Trends in opioid use for chronic neuropathic pain: a survey of patients pursuing enrollment in clinical trials

Abstract

P Pu ur rp po os se e: : Clinical trials suggest that opioids relieve neuropathic pain and decrease pain-related disability. We conducted a pilot study of current prescribing trends and patients' attitudes towards opioids for neuropathic pain.M Me et th ho od ds s: : A patient questionnaire was completed by individuals pursuing enrollment in neuropathic pain clinical trials at our facility.R Re es su ul lt ts s: : Of 154 patients with diabetic neuropathy (55.2%), postherpetic neuralgia (29.9%), idiopathic peripheral neuropathy (9.7%) and other neuropathies (5.2%), 73.4% complained of inadequate pain control, the mean pain duration was 4.7 (SD = 4.4) yr and the mean pain intensity (0-10) was 7.7 (SD = 2.3). In this group, 40.9% had never tried opioids and 24.7% had never tried any opioids, tricyclic antidepressants or anticonvulsants. Only 9.7% were receiving long-acting opioids or "around the clock" dosing whereas 25.3% were receiving opioids on an "as needed" basis. Opioids combined with tricyclic antidepressants and/or anticonvulsants were used in 11.0%. Fear of addiction and adverse effects were expressed by 31.8% and 46.8% respectively.

Effect of Pregabalin in the Treatment of Refractory Neck Pain: Cost and Clinical Evidence from Medical Practice in Orthopedic Surgery and Rehabilitation Clinics

“…This increase is due in part to the study‐defined incorporation of PGB to this group of patients. This is in concordance with other first‐line treatments available among the current drug options, and which include tricyclic antidepressants and opioids 45 . In the present study, we recorded an important use of NSAIDs in the management of neck pain.…”

“…If it is accepted that by definition all the patients in the PGB group received at least one antiepileptic drug (ie, PGB), then the results of the drug use analysis indicate that this pharmacological group was employed concomitantly in a significantly greater proportion among the patients in the UC group, both before and during the study. This percentage reached 25% in the latter patient group, despite the fact that the lack of appropriate clinical trials does not allow us to establish clear recommendations for the combined use of several drugs in treating chronic NeP 44,45 . The changes in health outcome in turn were reflected in the costs of the disease.…”

“…This, in turn, resulted in numerically fewer days of sick leave and LWDE than in the UC group, although not statistically significant. One of the possible explanations for these results can be found in the low rate of antiepileptic drug use, with indications more suited to treatment of the neuropathic component of chronic pain, 5,11,17,24,45 found at the baseline visit. Such rate of use was significantly lower even in the PGB group: barely 5% vs. close to 17% in the UC group.…”

Combination pharmacotherapy for neuropathic pain: current evidence and future directions

“…In fact, a recent survey of neuropathic pain patients has indicated that a considerable proportion of patients are being prescribed combinations of analgesic drugs for neuropathic pain [15]. This is being performed in the absence of evidence to support polypharmacy, and the need to study combination therapy in neuropathic pain has recently been emphasized [7].…”

High-dose Morphine for Intractable Phantom Limb Pain

“…Various barriers are found for initiating opioids therapy for chronic pain and commonest barriers to opioid therapy for neuropathic pain include patient/s, and possibly physician/s, fears of addiction and adverse effects. 14 It is feared that habitation and/or addiction may occur negating the efficacy of therapy and leading to major problems of its own. 9,15 However, drug abuse in patients, whose narcotic intake is rigidly controlled by their physician, is extremely rare.…”