La douleur neuropathique apparaître en cas de lésion ou de maladie du système nerveux. Ce type de douleur peut être causée par la consommation excessive d’alcool, le diabète, le zona, les infections par le VIH et bien d’autres. On estime que 7 à 10 % de la population générale vit avec de la douleur neuropathique, qui peut avoir un impact considérable sur la qualité de vie. Une douleur foudroyante, brûlante ou lancinante, des picotements et des engourdissements sont quelques exemples de symptômes les courants de la douleur neuropathique. La douleur peut être spontanée ou provoquée par un effleurement léger.
Goal
Neuropathic pain can have many direct and indirect healthcare costs and proper prevention, treatment or cure are required for people living with this condition. There are currently four recommended pharmacological treatments classes: several antidepressants and antiepileptics are recommended as a first-line treatment, weak opioids such as tramadol will be given in the second-line treatment and finally strong opioids are prescribed as a third-line treatment. However, very few studies looked into comparing the different drug treatments available for neuropathic pain to determine what is the best course of action. In this study, researchers aimed to examine the clinical evolution of patients prescribed different drug treatments and compare the effectiveness of the medications. In other words, how did it affect their pain and what was the best medication for neuropathic pain?
Methodology
944 participants with neuropathic pain for more than 3 months were selected from patients enrolled in the Quebec Pain Registry (QPR), where they completed a series of self-report questionnaires about their pain intensity and how it interfered with daily life, sleep quality, the tendency to catastrophize (dramatize) related to pain, depression, physical and mental health-related quality of life. Medical data such as pain duration and diagnosis were collected by nurses using a structured interview protocol. Patients enrolled in the QPR were offered different treatment options based on their clinical profile and were followed up 6 months after. To evaluate the impact of drugs on the evolution of pain intensity and interference with the quality of life, researchers compared these outcomes from the first visit to the second visit, 6 months after.
Main findings
Researchers assessed in ‘real-life’ clinical setting the impact of specific anti-neuropathic antidepressants and antiepileptics as well as weak opioids and strong opioids to determine which had a better outcome on the evolution of neuropathic pain after 6 months of treatment. The research shows that patients that were prescribed stronger opioids showed much less improvement in pain intensity than patients who were prescribed another type of medication and only 1 patient in 10 saw a clear improvement in their pain after 6 months of treatment. This was shown even after considering potential confounders such as age, sex, pain duration, initial pain intensity and coprescriptions. Although research shows that strong opioids provide pain relief in a few patients with neuropathic pain, it’s difficult to know which patients are most likely to benefit from these drugs, which will mainly be prescribed to patients with low risk of substance use disorder.
Take home message
Regarding drug treatment for pain management, first-line and second-line drug treatments are recommended before prescribing stronger opioids (third-line) for pain relief and stronger opioid prescriptions should be carefully reconsidered after 12 weeks of prescription. It is still difficult to identify neuropathic pain patients who would potentially benefit from opioids and further research is required to properly assess the risks of using this type of medication.
