Abstract
Background and aimsThe French Pain Society published guidelines for neuropathic pain management in 2010. Our aim was to evaluate the compliance of GPs with these guidelines three years later.MethodsWe used “e” case vignette methodology for this non interventional study. A national panel of randomly selected GPs was included. We used eight “e” case-vignettes relating to chronic pain, differing in terms of the type of pain (neuropathic/non neuropathic), etiology (cancer, postoperative pain, low back pain with or without radicular pain, diabetes) and symptoms. GPs received two randomly selected consecutive “e” case vignettes (with/without neuropathic pain). We analyzed their ability to recognize neuropathic pain and to prescribe appropriate first-line treatment.ResultsFrom the 1265 GPs in the database, we recruited 443 (35.0%), 334 of whom logged onto the web site (26.4%) and 319 (25.2%) of whom completed the survey. Among these GPs, 170 (53.3%) were aware of the guidelines, 136 (42.6%) were able to follow them, and 110 (34.5%) used the DN4 diagnostic tool. Sensitivity for neuropathic pain recognition was 87.8% (CI: 84.2%; 91.4%). However, postoperative neuropathic pain was less well diagnosed (77.9%; CI: 69.6%; 86.2%) than diabetic pain (95.2%; CI: 90.0%; 100.0%), cancer pain (90.6%; CI: 83.5%; 97.8%) and typical radicular pain (90.7%; CI: 84.9%; 96.5%). When neuropathic pain was correctly recognized, the likelihood of appropriate first-line treatment prescription was 90.6% (CI: 87.4%; 93.8%). The treatments proposed were pregabaline (71.8%), gabapentine (43.9%), amiptriptylline (23.2%) and duloxetine (18.2%). However, ibuprofen (11%), acetaminophen-codeine (29.5%) and clonazepam (10%) were still prescribed.ConclusionsThe compliance of GPs with clinical practice guidelines appeared to be satisfactory, but differed between etiologies.
Highlights
Neuropathic pain constitutes a significant burden for society in terms of impaired quality of life, comorbidities and cost [1,2,3]
In France, the French Pain Society (Societe Francaise d’Etude et Traitement de la Douleur/SFETD), in particular, has proposed and disseminated evidence-based recommendations targeting all health professionals, with the aim of facilitating neuropathic pain recognition and management in the ambulatory care setting [14]. These recommendations emphasize the importance of screening tools as a first step in the diagnosis of neuropathic pain, and propose first- and second-line drug treatments for neuropathic pain, regardless of its etiology, akin to European or international recommendations
We found that 53.6% general practitioners (GPs) faced with a case of neuropathic pain of any etiology prescribed at least one first-line treatment recommended for this type of pain
Summary
Neuropathic pain constitutes a significant burden for society in terms of impaired quality of life, comorbidities and cost [1,2,3]. In France, the French Pain Society (Societe Francaise d’Etude et Traitement de la Douleur/SFETD), in particular, has proposed and disseminated evidence-based recommendations targeting all health professionals, with the aim of facilitating neuropathic pain recognition and management in the ambulatory care setting [14]. These recommendations emphasize the importance of screening tools ( the DN4, which was developed in France [7]) as a first step in the diagnosis of neuropathic pain, and propose first- and second-line drug treatments for neuropathic pain, regardless of its etiology, akin to European or international recommendations. Our aim was to evaluate the compliance of GPs with these guidelines three years later
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