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

JOURNAL OF PAIN

卷:16

Article

Moulin, Dwight E.¹  Clark, A. John^3,4  Gordon, Allan⁵  Lynch, Mary^3,4  Morley-Forster, Patricia K.²  Nathan, Howard⁶  Smyth, Cathy⁶  Toth, Cory⁷  VanDenKerkhof, Elizabeth^8,9  Gilani, Ammar¹⁰  Ware, Mark A.¹¹ 

[1] Univ Western Ontario, Dept Clin Neurol Sci, London, ON N6A 3K7, Canada

[2] Univ Western Ontario, Dept Anesthesia & Perioperat Med, London, ON N6A 3K7, Canada

[3] Dalhousie Univ, Dept Anesthesiol, Halifax, NS, Canada

[4] Dalhousie Univ, Dept Psychiat, Halifax, NS, Canada

[5] Univ Toronto, Wasser Pain Management Ctr, Toronto, ON, Canada

[6] Univ Ottawa, Dept Anesthesiol, Ottawa, ON, Canada

[7] Univ Calgary, Dept Clin Neurol Sci, Calgary, AB, Canada

[8] Queens Univ, Sch Nursing, Kingston, ON, Canada

[9] Queens Univ, Dept Anesthesiol & Perioperat Med, Kingston, ON, Canada

[10] McMaster Univ, Dept Internal Med, Hamilton, ON, Canada

[11] McGill Univ, Dept Family Med, Montreal, PQ H3A 2T5, Canada

关键词: Prospective cohort study;    chronic neuropathic pain;    long-term outcome;    opioid treatment;   

DOI  :  10.1016/j.jpain.2015.05.011

来源: Elsevier

【 摘 要 】

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. (C) 2015 by the American Pain Society

【 授权许可】

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