Elsevier

The Journal of Pain

Volume 16, Issue 9, September 2015, Pages 852-861
The Journal of Pain

Original Report
Long-Term Outcome of the Management of Chronic Neuropathic Pain: A Prospective Observational Study

https://doi.org/10.1016/j.jpain.2015.05.011Get rights and content
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Highlights

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    One-quarter of patients achieved improved pain and function at 12-month follow-up.

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    Poorer outcomes are related to longer duration of pain and higher opioid doses.

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    Opioid therapy may not be beneficial in the long term for management of neuropathic pain.

Abstract

This prospective observational cohort study addressed the long-term clinical effectiveness of the management of chronic neuropathic noncancer pain at 7 Canadian tertiary pain centers. Patients were treated according to standard guidelines and were followed at 3, 6, 12, 18, and 24 months. Standard outcome measures for pain, mood, quality of life, and overall treatment satisfaction were administered, with the primary outcome measure designated as the composite of 30% reduction in average pain intensity and 1-point decrease in the mean Interference Scale Score (0–10) of the Brief Pain Inventory at 12 months relative to baseline. Of 789 patients recruited, mean age was 53.5 ± 14.2 years (55% female) and mean duration of pain was 4.88 ± 5.82 years. Mean average pain intensity (0–10) at baseline was 6.1 ± 1.9. All standard outcome measures showed statistically significant improvement at 12 months relative to baseline (P < .001). However, only 23.7% attained clinically significant improvement in pain and function at 12 months as the primary outcome measure. Univariable analyses showed poorer outcomes at 12-month follow-up with longer duration of pain (P = .002), greater cigarette use (P = .01), more disability compensation (P = .001), and higher opioid doses at baseline and at 12 months (P < .02). Our present treatment modalities provide significant long-term benefit in only about a quarter of patients with neuropathic pain managed at tertiary care pain clinics. Opioid therapy may not be beneficial for the long term.

Perspective

Evidence-based treatment of chronic neuropathic pain provides long-term benefit in only about one-quarter of patients seen in tertiary care centers. Opioid therapy may not be beneficial.

Key words

Prospective cohort study
chronic neuropathic pain
long-term outcome
opioid treatment

Cited by (0)

Research funding: This study was funded by Canadian Foundation for Innovation (grant no. 7878) and by Pfizer Canada.

D.E.M. has received speaker's honoraria and/or consulting fees from Pfizer Canada, Eli Lilly Canada Inc, Janssen Pharmaceuticals, and Purdue Pharma Canada. C.T. has received speaker's honoraria and/or clinical and preclinical research funding from Pfizer Canada, Eli Lilly Canada Inc, Johnson & Johnson, and Janssen Pharmaceuticals. A.G. has received speaker's honoraria and/or consulting fees from Pfizer Canada, Eli Lilly Canada Inc, and Purdue Pharma Canada. P.K.M.-F. has received an honorarium from Eli Lilly Canada Inc. A.J.C. has received speaker's honoraria and/or consulting fees from Pfizer Canada and Wex Pharmaceuticals. A.G. has received honoraria and research or educational support from Purdue Pharma Canada, Pfizer Canada, Allergan, AstraZeneca, Eli Lilly Canada Inc, Boehringer, and Valeant. Catherine Smyth and the Ottawa Hospital Pain Clinic have received research awards from Purdue Pharma, Pfizer Canada, Medtronics, and Reckitt-Benckiser. M.A.W., E.V.D.K., H.N., and M.L. declare no conflict of interest. All conflict of interest statements declared for past 36 months.

Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.