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dc.contributor.advisorRangel Jaimes, German William
dc.contributor.authorTrujillo Uribe, Néstor José
dc.coverage.spatialBucaramanga (Santander, Colombia)spa
dc.date.accessioned2020-08-04T23:15:34Z
dc.date.available2020-08-04T23:15:34Z
dc.date.issued2020
dc.identifier.urihttp://hdl.handle.net/20.500.12749/7152
dc.description.abstractIntroducción: el dolor crónico es un problema serio de salud pública. Las herramientas terapéuticas disponibles han sido cuestionadas por sus efectos secundarios indeseables. El uso de cannabis medicinal se ha propuesto como parte de una estrategia multimodal, para manejo del dolor crónico, por considerarle una alternativa más segura y efectiva. En las últimas dos décadas, el cannabis medicinal ha ganado gran relevancia mediática, socioeconómica y científica en el país. Con gran controversia, los medicamentos a base de cannabis son empleados en todas latitudes, mientras la comunidad científica en todo el mundo se interesa en recopilar evidencia del efecto clínico. Pocos estudios se han enfocado en las percepciones, actitudes y creencias de los pacientes. En Colombia, no se había realizado ninguno. Planteamiento del problema: tras varias décadas de proscripción legal del cultivo, transporte, posesión, uso o consumo de marihuana, en Colombia se viene gestando un enfoque diferencial entre el narcotráfico, el microtráfico, el uso recreativo y el medicinal. El uso medicinal de cannabis ha sido despenalizado y el Gobierno inició el proceso de reglamentar la producción, transformación y comercialización. El uso medicinal de cannabis en Colombia es relevante, tanto en el ámbito científico, como en el social; al igual que en el resto del mundo. La marihuana aquí es la droga ilícita más comúnmente usada. En este país prevalecen ideas vagamente relacionadas con las percepciones y actitudes de la población colombiana frente a la marihuana. La percepción pública acerca de la eficacia de los cannabinoides en dolor no parece ser consistente con la evidencia científica disponible pues la percepción de efectividad es muy subjetiva. Igualmente, es necesario que los profesionales de la salud entiendan, controlen y adapten los procesos de farmacología y medicina actuales a los aspectos claves del cannabis en el manejo del dolor, con el fin de disminuir el riesgo derivado de su uso. Objetivos: describir las percepciones, actitudes y creencias acerca del uso de cannabis medicinal en pacientes con dolor crónico en una institución de salud de tercer nivel del Nororiente colombiano. Metodología: el presente estudio, se desarrolló usando técnicas de investigación de campo, a partir de un cuestionario autoadministrado que preservó el anonimato. El muestreo se hizo por conveniencia, tanto en pacientes como en sus familiares o acudientes. Se evaluaron las relaciones entre percepciones, creencias y actitudes y las características demográficas del consumo de cannabis, experiencias previas, estado de salud y calidad de vida, intensidad del dolor, presencia de comorbilidades y consumo de otras sustancias psicoactivas. Resultados: se logró obtener información útil para comprender el constructo psicosocial de los pacientes en lo referente al cannabis medicinal. Predominó entre ellos una postura neutral, mientras que la de los familiares fue más variada, con tendencia positiva en la mayoría de los aspectos. La prevalencia de consumo medicinal fue baja en los dos grupos. Los pacientes con dolor crónico encuestados no se comportan igual que lo reportado en estudios internacionales. Discusión: a pesar del complicado contexto colombiano referente al uso de las sustancias psicoactivas y el impacto del narcotráfico, los pacientes no son renuentes a la posibilidad de emplear el cannabis medicinal para el manejo del dolor crónico; tampoco para el manejo de otros síntomas. Su posición neutral permite que, dirigiendo apropiadamente las políticas públicas en salud y educación, puedan modificarse estas percepciones de acuerdo a la evidencia científica. También se destaca a partir de los resultados el importante papel de los familiares, no solo en la toma de decisiones, sino también como amplificadores positivos de la idea de utilidad terapéutica del cannabis medicinal. Este estudio abre las puertas a lo que debe ser un campo de investigación amplio y dinámico, que integre el conocimiento científico con el contexto del paciente usando un enfoque biopsicosocial integrador.spa
dc.description.tableofcontentsLISTA DE FIGURAS I LISTA DE TABLAS II GLOSARIO III RESUMEN 1 ABSTRACT 1 INTRODUCCIÓN 3 PLANTEAMIENTO DEL PROBLEMA 4 RELEVANCIA DEL USO MEDICINAL DEL CANNABIS ¿POR QUÉ INVESTIGAR? 4 CANNABIS COMO FITOTERAPIA 5 Cannabis 6 Cannabinoides 6 CANNABIS MEDICINAL 7 EPIDEMIOLOGIA DEL CONSUMO DE CANNABIS 9 Prevalencia de Consumo en Europa 10 Prevalencia de Consumo en Norteamérica 11 Prevalencia de Consumo en Latinoamérica 11 Características de Consumo por Edad 11 Características de Consumo por Sexo 12 Características de Consumo por Nivel Socioeconómico 14 Características de Consumo por Estado Civil 15 Características de Consumo por Nivel Educativo 15 Características de Consumo por Vinculación Laboral 16 Características de Consumo por Estado de Salud 16 USO RECREATIVO VERSUS MEDICINAL 17 CONTEXTO PSICOSOCIAL LATINOAMERICANO 19 USO DE CANNABIS EN COLOMBIA 20 Contexto Psicosocial 21 BARRERAS PARA LA INVESTIGACIÓN 25 JUSTIFICACIÓN 33 OBJETIVOS 36 GENERAL 36 ESPECÍFICOS 36 MARCO REFERENCIAL 37 MARCO TEÓRICO 38 ASPECTOS HISTÓRICOS 38 CONCEPTOS FARMACOLÓGICOS RELEVANTES 41 Cannabis 41 Cannabinoides 41 Sistema Endocannabinoide 42 PRODUCTOS MEDICINALES DISPONIBLES 46 Vías de Administración 48 Absorción 50 Distribución 51 Metabolismo 51 Eliminación 51 Productos en Desarrollo 52 Presentaciones Concentradas 52 SEGUNDO EFECTO 54 Impacto Sobre el Consumo de Otros Fármacos 56 EFECTOS SECUNDARIOS INDESEABLES 58 Consumo Problemático 60 Tratamiento del Uso Problemático 64 ASPECTOS LEGALES 67 CONTEXTO COLOMBIANO 72 ESTADO DEL ARTE 76 GENERALIDADES 76 TEORÍAS Y APROXIMACIONES ANALÍTICAS 77 ACTITUDES Y CREENCIAS 81 MOTIVACIONES PARA EL USO 86 PERCEPCIÓN DE EFICACIA 87 PERCEPCIÓN DE PLACER 89 MOTIVACIONES PARA EL NO USO 90 PERCEPCIÓN DE RIESGO 93 ESTIGMATIZACIÓN 95 ACTITUDES, CREENCIAS Y PERCEPCIONES DE LOS TRABAJADORES DE LA SALUD 98 ESTRATEGIAS PARA REDUCIR LA ESTIGMATIZACIÓN Y LAS BARRERAS DE ACCESO A CANNABIS MEDICINAL 100 Educación para Trabajadores de la Salud 102 PERFIL DEL CONSUMIDOR 104 Frecuencia de Consumo 106 POBLACIONES ESPECIALES 107 Embarazo 107 Infantes y Adolescentes 109 LISTA DE FIGURAS I LISTA DE TABLAS II GLOSARIO III RESUMEN 1 ABSTRACT 1 INTRODUCCIÓN 3 PLANTEAMIENTO DEL PROBLEMA 4 RELEVANCIA DEL USO MEDICINAL DEL CANNABIS ¿POR QUÉ INVESTIGAR? 4 CANNABIS COMO FITOTERAPIA 5 Cannabis 6 Cannabinoides 6 CANNABIS MEDICINAL 7 EPIDEMIOLOGIA DEL CONSUMO DE CANNABIS 9 Prevalencia de Consumo en Europa 10 Prevalencia de Consumo en Norteamérica 11 Prevalencia de Consumo en Latinoamérica 11 Características de Consumo por Edad 11 Características de Consumo por Sexo 12 Características de Consumo por Nivel Socioeconómico 14 Características de Consumo por Estado Civil 15 Características de Consumo por Nivel Educativo 15 Características de Consumo por Vinculación Laboral 16 Características de Consumo por Estado de Salud 16 USO RECREATIVO VERSUS MEDICINAL 17 CONTEXTO PSICOSOCIAL LATINOAMERICANO 19 USO DE CANNABIS EN COLOMBIA 20 Contexto Psicosocial 21 BARRERAS PARA LA INVESTIGACIÓN 25 JUSTIFICACIÓN 33 OBJETIVOS 36 GENERAL 36 ESPECÍFICOS 36 MARCO REFERENCIAL 37 MARCO TEÓRICO 38 ASPECTOS HISTÓRICOS 38 CONCEPTOS FARMACOLÓGICOS RELEVANTES 41 Cannabis 41 Cannabinoides 41 Sistema Endocannabinoide 42 PRODUCTOS MEDICINALES DISPONIBLES 46 Vías de Administración 48 Absorción 50 Distribución 51 Metabolismo 51 Eliminación 51 Productos en Desarrollo 52 Presentaciones Concentradas 52 SEGUNDO EFECTO 54 Impacto Sobre el Consumo de Otros Fármacos 56 EFECTOS SECUNDARIOS INDESEABLES 58 Consumo Problemático 60 Tratamiento del Uso Problemático 64 ASPECTOS LEGALES 67 CONTEXTO COLOMBIANO 72 ESTADO DEL ARTE 76 GENERALIDADES 76 TEORÍAS Y APROXIMACIONES ANALÍTICAS 77 ACTITUDES Y CREENCIAS 81 MOTIVACIONES PARA EL USO 86 PERCEPCIÓN DE EFICACIA 87 PERCEPCIÓN DE PLACER 89 MOTIVACIONES PARA EL NO USO 90 PERCEPCIÓN DE RIESGO 93 ESTIGMATIZACIÓN 95 ACTITUDES, CREENCIAS Y PERCEPCIONES DE LOS TRABAJADORES DE LA SALUD 98 ESTRATEGIAS PARA REDUCIR LA ESTIGMATIZACIÓN Y LAS BARRERAS DE ACCESO A CANNABIS MEDICINAL 100 Educación para Trabajadores de la Salud 102 PERFIL DEL CONSUMIDOR 104 Frecuencia de Consumo 106 POBLACIONES ESPECIALES 107 Embarazo 107 Infantes y Adolescentes 109 Usuarios de Otras Sustancias Psicoactivas 111 Pacientes Psiquiátricos 113 Pacientes con Infección por VIH/SIDA 114 Profesionales de la Salud 114 Militares Activos y en Retiro 114 Adultos Mayores 116 Pacientes Oncológicos y en Cuidados Paliativos 116 METODOLOGÍA 120 PREGUNTA DE INVESTIGACIÓN 120 DISEÑO 120 POBLACIÓN 120 Población Blanco 120 Población a Estudio 121 CÁLCULO DEL TAMAÑO DE LA MUESTRA 121 MUESTREO 122 CRITERIOS DE INCLUSIÓN 122 CRITERIOS DE EXCLUSIÓN 122 FUENTES DE INFORMACIÓN 123 VARIABLES 124 Universales 124 Demográficas 125 Estado de Salud y Calidad de Vida 130 Dolor y calidad de vida 135 Percepción frente al uso de cannabis medicinal como tratamiento del dolor 140 Patrón de consumo de cannabis 144 Patrón de consumo de alcohol y tabaco (cigarrillo) 147 Comentarios 149 Consideraciones adicionales 149 PROCEDIMIENTOS 149 Elegibilidad 150 Consentimiento 150 PROCESAMIENTO DE DATOS 151 ANÁLISIS DE DATOS 151 RESULTADOS ESPERADOS 152 RELACIONADOS CON LA GENERACIÓN DE CONOCIMIENTO 152 FORTALECIMIENTO DE LA COMUNIDAD CIENTÍFICA 153 APROPIACIÓN SOCIAL DEL CONOCIMIENTO 154 IMPACTOS ESPERADOS 155 VENTAJAS DEL ESTUDIO 156 LIMITACIONES DEL ESTUDIO 156 CONSIDERACIONES ÉTICAS 158 RESULTADOS OBTENIDOS 159 INCLUSIÓN DE PACIENTES 159 VARIABLES UNIVERSALES 160 ELEGIBILIDAD 160 TASA DE RESPUESTA y asistencia 161 VARIABLES DEMOGRÁFICAS 162 edad 162 SEXO AL NACER 164 estado civil 166 educación 167 empleo 169 residencia 170 nivel socieconómico 171 VARIABLES DEL ESTADO DE SALUD Y CALIDAD DE VIDA 172 estado de salud autopercibido 172 cognición 176 VARIABLES DE DOLOR Y CALIDAD DE VIDA 177 intensidad del dolor 177 comorbilidades 178 automedicación 179 ansiedad Y DEPRESIÓN 179 VARIABLES DE PERCEPCIONES, ACTITUDES Y CREENCIAS 180 percepción de eficacia 180 percepción de riesgo 185 aceptabilidad 191 actitudes 194 experiencia 201 VARIABLES DE PATRÓN DE CONSUMO DE CANNABIS 202 prevalencia de uso 202 patrón de consumo 204 motivaciones 206 decisión para el uso medicinal 208 impacto sobre el uso de analgésicos 210 VARIABLES DE CONSUMO DE ALCOHOL Y TABACO (CIGARRILLO) 211 ANALISIS BIVARIADO 214 COMENTARIOS 226 DISCUSIÓN 230 CRONOGRAMA DE ACTIVIDADES 232 REFERENCIAS BIBLIOGRÁFICAS 233 ANEXOS 247 PRESUPUESTO 247 CONSENTIMIENTO INFORMADO 249 INSTRUMENTO DE RECOLECCION DE DATOS 251 MANUAL DEL CUESTIONARIO PARA ENTREVISTA TELEFÓNICA: PACIENTES 266 MANUAL DEL CUESTIONARIO PARA ENTREVISTA TELEFÓNICA: FAMILIARES O ACUDIENTES 298 OPERACIONALIZACIÓN DE VARIABLES - PACIENTES 319 OPERACIONALIZACIÓN DE VARIABLES - FAMILIARES O ACUDIENTES 337 TABLAS Y FIGURAS 350spa
dc.format.mimetypeapplication/pdf
dc.language.isospaspa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/co/*
dc.subject.meshDolor crónicospa
dc.subject.meshMarihuana medicinalspa
dc.subject.meshManejo del dolorspa
dc.titleCannabis medicinal para manejo de dolor ¿lo usaría?spa
dc.title.translatedMedicinal cannabis for pain management would you use it?eng
dc.degree.nameEspecialista en Anestesiologíaspa
dc.publisher.grantorUniversidad Autónoma de Bucaramanga UNABspa
dc.rights.localAbierto (Texto Completo)spa
dc.publisher.facultyFacultad Ciencias de la Salud
dc.publisher.programEspecialización en Anestesiología
dc.description.degreelevelEspecializaciónspa
dc.type.driverinfo:eu-repo/semantics/masterThesis
dc.type.localTesisspa
dc.type.coarhttp://purl.org/coar/resource_type/c_7a1f
dc.subject.keywordsAnesthesiology
dc.subject.keywordsMedical sciences
dc.subject.keywordsHealth sciences
dc.subject.keywordsMedicine
dc.subject.keywordsTherapeutic tools
dc.subject.keywordsClinical effect
dc.subject.keywordsSide effects
dc.subject.keywordsChronic pain
dc.subject.keywordsMedical marijuana
dc.subject.keywordsMedicine botanic
dc.subject.keywordsMedicines
dc.subject.keywordsMedicinal consumption
dc.subject.keywordsPain management
dc.subject.keywordsPublic health
dc.identifier.instnameinstname:Universidad Autónoma de Bucaramanga - UNAB
dc.identifier.reponamereponame:Repositorio Institucional UNAB
dc.type.hasversioninfo:eu-repo/semantics/acceptedVersion
dc.rights.accessrightsinfo:eu-repo/semantics/openAccess
dc.rights.accessrightshttp://purl.org/coar/access_right/c_abf2
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dc.contributor.cvlachttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000320609spa
dc.contributor.orcidhttps://orcid.org/0000-0003-1791-8099
dc.subject.lembAnestesiologíaspa
dc.subject.lembCiencias médicasspa
dc.subject.lembMedicinaspa
dc.subject.lembCannabisspa
dc.subject.lembBotánica médicaspa
dc.subject.lembMedicamentosspa
dc.subject.lembSalud públicaspa
dc.identifier.repourlrepourl:https://repository.unab.edu.cospa
dc.description.abstractenglishIntroduction: chronic pain is a serious public health problem. Available therapeutic tools have been questioned for their undesirable side effects. The use of medicinal cannabis has been proposed as part of a multimodal strategy for the management of chronic pain, considering it a safer and more effective alternative. In the last two decades, medical cannabis has gained great media, socio-economic and scientific relevance in Colombia. Controversially, cannabis-based medicinal products are used across all latitudes, while the scientific community around the world is interested in collecting evidence of the clinical effect. Few studies have focused on patients' perceptions, attitudes, and beliefs. None of them had been done in Colombia. Approach to the problem: after several decades of legal prohibition of the cultivation, transport, possession, use or consumption of marijuana, a differential approach has been developing in Colombia between drug trafficking, micro-trafficking, recreational use and medicinal use. The medicinal use of cannabis has been decriminalized and the Government have begun the process of regulating the production, transformation and marketing. The medicinal use of cannabis in Colombia is relevant, both scientifically and socially; just like in the rest of the world. Marijuana here is the most commonly used illicit drug. Ideas loosely related to the perceptions and attitudes of the Colombian population towards marijuana prevail in this country. Public perception of the efficacy of cannabinoids in pain does not seem to be consistent with the available scientific evidence, since the perception of effectiveness is very subjective. Likewise, it is necessary that health professionals understand, control and adapt current pharmacology and medicine processes to the key aspects of cannabis in pain management, in order to reduce the risk derived from its use. Objectives: to describe the knowledge, attitudes and perceptions about the use of medicinal cannabis in patients with chronic pain from a third-level health institution in the Colombian Northeast. Methodology: the present study was developed using field research techniques, based on a self-administered questionnaire that preserved anonymity. Sampling was done by convenience, both in patients and their relatives or caregivers. The relationships between knowledge, attitudes and perceptions and the demographic characteristics of cannabis use, previous experiences, state of health and quality of life, intensity of pain, presence of comorbidities and use of other psychoactive substances were evaluated. Results: it was possible to obtain useful information to understand the psychosocial construct of patients in relation to medicinal cannabis. A neutral posture prevailed among them, while that of the proxies was more varied, with a positive trend in the majority of the aspects. The prevalence of medicinal consumption was low in both groups. The chronic pain patients surveyed showed a different set of knowledge, attitudes and perceptions in comparison with those reported by international studies. Discussion: Despite the complicated Colombian context regarding psychoactive substances use and the impact of drug trafficking, patients are not reluctant to use medicinal cannabis for the management of chronic pain; nor for the management of other symptoms. Their neutral position allows, by appropriately directing public policies on health and education, to modify these perceptions according to scientific evidence. The important role of family members is also highlighted, not only in decision-making process, but also as positive amplifiers of the therapeutic usefulness of medicinal cannabis. This study opens the doors to what should be a wide and dynamic field of research that integrates scientific knowledge with the context of the patient using an integrative biopsychosocial approach.spa
dc.subject.proposalCiencias de la saludspa
dc.subject.proposalHerramientas terapéuticasspa
dc.subject.proposalEfecto clínicospa
dc.subject.proposalEfectos secundariosspa
dc.subject.proposalConsumo medicinalspa
dc.subject.proposalCannabisspa
dc.rights.creativecommonsAtribución-NoComercial-SinDerivadas 2.5 Colombia*


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