Pharmacological Treatment Patterns in Neuropathic Pain—Lessons from Swedish Administrative Registries

• Published in: Pain medicine (Malden, Mass.) Vol. 14; no. 7; pp. 1072 - 1080
• Main Authors: Gustavsson, Anders, Bjorkman, Johan, Ljungcrantz, Christina, Rhodin, Annica, Rivano‐Fischer, Marcelo, Sjolund, Karl‐Fredrik, Mannheimer, Clas
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.07.2013
• Subjects: Adolescent; Adrenergic Uptake Inhibitors - therapeutic use; Adult; Aged; Aged, 80 and over; Analgesics - therapeutic use; Anticonvulsants; Anticonvulsants - therapeutic use; Antidepressants; Antidepressive Agents - therapeutic use; Antidepressive Agents, Tricyclic - therapeutic use; Child; Chronic Pain; Chronic Pain - drug therapy; Comorbidity; Drug Prescriptions - statistics & numerical data; Drug therapy; Drug Therapy, Combination; Female; Humans; Hypnotics and Sedatives - therapeutic use; Male; Medicin och hälsovetenskap; Mental Disorders - complications; Mental Disorders - psychology; Middle Aged; Neuralgia - complications; Neuralgia - drug therapy; Neuralgia - psychology; Psychiatric Comorbidity; Registries; Retrospective Studies; Serotonin Uptake Inhibitors - therapeutic use; Serotonin-Norepinephrine Reuptake Inhibitors; Sweden; Treatment Pattern; Tricyclic Antidepressants; Young Adult; Sweden; Treatment Pattern; Tricyclic Antidepressants; Anticonvulsants; Psychiatric Comorbidity; Serotonin-Norepinephrine Reuptake Inhibitors; Chronic Pain
• ISSN: 1526-2375; 1526-4637; 1526-4637
• DOI: 10.1111/pme.12095

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.