Guidelines for Neuropathic Pain Management in Patients with Cancer: A European Survey and Comparison

Abstract

Between 19% and 39% of patients with cancer pain suffer from neuropathic pain. Its diagnosis and treatment is still challenging. Yet, national clinical practice guidelines (CPGs) have been developed in several European countries to assist practitioners in managing these patients safely and legally. The aim of this study was to assess the quality of the development and reporting of these CPGs. In collaboration with the European Federation of IASP Chapters, a European inventory of CPGs was conducted. Inclusion criteria were at least one paragraph dedicated to the treatment of neuropathic pain in cancer. Using the Appraisal of Guidelines, Research and Evaluation II instrument, 2 appraisers independently assessed the quality of the development process of the included CPGs in 6 quality domains. Besides, CPGs developed by governmental organization were compared with those developed by professional societies using t-tests. Mean scores of the domains "scope and purpose" (80%) and "clarity of presentation" (61%) were satisfactory, "stakeholder involvement" (58%), "rigor of development" (57%), and "editorial independence" (53%) were acceptable, and "applicability" was insufficient (39%). Governmental guidelines had higher quality scores than professional society guidelines for domain "stakeholder involvement" and "editorial independence" (P<0.01). The quality of the development process of the 9 included CPGs varied widely. CPGs should be developed within a structured guideline program, including methodological support. As developing a CPG is expensive and time-consuming, we recommend more international cooperation to increase quality and lower the development costs.