Gerard Mick1, Mick Serpell2, Ralf Baron3, Victor Mayoral4, Guy Hans5, Ignacio Mendez6, Esther Artime6, Nawab Qizilbash6,7, Melanie Sohns8. 1. Centre for Pain Evaluation and Treatment, University Neurological Hospital, Lyon, France. 2. Department of Anaesthesia, University of Glasgow, Glasgow, Scotland. 3. Department of Neurology, Christian-Albrechts University, Kiel, Germany. 4. Hospital Universitari Bellvitge, Llobregat, Spain. 5. Multidisciplinary Pain Center, Antwerp University Hospital, Edegem, Belgium. 6. OXON Epidemiology, Madrid, Spain. 7. London School of Hygiene & Tropical Medicine, London, UK. 8. Grunenthal GmbH, Aachen, Germany.
Abstract
BACKGROUND: Localised Neuropathic Pain (LNP) is challenging to diagnose and manage in primary care. OBJECTIVE: To describe clinical characteristics, treatment patterns, quality of life and sleep performance of patients with LNP and estimate its prevalence in primary care. METHODS: Cross-sectional study in 4 European countries. Patients were identified using a screening tool for LNP. Patients completed the EQ-5D VAS score and Chronic Pain Sleep Inventory (CPSI). RESULTS: There were 1030 LNP patients for analysis. They presented a median pain intensity of 6.0 (IQR 4.0-7.0) with a median duration of 30.9 months (IQR 12.0-75.3), despite 97% receiving pain treatment. Main sites affected were the limbs (62% upper/58% lower) and spine (41%). Main aetiologies were neuropathic low back pain (47%), post-surgical neuropathic pain (17%), and diabetic poly-neuropathy (12%). Thirty percent received a single analgesic (2% topical), while combinations comprised 43% systemic-systemic, 24% topical-systemic, 1% topical-topical. Medications included NSAIDs (45%), anticonvulsants (38%), WHO step 2 opioids (35%), and topical analgesics (27%). In the previous 6 months, 40% had switched treatment. The mean (SD) EQ-5D VAS score was 58 (22.3) and the mean (SD) EQ-5D summary score (UK tariff) was 0.62 (0.25). Patients had a CPSI mean index of 41/100, and sleeping pills were used by 33% of patients. The standardized prevalence of LNP by age and sex was 2.01% in the general population and 43.3% among chronic pain patients. CONCLUSIONS: Many LNP patients reported pain intensities of six on a ten-point scale in average for durations longer than 2.5 years, with quality of life and sleep performance affected, with frequent treatment combinations and switches, suggesting suboptimal pain management.
BACKGROUND: Localised Neuropathic Pain (LNP) is challenging to diagnose and manage in primary care. OBJECTIVE: To describe clinical characteristics, treatment patterns, quality of life and sleep performance of patients with LNP and estimate its prevalence in primary care. METHODS: Cross-sectional study in 4 European countries. Patients were identified using a screening tool for LNP. Patients completed the EQ-5D VAS score and Chronic Pain Sleep Inventory (CPSI). RESULTS: There were 1030 LNP patients for analysis. They presented a median pain intensity of 6.0 (IQR 4.0-7.0) with a median duration of 30.9 months (IQR 12.0-75.3), despite 97% receiving pain treatment. Main sites affected were the limbs (62% upper/58% lower) and spine (41%). Main aetiologies were neuropathic low back pain (47%), post-surgical neuropathic pain (17%), and diabetic poly-neuropathy (12%). Thirty percent received a single analgesic (2% topical), while combinations comprised 43% systemic-systemic, 24% topical-systemic, 1% topical-topical. Medications included NSAIDs (45%), anticonvulsants (38%), WHO step 2 opioids (35%), and topical analgesics (27%). In the previous 6 months, 40% had switched treatment. The mean (SD) EQ-5D VAS score was 58 (22.3) and the mean (SD) EQ-5D summary score (UK tariff) was 0.62 (0.25). Patients had a CPSI mean index of 41/100, and sleeping pills were used by 33% of patients. The standardized prevalence of LNP by age and sex was 2.01% in the general population and 43.3% among chronic painpatients. CONCLUSIONS: Many LNP patients reported pain intensities of six on a ten-point scale in average for durations longer than 2.5 years, with quality of life and sleep performance affected, with frequent treatment combinations and switches, suggesting suboptimal pain management.
Authors: Jamison Falk; Betsy Thomas; Jessica Kirkwood; Christina S Korownyk; Adrienne J Lindblad; Joey Ton; Samantha Moe; G Michael Allan; James McCormack; Scott Garrison; Nicolas Dugré; Karenn Chan; Michael R Kolber; Anthony Train; Liesbeth Froentjes; Logan Sept; Michael Wollin; Rodger Craig; Danielle Perry Journal: Can Fam Physician Date: 2021-05 Impact factor: 3.275