Adherence/compliance with the treatment in chronic non-malignant pain

Abstract

We read with interest the review by Broekmans and colleagues (2009) concerning the medication adherence in patients with chronic non-malignant pain. The authors concluded that medication non adherence is common in these patients and highlighted important issues in the adherence literature in the management of pain. We think that this review raises important questions concerning adherence/compliance with analgesic treatment: First, how do we define adherence and compliance to treatment? Second, is adherence and compliance numeric or qualitative factors? To our knowledge in two recent articles published after 2006 and not included in this review, in order to define compliance (Gordh et al., 2008) used the same numeric rationale of at least 75% intake of scheduled dosages, as we did in our study (Giannopoulos et al., 2007) that compared compliance with gabapentin versus SSRIs in painful diabetic neuropathy. In this review, the authors in order to define adherence used the rationale of the agreed recommendation of the health provider and for further definitions the DSM IV criteria. The lack of established common criteria, forces us to support a common agreement for the future studies as far as the numeric factors is concerned. For the qualitative factors we propose the established definitions and methodology. The third issue that arises from this review is that there are no studies focusing on neuropathic pain, a common cause of chronic non-malignant pain. Additionally, studies on anticonvulsants, tricyclics, SSRIs and SNRIs are not included. It is true that literature is limited concerning adherence/compliance with neuropathic pain treatment. To our knowledge our study (Giannopoulos et al., 2007) and a more recent one (Gordh et al., 2008) are focusing in compliance with neuropathic pain treatment. Interestingly, both these studies observed a similar percentage of non-compliant patients with gabapentin, suggesting a common attitude to this drug in pain patients worldwide. It would be of great interest and the only approach for safe conclusions to see in the future studies comparing adherence/compliance of classic analgesic treatment versus anticonvulsants and antidepressants. Relieving chronic pain is a health care priority and the unsuccessful management is leading to decreased productivity, anxiety and depression. The consequences of non-compliance include poor health, discomfort, further expensive diagnostic testing and deterioration of the doctor–patient relationship (Berndt et al., 1993; Giannopoulos et al., 2008). It is well reported in this review that limited number of patients treated for chronic non-malignant pain are compliant with treatment. We agree that medication adherence with chronic pain treatment is a major medical and social problem.