Pharmacological treatment patterns in neuropathic pain--lessons from Swedish administrative registries

Anders Gustavsson, Johan Bjorkman, Christina Ljungcrantz, Annica Rhodin, Marcelo Rivano-Fischer, Karl-Fredrik Sjolund, Clas Mannheimer

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7 Citations (SciVal)

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).

DESIGN: Retrospective study on administrative registers.

SETTING: General population in Western Sweden (one sixth of the country).

SUBJECTS: All patients with a DRCP (N = 840,000) in years 2004-2009.

OUTCOME MEASURES: 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.

Original languageEnglish
Pages (from-to)1072-80
Number of pages9
JournalPain Medicine
Volume14
Issue number7
DOIs
Publication statusPublished - 2013 Jul
Externally publishedYes

Subject classification (UKÄ)

  • Health Care Service and Management, Health Policy and Services and Health Economy
  • Family Medicine

Keywords

  • Adolescent
  • Adrenergic Uptake Inhibitors
  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics
  • Anticonvulsants
  • Antidepressive Agents
  • Antidepressive Agents, Tricyclic
  • Child
  • Chronic Pain
  • Comorbidity
  • Drug Prescriptions
  • Drug Therapy, Combination
  • Female
  • Humans
  • Hypnotics and Sedatives
  • Male
  • Mental Disorders
  • Middle Aged
  • Neuralgia
  • Registries
  • Retrospective Studies
  • Serotonin Uptake Inhibitors
  • Sweden
  • Young Adult
  • Journal Article

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