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Management of patients with chronic neuropathic pain
- Sotirios Giannopoulos (9 August 2007)
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Sotirios Giannopoulos, Lecturer in Neurology University of Ioannina School of Medicine
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Management of patients with chronic neuropathic pain in general practice settings Sotirios Giannopoulos,MD; George Lagos,MD; Sygliti-Henrietta Pelidou, MD; and Athanassios P. Kyritsis. MD Department of Neurology, University of Ioannina School of Medicine, Ioannina, GREECE Correspondence: Sotirios Giannopoulos, MD Dept. of Neurology University of Ioannina School of Medicine University Campus Ioannina 45110 Greece Phone: +30-26510-97514 Fax: +30-26510-97011 Email: sgiannop@uoi.gr Keywords: Neuropathic pain, antiepileptic drug, antidepressant drug, chronic pain, general practice We read with great interest the article by Torrance et al.1 concerning the management of primary care patients with chronic pain of predominantly neuropathic origin. The authors distributed the self- complete Leeds assessment of neuropathic symptoms and signs (S-LANSS) questionnaire that identifies pain of predominantly neuropathic origin, to 6000 adults identified from general practices in the UK, and collected data about chronic pain identification, medications and treatments received for pain. They found that for chronic neuropathic pain management, most general practitioners usually prescribe standard anti- inflammatory agents (NSAIDs), paracetamol and opioids, rather than medications with clinical evidence demonstrating efficacy in neuropathic pain, such as tricyclic antidepressants, second generation antidepressants (SSRIs, SNRIs), and antiepileptics. They concluded that it is important that patients with any chronic pain are identified and managed appropriately according to their specific etiology of pain. It has been increasingly recognized that the most difficult to manage chronic pain, the neuropathic pain, is inadequately handled in the general practice setting.2 The predominant etiology for this problem is the frequent complexity of chronic pain syndromes which are difficult to accurately diagnose by the general practitioners and treat appropriately.3 In addition, the familiarity of the general practitioners with the use of NSAIDs and opioids rather than the antiepileptic and antidepressant drugs, leads them to employ the NSAIDs and opioids more frequently for neuropathic pain.3 Moreover, patient non-compliance with the use of antiepileptics and antidepressants might be another limitation that guides the general practitioners against the use of these specific neuropathic- pain specific drugs.4 Thus, better patient education about the specific neuropathic pain control properties of some antidepressant and antiepileptic drugs, as well as better education of the general practitioners to correctly diagnose and manage complex pain syndromes may be needed for appropriate pain management in the general practice setting. References 1. Torrance N, Smith BH, Watson MC, Bennett MI. Medication and treatment use in primary care patients with chronic pain of predominantly neuropathic origin. Fam Pract. 2007 Aug 1; [Epub ahead of print] 2. Gore M, Dukes E, Rowbotham DJ, Tai K-S, Leslie D. Clinical characteristics and pain management among patients with painful peripheral neuropathic disorders in general practice settings •Eur J Pain 11(6):652- 64. 3. Giannopoulos S, Pelidou SH, Kyritsis AP, Kosmidou M. Burden of illness in painful diabetic peripheral neuropathy. J Pain. 2007 Jun;8(6):530. 4. Giannopoulos S, Kosmidou M, Sarmas I, Markoula S, Pelidou SH, Lagos G, Kyritsis AP. Patient compliance with SSRIs and gabapentin in painful diabetic neuropathy. Clin J Pain. 2007 Mar-Apr;23(3):267-9. Conflict of Interest:None declared |
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