Abstract
Purpose
Clinical trials suggest that opioids relieve neuropathic pain and decrease pain-related disability. We conducted a pilot study of current prescribing trends and patients’ attitudes towards opioids for neuropathic pain.
Methods
A patient questionnaire was completed by individuals pursuing enrollment in neuropathic pain clinical trials at our facility.
Results
Of 154 patients with diabetic neuropathy (55.2%), postherpetic neuralgia (29.9%), idiopathic peripheral neuropathy (9.7%) and other neuropathies (5.2%), 73.4% complained of inadequate pain control, the mean pain duration was 4.7 (SD = 4.4) yr and the mean pain intensity (0–10) was 7.7 (SD = 2.3). In this group, 40.9% had never tried opioids and 24.7% had never tried any opioids, tricyclic antidepressants or anticonvulsants. Only 9.7% were receiving long-acting opioids or “around the clock” dosing whereas 25.3% were receiving opioids on an “as needed” basis. Opioids combined with tricyclic antidepressants and/or anticonvulsants were used in 11.0%. Fear of addiction and adverse effects were expressed by 31.8% and 46.8% respectively.
Conclusion
These data suggest that barriers to opioid therapy for neuropathic pain include patients’, and possibly physicians’, fears of addiction and adverse effects, which are exaggerated in light of current evidence. The merits of continuous treatment with sustained-release opioids, “as needed” dosing with short-acting preparations, or combining opioids with other agents are discussed. Continued research and communication between health professionals, law enforcement officials and legislators is vital in order to facilitate appropriate opioid use which has a minimal negative impact on the public yet optimally benefits individuals who suffer from disabling neuropathic pain.
Résumé
Objectif
Les essais cliniques montrent que les opioïdes soulagent les douleurs neuropathiques et diminuent l’incapacité reliée à la douleur. Notre étude pilote porte sur les modes courants de prescriptions et les attitudes des patients face aux opioïdes contre la douleur neuropathique.
Méthode
Un questionnaire adressé aux patients a été rempli par des malades intéressés à participer à des essais cliniques sur la douleur neuropathique à notre établissement.
Résultats
Des 154 patients présentant une neuropathie diabétique (55,2 %), une névralgie postherpétique (29,9 %), une neuropathie périphérique idiopathique (9,7 %) ou d’autres neuropathies (5,2 %), 73,4 % se plaignaient d’un soulagement incomplet de la douleur. La durée moyenne des douleurs chroniques était 4,7 ans (écart type = 4,4) et l’intensité moyenne, de 7,7 (écart type = 2,3) sur une échelle de 0–10. Parmi eux, 40,9 % n’avaient jamais pris d’opioïdes et 24,7 % n’avaient jamais pris aucune forme d’opioïdes, d’antidépresseurs ou d’anticonvulsivants tricycliques. Seulement 9,7% avaient des opioïdes à action prolongée ou des dosages continus et 25,3 % prenaient des opioïdes au besoin. Une combinaison d’opioïdes et d’antidépresseurs ou d’anticonvulsivants tricycliques était utilisée par 11,0 % des malades. La crainte d’une accoutumance et des effets indésirables a été exprimée par 31,8 % et 46,8 % respectivement.
Conclusion
Les obstacles au traitement de la douleur neuropathique par des opioïdes comprennent des craintes des patients, et probablement des médecins, d’une accoutumance ou des effets indésirables, ce qui semble exagéré à la lumière des données actuelles. Les mérites du traitement continu avec des opioïdes à libération lente, des dosages “au besoin” avec des préparations à action brève ou des combinaisons d’opioïdes et d’autres médicaments sont discutés. La recherche et les échanges continus entre les professionnels de la santé, les responsables de l’application de la loi et les législateurs sont d’une importance vitale pour faciliter l’usage approprié des opioïdes avec le minimum d’impact négatif sur le public, mais des avantages optimaux pour les malades qui souffrent de douleurs neuropathiques invalidantes.
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This work was supported by CIHR Grant #MCT-38149 and Queen’s University Grant #383-861.
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Gilron, I., Bailey, J.M. Trends in opioid use for chronic neuropathic pain: a survey of patients pursuing enrollment in clinical trials. Can J Anesth 50, 42–47 (2003). https://doi.org/10.1007/BF03020185
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DOI: https://doi.org/10.1007/BF03020185