title: Clinical characteristics and pain management among patients with painful peripheral neuropathic disorders in general practice settings.
abstract: Alleviating chronic pain is a global healthcare priority. Understanding the medical profile and current treatment patterns in patients with painful neuropathic disorders (PNDs) is crucial to the development of effective pain management strategies. Thus, our objective was to describe the demographic and clinical characteristics of persons with PNDs and their use of pain medications. Using the general practice research database, we categorized PNDs in two ways: Pure PNDs (which include diabetic neuropathy, postherpetic neuralgia, etc.; N=16,690) and Mixed PNDs (which include back/neck pain with neuropathic involvement; N=14,309). On average, PND patients were 55 years old (Pure, 55.4 [SD=16.9] years; Mixed, 54.3 [SD=16.4] years). Over a third had other chronic pain-related (Pure, 37.5%; Mixed, 37.1%) and nearly a quarter had non-pain related (Pure, 28.1%; Mixed, 24.1%) comorbidities. Use of medications with clinically demonstrated efficacy in PNDs was higher among patients with Pure PNDs (tricyclic antidepressants [Pure, 16.6%; Mixed, 10.1%]; 2nd generation antidepressants [Pure, 11.0%; Mixed, 9.7%]; and antiepileptics [Pure, 12.2%; Mixed, 2.6%]), whereas use of NSAIDs (Pure, 43.1%; Mixed, 65.2%) and opioids (Pure, 8.5%; Mixed, 14.3%) was higher among patients with Mixed PNDs. Average daily doses of select neuropathic pain-related medications among PND patients (Pure and Mixed) were lower than those recommended for neuropathic pain. Among both Pure and Mixed PND patients, use and doses of evidenced-based neuropathic pain-related medications was low, and lower than the use of NSAIDs (a medication class with no proven efficacy for PNDs) in each group, suggesting possible sub-optimal neuropathic pain management among these patients.
authors.affiliation: Avalon Health Solutions Inc, Philadelphia, PA 19102, USA. mgore@avalonhealthsolutions.com
authors.forename: Mugdha
authors.initials: M
authors.lastname: Gore
authors.forename: Ellen
authors.initials: E
authors.lastname: Dukes
authors.forename: David J
authors.initials: DJ
authors.lastname: Rowbotham
authors.forename: Kei-Sing
authors.initials: KS
authors.lastname: Tai
authors.forename: Douglas
authors.initials: D
authors.lastname: Leslie
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000698:Analgesia / Q000379:methods / Q000706:statistics & numerical data*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001416:Back Pain / Q000188:drug therapy / Q000453:epidemiology; D002908:Chronic Disease; D015897:Comorbidity; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000188:drug therapy / Q000453:epidemiology; D009437:Neuralgia / Q000188:drug therapy* / Q000453:epidemiology; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy* / Q000453:epidemiology; D011787:Quality of Health Care; D012646:Self Administration; D012651:Self Medication; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000927:Anticonvulsants; D000928:Antidepressive Agents