with increased pain sensitivity but the potential causal mechanisms are unclear.en_US
dc.description.doctoraltypeph.d.en_US
dc.description.popularabstractI 2007-2008 oppga nær 60 % av kvinner og en tredjedel av menn i alderen 30 år og eldre bruk av smertestillende siste fire uker. Forbruket har økt de siste tre-fire tiårene. – Økningen kan skyldes bedre behandling av smerte. Andre mulige forklaringer er en mulig økning i forekomst av smertetilstander, høyere levealder, økt tilgjengelighet, holdningsendringer og markedsføring, sier Per-Jostein Samuelsen, doktorgradsstipendiat ved RELIS Nord-Norge og Institutt for samfunnsmedisin, UiT Norges arktiske universitet. – Mange bruker smertestillende, men få er langvarige brukere. Fire prosent av befolkningen i alderen 30-87 år var langvarige brukere av reseptpliktige smertestillende mens forekomsten var 10 % blant de med kroniske smerter, sier Samuelsen. Effekten av smertestillende ved kroniske smerter synes begrenset. – For et mindretall kan likevel smertestillende virke godt. Utfordringen er bivirkningene. Vi fant holdepunkter for høyrisikobruk av smertestillende, sier Samuelsen. Bruk av smertestillende var forbundet med høy smertefølsomhet. Brukere av opioider alene, som Paralgin forte, var mer smertefølsomme enn brukere av andre smertestillende eller ikke-brukere. – Opioidbruk kan noen ganger føre til mer smerte. Smertefølsomhet sier kanskje likevel mer om alvorlighetsgraden til den underliggende smertetilstanden. Kanskje kan smertetester i fremtiden være til hjelp i valget av smertestillende, slik at færre blir utsatt for bivirkninger?, avslutter Samuelsen.en_US
dc.description.sponsorshipHelse Norden_US
dc.descriptionPaper II and III of this thesis are not available in Munin <br> Paper II: Samuelsen, P. J., Svendsen, K., Wilsgaard, T., Stubhaug, A., Nielsen, C. S., Eggen, A.E.: “Persistent analgesic use and the association with chronic pain and other risk factors in the population - a longitudinal study from the Tromsø Study and the Norwegian Prescription Database”. Available in <a href=http://dx.doi.org/10.1007/s00228-016-2056-7>European Journal of Clinical Pharmacology 2016 </a> <br> Paper III: Samuelsen, P. J., Nielsen, C. S., Wilsgaard, T., Stubhaug, A., Svendsen, K., Eggen, A. E.: “Pain sensitivity as risk factor for analgesic use in 10,486 adults: The Tromsø Study”. (Manuscript)en_US
dc.identifier.urihttps://hdl.handle.net/10037/9517
dc.identifier.urnURN:NBN:no-uit_munin_9075
dc.language.isoengen_US
dc.publisherUiT The Arctic University of Norwayen_US
dc.publisherUiT Norges arktiske universiteten_US
dc.rights.accessRightsopenAccess
dc.rights.holderCopyright 2016 The Author(s)
dc.subject.courseIDDOKTOR-003
dc.subjectVDP::Medisinske Fag: 700::Helsefag: 800::Epidemiologi medisinsk og odontologisk statistikk: 803en_US
dc.subjectVDP::Medical disciplines: 700::Health sciences: 800::Epidemiology medical and dental statistics: 803en_US
dc.subjectVDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsfarmasi: 812en_US
dc.subjectVDP::Medical disciplines: 700::Health sciences: 800::Community pharmacy: 812en_US
dc.subjectFarmakoepidemiologien_US
dc.subjectPharmacoepidemiologyen_US
dc.subjectSmerteen_US
dc.subjectPainen_US
dc.subjectSmertestillendeen_US
dc.subjectAnalgesicsen_US
dc.subjectEpidemiologien_US
dc.subjectEpidemiologyen_US
dc.subjectThe Tromsø Study
dc.subjectTromsøundersøkelsen
dc.titleUse of analgesics in the general population: Trends, persistence, high-risk use and associations with pain sensitivityen_US
dc.typeDoctoral thesisen_US
dc.typeDoktorgradsavhandlingen_US


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