title: Pharmacological treatment patterns in neuropathic pain--lessons from Swedish administrative registries.
abstract: OBJECTIVE
  To explore the treatment patterns of patients with a diagnosis related to chronic pain (DRCP) initiating pharmacological treatment indicated for neuropathic pain (NeuP: tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and anticonvulsants).
  
  
  METHODS
  Retrospective study on administrative registers.
  
  
  METHODS
  General population in Western Sweden (one sixth of the country).
  
  
  METHODS
  All patients with a DRCP (N = 840,000) in years 2004-2009.
  
  
  METHODS
  Treatment sequence, continuation, switching, and comedication.
  
  
  RESULTS
  In total, 22,997 patients with a first NeuP in 2007 or 2008 were identified, out of which 2% also had epilepsy and 39% had a mood disorder. The remaining 13,749 patients were assumed to be treated for neuropathic pain, out of which 16% had a neuropathy diagnosis, 18% had a mixed pain diagnosis, and the remaining 66% had another DRCP. The most common first prescription was amitriptyline (40%) followed by pregabalin (22%) and gabapentin (19%). More than half had discontinued treatment after 3 months, and 60-70% at 6 months. Seven percent received another NeuP drug within 6 months of the discontinuation of their first NeuP treatment, 11% had another analgesic and 22% had a prescription indicating psychiatric comorbidity (selective serotonin reuptake inhibitors or benzodiazepine).
  
  
  CONCLUSIONS
  Treatment initiation of currently available drugs indicated for neuropathic pain less frequently lead to long-term treatment in clinical practice compared with clinical trial, and few try more than one drug. We suggest our findings to be indications of a need for better routines in diagnosing patients to ascertain optimal treatment and follow-up.
authors.affiliation: i3 Innovus, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Gustavsson
authors.forename: Johan
authors.initials: J
authors.lastname: Bjorkman
authors.forename: Christina
authors.initials: C
authors.lastname: Ljungcrantz
authors.forename: Annica
authors.initials: A
authors.lastname: Rhodin
authors.forename: Marcelo
authors.initials: M
authors.lastname: Rivano-Fischer
authors.forename: Karl-Fredrik
authors.initials: KF
authors.lastname: Sjolund
authors.forename: Clas
authors.initials: C
authors.lastname: Mannheimer
mesh_terms: D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D002648:Child; D059350:Chronic Pain / Q000188:drug therapy; D015897:Comorbidity; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000523:psychology; D008875:Middle Aged; D009437:Neuralgia / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D012042:Registries; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013548:Sweden; D055815:Young Adult
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000700:Analgesics; D000927:Anticonvulsants; D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D006993:Hypnotics and Sedatives; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Anticonvulsants; Chronic Pain; Psychiatric Comorbidity; Serotonin-Norepinephrine Reuptake Inhibitors; Treatment Pattern; Tricyclic Antidepressants