The evidence for pharmacological treatment of neuropathic pain

Finnerup, Nanna Brix; Sindrup, Søren Hein; Jensen, Troels Staehelin

doi:10.1016/j.pain.2010.06.019

Cited by 915 publications

(667 citation statements)

References 112 publications

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“…We attribute this finding to the common use of non-opioid analgesics including NSAIDs, neuropathic agents, and physical therapy or massage for pain control. 7,[69][70][71][72][73][74][75][76] We did find a significant association between 'admission diagnosis of chronic pain' and 'opioid receipt at discharge.' It was possible that the acute event leading to hospitalization exacerbated one's baseline chronic pain, necessitating the use of opioids for pain control at discharge.…”

Section: Discussionmentioning

confidence: 99%

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

et al. 2015

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BACKGROUND: Chronic opioid therapy for chronic pain treatment has increased. Hospital physicians, including hospitalists and medical/surgical resident physicians, care for many hospitalized patients, yet little is known about opioid prescribing at hospital discharge and future chronic opioid use. OBJECTIVE: We aimed to characterize opioid prescribing at hospital discharge among 'opioid naïve' patients. Opioid naïve patients had not filled an opioid prescription at an affiliated pharmacy 1 year preceding their hospital discharge. We also set out to quantify the risk of chronic opioid use and opioid refills 1 year post discharge among opioid naïve patients with and without opioid receipt at discharge. DESIGN: This was a retrospective cohort study. PARTICIPANTS: From 1 January 2011 to 31 December 2011, 6,689 opioid naïve patients were discharged from a safety-net hospital. MAIN MEASURE: Chronic opioid use 1 year post discharge. KEY RESULTS: Twenty-five percent of opioid naïve patients (n=1,688) had opioid receipt within 72 hours of discharge. Patients with opioid receipt were more likely to have diagnoses including neoplasm (6.3 % versus 3.5 %, p<0.001), acute pain (2.7 % versus 1.0 %, p<0.001), chronic pain at admission (12.1 % versus 3.3 %, p<0.001) or surgery during their hospitalization (65.1 % versus 18.4 %, p<0.001) compared to patients without opioid receipt. Patients with opioid receipt were less likely to have alcohol use disorders (15.7 % versus 20.7 %, p<0.001) and mental health disorders (23.9 % versus 31.4 %, p<0.001) compared to patients without opioid receipt. Chronic opioid use 1 year post discharge was more common among patients with opioid receipt (4.1 % versus 1.3 %, p<0.0001) compared to patients without opioid receipt. Opioid receipt was associated with increased odds of chronic opioid use (AOR=4.90, 95 % CI 3.22-7.45) and greater subsequent opioid refills (AOR=2.67, 95 % CI 2.29-3.13) 1 year post discharge compared to no opioid receipt. CONCLUSION:Opioid receipt at hospital discharge among opioid naïve patients increased future chronic opioid use. Physicians should inform patients of this risk prior to prescribing opioids at discharge.

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Section: Discussionmentioning

confidence: 99%

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

et al. 2015

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“…A neuropathic pain case was defined in this study as a type 2 diabetic individual with a history of at least one prescription of any of the following five medicines, which are effective and recommended in diabetic peripheral neuropathy (Attal et al., 2010; Finnerup et al., 2010; NICE, 2013) and used less frequently for other indications: duloxetine, gabapentin, pregabalin, capsaicin cream/patch and lidocaine patch. The cases also had positive monofilament tests in at least one foot, indicating the likely presence of sensory neuropathy.…”

Section: Methodsmentioning

confidence: 99%

A genome‐wide association study suggests an association of Chr8p21.3 (GFRA2) with diabetic neuropathic pain

Wang

Deshmukh

Zuydam

et al. 2015

European Journal of Pain

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BackgroundNeuropathic pain, caused by a lesion or a disease affecting the somatosensory system, is one of the most common complications in diabetic patients. The purpose of this study is to identify genetic factors contributing to this type of pain in a general diabetic population.MethodWe accessed the Genetics of Diabetes Audit and Research Tayside (GoDARTS) datasets that contain prescription information and monofilament test results for 9439 diabetic patients, among which 6927 diabetic individuals were genotyped by Affymetrix SNP6.0 or Illumina OmniExpress chips. Cases of neuropathic pain were defined as diabetic patients with a prescription history of at least one of five drugs specifically indicated for the treatment of neuropathic pain and in whom monofilament test result was positive for sensory neuropathy in at least one foot. Controls were individuals who did not have a record of receiving any opioid analgesics. Imputation of non‐genotyped SNPs was performed by IMPUTE2, with reference files from 1000 Genomes Phase I datasets.ResultsAfter data cleaning and relevant exclusions, imputed genotypes of 572 diabetic neuropathic pain cases and 2491 diabetic controls were used in the Fisher's exact test. We identified a cluster in the Chr8p21.3, next to GFRA2 with a lowest p‐value of 1.77 × 10−7 at rs17428041. The narrow‐sense heritability of this phenotype was 11.00%.ConclusionThis genome‐wide association study on diabetic neuropathic pain suggests new evidence for the involvement of variants near GFRA2 with the disorder, which needs to be verified in an independent cohort and at the molecular level.

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“…Managing patients with PNP is challenging (Dworkin et al., 2007, 2010; Finnerup et al., 2010; Finnerup, Attal et al ., 2015); it often becomes chronic, with marked long‐term reductions in health‐related quality of life (HRQOL) (O'Connor, 2009), decreased individual productivity and increased patient and healthcare expenditure (Rodríguez et al., 2007; Navarro et al., 2011). Aetiologies range from mechanical and inflammatory diseases to injury and nerve compression (Hall et al., 2006).…”

Section: Introductionmentioning

confidence: 99%

Capsaicin 8% patch versus oral pregabalin in patients with peripheral neuropathic pain

Haanpää

Cruccu

Nurmikko

et al. 2015

European Journal of Pain

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BackgroundClinical trials have not yet compared the efficacy of capsaicin 8% patch with current standard therapy in peripheral neuropathic pain (PNP).ObjectivesHead‐to‐head efficacy and safety trial comparing the capsaicin patch with pregabalin in PNP.MethodsOpen‐label, randomized, multicentre, non‐inferiority trial. Patients with PNP, aged 18–80 years, were randomly assigned to either the capsaicin 8% patch (n = 282) or an optimised dose of oral pregabalin (n = 277), and assessed for a ≥30% mean decrease in Numeric Pain Rating Scale (NPRS) score from baseline to Week 8. Secondary endpoints included optimal therapeutic effect (OTE), time‐to‐onset of pain relief and treatment satisfaction.ResultsThe capsaicin 8% patch was non‐inferior to pregabalin in achievement of a ≥30% mean decrease in NPRS score from baseline to Week 8 (55.7% vs. 54.5%, respectively; Odds ratio: 1.03 [95% CI: 0.72, 1.50]). The proportion of patients achieving OTE at Week 8 was 52.1% for the capsaicin 8% patch versus 44.8% for pregabalin (difference: 7.3%; 95% CI: −0.9%, 15.6%). The median time‐to‐onset of pain relief was significantly shorter for capsaicin 8% patch versus pregabalin (7.5 vs. 36.0 days; Hazard ratio: 1.68 [95% CI: 1.35, 2.08]; p < 0.0001). Treatment satisfaction was also significantly greater with the capsaicin 8% patch versus pregabalin. TEAEs were mild‐to‐moderate in severity, and resulted in treatment discontinuation only with pregabalin (n = 24). Systemic adverse drug reactions ranged from 0 to 1.1% with capsaicin 8% patch and 2.5 to 18.4% with pregabalin.ConclusionsThe capsaicin 8% patch provided non‐inferior pain relief to an optimized dose of pregabalin in PNP, with a faster onset of action, fewer systemic side effects and greater treatment satisfaction.

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The evidence for pharmacological treatment of neuropathic pain

Cited by 915 publications

References 112 publications

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

A genome‐wide association study suggests an association of Chr8p21.3 (GFRA2) with diabetic neuropathic pain

Capsaicin 8% patch versus oral pregabalin in patients with peripheral neuropathic pain

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