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

Gustavsson, Anders; Bjorkman, Johan; Ljungcrantz, Christina; Rhodin, Annica; Rivano-Fischer, Marcelo LU ; Sjolund, Karl-Fredrik and Mannheimer, Clas (2013) In Pain Medicine 14(7). p.80-1072
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... (More)

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.

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author
publishing date
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published
subject
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
in
Pain Medicine
volume
14
issue
7
pages
9 pages
publisher
Wiley-Blackwell
external identifiers
  • scopus:84880644869
ISSN
1526-2375
DOI
10.1111/pme.12095
language
English
LU publication?
no
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9714a83a-8e10-4689-9ef5-59c40487e8f3
date added to LUP
2018-02-21 13:08:14
date last changed
2018-02-25 04:22:18
@article{9714a83a-8e10-4689-9ef5-59c40487e8f3,
  abstract     = {<p>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).</p><p>DESIGN: Retrospective study on administrative registers.</p><p>SETTING: General population in Western Sweden (one sixth of the country).</p><p>SUBJECTS: All patients with a DRCP (N = 840,000) in years 2004-2009.</p><p>OUTCOME MEASURES: Treatment sequence, continuation, switching, and comedication.</p><p>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).</p><p>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.</p>},
  author       = {Gustavsson, Anders and Bjorkman, Johan and Ljungcrantz, Christina and Rhodin, Annica and Rivano-Fischer, Marcelo and Sjolund, Karl-Fredrik and Mannheimer, Clas},
  issn         = {1526-2375},
  keyword      = {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},
  language     = {eng},
  number       = {7},
  pages        = {80--1072},
  publisher    = {Wiley-Blackwell},
  series       = {Pain Medicine},
  title        = {Pharmacological treatment patterns in neuropathic pain--lessons from Swedish administrative registries},
  url          = {http://dx.doi.org/10.1111/pme.12095},
  volume       = {14},
  year         = {2013},
}