Prevalence and characterization of neuropathic pain in a primary-care setting in Spain: a cross-sectional, multicentre, observational study.
OBJECTIVE
Different studies have shown pain to be one of the most frequent causes of health-care resource utilization, and a major public health concern because of its social repercussions. In Spain there are no recent data on the prevalence and management of neuropathic pain in the general primary-care setting.


METHODS
This study aimed to gain epidemiological insight into neuropathic pain in the Spanish primary-care setting. This was a cross-sectional, one-day, multicentre, observational epidemiological study involving 623 primary-care physicians in Spain. Patients who experienced pain were classified into three groups: pure neuropathic pain, mixed neuropathic pain or nociceptive pain. Pain intensity was evaluated on a visual analogue scale (VAS), range 0-10. Information on the location, duration, aetiology and current treatment of pain was obtained, together with data on whether the patients were referred to specialized care and to which type of specialist.


RESULTS
In a single day, 23 529 patients received primary care, and of these, 7220 experienced pain (30.7% [95% CI 29.5, 31.7]). Patients with pure neuropathic pain comprised 11.8% (95% CI 10.5, 13.2) of the 3044 patients for whom pain was the reason for consultation and the type of pain was documented, patients with mixed neuropathic pain accounted for 13.4% (95% CI 12.0, 14.8) of this group, and patients with nociceptive pain for 74.9% (95% CI 73.1, 76.7). Patients with pure neuropathic pain mostly received exclusively pharmacological treatment (84.6% [95% CI 80.3, 89.0]), with antiepileptic drugs being the most widely used substances (52.5% [95% CI 47.3, 57.7]), followed by non-opioid analgesics (35.2% [95% CI 30.2, 40.1]) and NSAIDs (26.8% [95% CI 22.2, 31.4]). The mean duration of neuropathic pain was 11.7 +/- 23.3 months. The mean pain intensity on the VAS exceeded 6 in all groups. Over half of the patients were diagnosed in the primary-care centre, and a large proportion in turn were referred to a specialist, most frequently an orthopaedist.


CONCLUSIONS
The results of the present study show the high prevalence of neuropathic pain at the primary-care level in Spain. In addition, the data presented here point to a need to improve the management of outpatients with neuropathic pain in the Spanish primary-care setting, particularly in relation to the higher than recommended use of NSAIDs (which are not indicated for neuropathic pain) and the lower than recommended use of antiepileptic drugs with an analgesic indication for pain with a neuropathic component.
Pérez
Concepción
C
Pain Clinic, University Hospital 'La Princesa', C/Diego de León, 62, 28006, Madrid, Spain. cperez.hlpr@salud.madrid.org.
Saldaña
María Teresa
MT
Primary-Care Health Centre 'Raíces', Castrillón, Asturias, Spain.
Navarro
Ana
A
Primary-Care Health Centre 'Puerta del Ángel', Madrid, Spain.
Vilardaga
Inma
I
Department of Biometrics, European Biometrics Institute, Barcelona, Spain.
Rejas
Javier
J
Health Outcomes Research Department, Medical Unit, Pfizer España, Alcobendas, Spain.
D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009437:Neuralgia / Q000145:classification / Q000188:drug therapy / Q000453:epidemiology*; D010146:Pain / Q000145:classification / Q000188:drug therapy / Q000453:epidemiology*; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D011320:Primary Health Care; D012017:Referral and Consultation; D013030:Spain / Q000453:epidemiology
D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000927:Anticonvulsants