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

Dwight E. Moulin; A. John Clark; Allan Gordon; Mary Lynch; Patricia K. Morley-Forster; Howard Nathan; Cathy Smyth; Cory Toth; Elizabeth Vandenkerkhof; Ammar Gilani; Mark A. Ware

doi:10.1016/j.jpain.2015.05.011

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

Dwight E. Moulin, A. John Clark, Allan Gordon, Mary Lynch, Patricia K. Morley-Forster, Howard Nathan, Cathy Smyth, Cory Toth, Elizabeth Vandenkerkhof, Ammar Gilani, Mark A. Ware

Medicine

Research output: Contribution to journal › Article › peer-review

41 Citations (Scopus)

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.

Original language	English
Article number	3096
Pages (from-to)	852-861
Number of pages	10
Journal	Journal of Pain
Volume	16
Issue number	9
DOIs	https://doi.org/10.1016/j.jpain.2015.05.011
Publication status	Published - Sept 1 2015

Bibliographical note

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

Funding Information:
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.

Publisher Copyright:
© 2015 American Pain Society.

ASJC Scopus Subject Areas

Neurology
Clinical Neurology
Anesthesiology and Pain Medicine

PubMed: MeSH publication types

Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

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10.1016/j.jpain.2015.05.011

Cite this

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title = "Long-Term Outcome of the Management of Chronic Neuropathic Pain: A Prospective Observational Study",

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.",

author = "Moulin, {Dwight E.} and Clark, {A. John} and Allan Gordon and Mary Lynch and Morley-Forster, {Patricia K.} and Howard Nathan and Cathy Smyth and Cory Toth and Elizabeth Vandenkerkhof and Ammar Gilani and Ware, {Mark A.}",

note = "Funding Information: Research funding: This study was funded by Canadian Foundation for Innovation (grant no. 7878 ) and by Pfizer Canada. Funding Information: 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. Publisher Copyright: {\textcopyright} 2015 American Pain Society.",

year = "2015",

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doi = "10.1016/j.jpain.2015.05.011",

language = "English",

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T2 - A Prospective Observational Study

AU - Moulin, Dwight E.

AU - Clark, A. John

AU - Gordon, Allan

AU - Lynch, Mary

AU - Morley-Forster, Patricia K.

AU - Nathan, Howard

AU - Smyth, Cathy

AU - Toth, Cory

AU - Vandenkerkhof, Elizabeth

AU - Gilani, Ammar

AU - Ware, Mark A.

N1 - Funding Information: Research funding: This study was funded by Canadian Foundation for Innovation (grant no. 7878 ) and by Pfizer Canada. Funding Information: 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. Publisher Copyright: © 2015 American Pain Society.

PY - 2015/9/1

Y1 - 2015/9/1

N2 - 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.

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

Abstract

Bibliographical note

ASJC Scopus Subject Areas

PubMed: MeSH publication types

Access to Document

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