Cancer-related neuropathic pain in out-patient oncology clinics: a European survey.

BACKGROUND: Although pain is frequently experienced by patients with cancer, it remains under-treated. The primary aim of this study was to estimate the prevalence of cancer-related neuropathic pain (CRNP) in patients with chronic pain who attended an outpatient clinic for standard care in Europe (irrespective of the reason or stage of the cancer). The secondary aims of this study were to characterise pain and cancer in patients with CRNP (including treatment) and to evaluate the usefulness of the painDETECT (PD-Q) screening tool to help physicians identify a potential neuropathic component of cancer-related pain. METHODS: An observational, non-interventional, cross-sectional, multi-centre study of adult patients with cancer using patient and physician case report forms (CRFs). Patients with CRNP were identified by physicians' clinical assessments after examining the completed PD-Q. RESULTS: A total of 951 patients visiting outpatient clinics across Europe were enrolled in this study between August 2010 and July 2011. Of these, 310 patients (32.60%; 95% confidence interval 29.62, 35.58) were identified as having CRNP. Twenty-nine of 39 (74.4%) physicians who completed the CRF relating to the PD-Q considered it a useful tool to help detect CRNP in daily practice and 28 of 39 (71.8%) indicated that they would use this tool in the future for most or some of their patients. Data from physicians before and after review of the completed PD-Qs showed a shift in clinical opinion (either to positive CRNP diagnosis [yes] or negative CRNP diagnosis [no]) in respect of 142 patients; about half of which (74) were categorised with an initial diagnosis of unknown. Opinions also shifted from a no to a yes diagnosis in 10 patients and from a yes to a no diagnosis in 51 patients. CONCLUSIONS: Approximately one-third of adults with cancer experiencing chronic pain attending outpatient clinics as part of routine care were considered to have CRNP in the opinion of the physicians after considering scores on the PD-Q. While physicians did not consider the PD-Q to be a useful tool for all patients, shifts in diagnosis before and after the use of this tool indicate that it may help physicians identify CRNP, especially where there is initial uncertainty.

Pregabalin for the management of neuropathic pain in adults with cancer: a systematic review of the literature.

OBJECTIVE: To systematically identify and appraise the current literature of pregabalin in the treatment of neuropathic pain resulting from cancer or cancer treatment. DESIGN: A systematic review of the literature was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses. INTERVENTIONS AND SUBJECTS: Studies reporting pregabalin data for adult (>18 years) patients with cancer experiencing neuropathic pain due to cancer or cancer treatment/surgery were considered eligible for inclusion. METHODS: A literature search was conducted in PubMed on February 22, 2012 using the following search terms: "neuropath* AND pain AND cancer OR oncology OR tumor OR tumour AND pregabalin." Open access journals were also searched. Abstracts were screened and reviewed for eligibility based on predetermined criteria for inclusion. Data reporting pain intensity, pain interference, quality of life, symptom quality and intensity, global impression of change, treatment satisfaction, and adverse effects were the predefined factors for analysis. Data were summarized descriptively due to variations in study outcome measures. RESULTS: Five articles were eligible for inclusion; one double-blind National Cancer Institute common toxicity criteria controlled trial, one single-arm open-label study, two observational analyses, and one case report. CONCLUSIONS: There were limited published data reporting efficacy and safety outcomes for pregabalin in the treatment of neuropathic pain in adult patients with cancer. Due to limitations within the studies included in this review, it is not possible to draw any conclusions on the descriptive summary of pregabalin for the treatment of cancer-related neuropathic pain, and further studies are required.

The burden associated with neuropathic pain in Western Europe.

BACKGROUND: The purpose of this study is to assess the burden of neuropathic pain (NeP) on health-related quality-of-life (HRQoL), health status, employment status, absenteeism and presenteeism, and direct medical costs in Western Europe. METHODS: Data are from the 2010 National Health and Wellness Survey (NHWS) for five countries in western Europe: the UK, France, Spain, Germany, and Italy. Among subjects who reported experiencing pain in the past month, those who attributed their pain to NeP were compared with those who attributed their pain to another chronic pain condition other than NeP (the latter was the reference group). These two groups were compared on demographic and both pain and non-pain related comorbidities. Generalized linear models were used to estimate the independent contribution of the presence of NeP on: (a) HRQoL (using the SF-12v2); (b) self-reported health status (the first item of the SF-12v2); (c) employment status; (d) absenteeism and presenteeism (using the WPAI questionnaire); and (e) direct medical costs (estimated from self-reported healthcare resource use and unit costs from the literature). RESULTS: Relative to the chronic pain reference group, subjects with NeP reported a higher prevalence of severe daily pain (38.12% vs 12.67%, p < 0.05), lower labor force participation (39.68% vs 55.56%; p < 0.05), higher prevalence of sleep difficulties (59.14% vs 46.73%; p < 0.05), insomnia (45.61% vs 29.78%; p < 0.05) anxiety (42.42% vs 31.99%; p < 0.05), and depression (35.25% vs 24.03%; p < 0.05). NeP subjects reported higher rates of absenteeism (39.78% vs 21.47%; p < 0.05) and presenteeism (86.48% vs. 66.70%; p < 0.050). Direct medical costs were approximately twice as high compared to non-NeP controls. In addition, >80% of NeP patients reported having other pain conditions. Regression results amplified these findings by indicating the independent contribution of confounding factors on the presence of NeP. LIMITATIONS: The NHWS is an Internet-based survey and may not be representative of the respective country populations if Internet access is limited. Second, respondents are asked to report their experience of pain. Although respondents are asked if their pain condition has been diagnosed by a physician there is no separate clinical confirmation of the presence of pain, pain conditions reported, and the presence of comorbidities. CONCLUSIONS: The presence of NeP is associated with an increased disease burden in the chronic pain population. This is seen in terms of HRQoL, health status, employment experience, and direct medical costs.