Manejo da dor em comunidade ribeirinhas na Amazônia brasileira

Abstract

Introduction: medications and medicinal plants are used worldwide by man as therapeutic strategies for pain relief or inhibition. In vulnerable populations in remote areas, with unique characteristics (socioeconomic, cultural, geographical and environmental) such as riverside populations in the Brazilian Amazon, the phenomenon lacks information. Objective: to evaluate pain management strategies in riverside communities in the Brazilian Amazon. Method: population-based cross-sectional study, part of the research "Health, Medications and Self-Medication in Amazon Riverside (SAMARA)", developed in 2015, in 24 riverside communities of Coari, Amazonas - Brazil (n= 492). The variables used in this study were sociodemographic, access to health services, alcohol consumption, smoking habits, selfreported diseases and medication consumption of the 246 participants who reported having carried out pain management (exclusive pain management with medications (n=180) + exclusive with medicinal plants (n=28) + mixed (n=38) with medications and plants). The dependent variable was evaluated by the use of at least one medication (exclusive with medications + mixed) or medicinal plant (exclusive with medicinal plants + mixed) consumed for pain management in the last 30 days preceding the interview. Data were analyzed based on descriptive and inferential statistics. The SAMARA research, which this study originated, is approved by the Research Ethics Committee of the School of Nursing of the University of São Paulo and registered with CAAE nº. 33560914.0.0000.5392. Results: Of the 246 riverside who executed pain management, the prevalence of pain management medications consumption was 88,6% (n=2019) among participants. The most consumed chemical substance was dipyrone (28,1%). Most of the medications used occurred on their own initiative (64,1%), were purchased in pharmacies (84,4%) and used to treat headache (58,5%). The variables "being literate" (OR: 2,632; CI 95%: 1,066-6,501) and "have family income above 1 minimum wage" (OR: 3,098; CI 95%: 1,303-7,368) remained independently associated with pain management practice with medications in logistic regression. The pain management with medicinal plants, it is prevailed in 26,8% (n=66) of the riverside. The most consumed medicinal plant as a home remedy for pain management was the bark of the orange tree fruit (Citrus sinensis (L.) Osbeck) (21,6%). Among all medicinal plants consumed, the use prevailed of barks (63,6%) and tea preparation (96,6%). Knowledge of the use was acquired mainly by family members (74,2%) and the pain problem that most led to pain management with medicinal plants was abdominal pain (70.5%). In logistic regression, only the variable age group between 18 and 49 years (OR: 2,154; 95% CI: 1,109-4,186) remained independently associated with pain management practice with medicinal plants. Conclusion: The riverside populations of the Amazon often use medications for pain management, evidencing the need for guidance on promoting the rational use of medications and the possibility of disease masking in the riverside context. Although the consumption of medicinal plants for pain management has occurred to a lesser extent in relation to medications, if we consider the exemption of costs, accessibility to the population, medicinal plants become an important therapeutic alternative in the communities of riverside, needing more research on its use and analgesic potential.