Epidemiology of physician-diagnosed neuropathic pain in Brazil

Abstract

ObjectivesEstimate the prevalence of neuropathic pain (NeP) among chronic pain patients attending Brazilian hospitals and pain clinics in São Paulo, Ceara, and Bahia and explore clinical characteristics by subtypes: painful diabetic peripheral neuropathy (pDPN), central neuropathic pain (CNP), chronic low back pain with a neuropathic component (CLBP-NeP), postherpetic neuralgia (PHN), post-traumatic neuropathic pain (PTN), and post-surgical neuropathic pain (PSN).MethodsPhysicians screened patients reporting chronic pain for ≥3 months (n=2,118) for probable NeP, using the Douleur Neuropathique 4 questionnaire and physician assessment, and reported their NeP subtype(s), symptoms, and medications. Identified NeP patients completed a questionnaire including treatment experiences, quality of life EuroQol 5 Dimensions [EQ-5D]), pain severity and interference (Brief Pain Inventory [BPI]), and Work Productivity and Activity Impairment scales. Descriptive analyses were performed by NeP subtype.ResultsThe prevalence of probable NeP was 14.5% (n=307). NeP patients were mostly female (80.5%), middle-aged (mean [M]=52.5, SD=13.9), and Pardo (44.3%). Of those diagnosed with an NeP subtype (n=209), the largest proportions were CLBP-NeP (36.8%), followed by pDPN (18.7%), CNP (17.7%), PTN (17.2%), PSN (13.4%), and PHN (3.3%). Across subtypes, the most widely reported symptoms were numbness (range: 62.2%–89.7%) and hyperalgesia (range: 32.1%–76.9%) and the most commonly prescribed pain analgesics were NSAID (range: 18.2%–57.1%), opioids (range: 0.0%–39.3%), and antiepileptics (range: 18.2%–57.1%). PTN and PSN patients reported the least favorable EQ-5D index scores (M=0.42, SD=0.19) and BPI-Pain Severity scores (M=7.0, SD=1.9), respectively. Those diagnosed with CNP had the least favorable BPI-Pain Interference scores (M=6.0, SD=2.7). Patients with PHN reported the least impairment based on EQ-5D index scores (M=0.60, SD=0.04). Those with pDPN had the most favorable BPI scores (BPI-Pain Severity: M=4.6, SD=2.3; BPI-Pain Interference: M=4.7, SD=2.7).ConclusionEvaluation of chronic pain patients in Brazil yielded a 14.5% probable NeP prevalence. NSAIDs and opioids were commonly used, and there was a high incidence of NeP-related symptoms with varying levels of dysfunction across subtypes.

Distal Symmetric Polyneuropathy Pain in Diabetes Mellitus

“…The BPI reported an average of seven points for pain intensity. These data corroborate an epidemiological study on the prevalence of painful diabetic neuropathy in the states of São Paulo, Ceará, and Bahia, Brazil, by applying the DN4 and BPI instruments, with scores above seven points (43). In conclusion, hyperalgesia and allodynia are related to high scores on the numerical pain scale, and this reflects in daily-life and professional activities, items assessed by the BPI (9).…”

A Retrospective Analysis of Pain Etiology in Middle-Aged Patients with Peripheral Neuropathy

“…Our analysis confirms that pain is more common in women between the ages of 50 s and 60 s, while most of them live in the city. A higher frequency of neuropathic pain in the middle-age population was also observed in a work carried out in Brazil [46].…”

Quantitative sensory profiles of upper extremity chemotherapy induced peripheral neuropathy: Are there differences in sensory profiles for neuropathic versus nociceptive pain?

“…From the regression model, the DASH score showed statistically significant differences between the groups in that the neuropathic group demonstrated impaired upper limb function (P = 0.002). More important, the DASH score mean of 35 (31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46) in the nonneuropathic group versus 51 (41-67) in the neuropathic group met the minimum clinical important difference in change scores, indicating that these groups are not only statistically but also clinically different. 18 Due to the heavily skewed distribution of pain scores, the 11-point NPRS was analyzed based on percentages of those experiencing pain (NPRS 1 or higher) versus no pain.…”

“…Neuropathic pain symptoms correlate with higher medical comorbidities, higher reported pain intensity, and greater disability burden than other causes of pain. 31 – 33 This often results in poorer prognosis, and studies have identified higher levels of depression and disability. 34 , 35 Pain catastrophizing and pain acceptance are important in treatment outcomes, and a multidisciplinary focus has been suggested for this population.…”