The diagnosis and management of neuropathic pain in daily practice in Belgium: an observational study

Abstract

Background: This open, multicentre, observational survey investigated how physicians diagnose neuropathic pain (NeP) by applying the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale, and how neuropathic pain conditions are managed in daily practice in Belgium.

Methods: Physicians were asked to complete the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale for diagnosing NeP, and to fill out a questionnaire regarding the management of NeP, together with a questionnaire evaluating the impact of pain on sleep and daily life. Data on 2,480 pain patients were obtained. A LANSS score > or = 12 (meaning NeP is most probably present) was reported for 1,163 patients. Pathologies typically associated with NeP scored above 12 on the LANSS scale, contrary to pathologies generally considered as being of non-neuropathic origin.

Results: Over 90% of the patients with a LANSS score > or = 12 reported that the pain impaired sleep. A high impact on social, family and professional life was also recorded. Additional examinations were performed in 89% of these patients. Most patients were taking multiple drugs, mainly paracetamol and non-steroidal anti-inflammatory drugs, indicating that physicians generally tend to follow treatment guidelines of chronic nociceptive pain, rather than the specific ones for NeP. Specific neuropathic guidelines rather recommend the use of anti-epileptic drugs, tricyclic antidepressants or weak opioids as first-line treatment.

Conclusion: In our survey, application of the LANSS scale lead to pronounced treatment simplification with fewer drug combinations. Awareness about NeP as well as its specific treatment recommendations should be raised among healthcare providers. We concluded that the LANSS screening scale is an interesting tool to assist physicians in detecting NeP patients in routine clinical care.

Figure 1

Identified causes of pain. Possible underlying causes of pain in (1) all patients pooled (n = 2,436) and (2) the patients with a LANSS pain score ≥ 12 (n = 1,163). Patients may have multiple underlying pathologies. DN: diabetic neuropathy, TS: trigeminal syndrome (neuralgia); Ca: cancer, LP: lumbar pain, OP: osteoporosis; MS: multiple sclerosis, PHN: post-herpetic neuralgia, CRPS: complex regional pain syndrome; SM: Syringomyelia; CCS: carpal canal syndrome; pCVA: post-cerebrovascular accident; Alc: alcohol abuse; PSL: post-surgical lesions; PTL: post-traumatic lesion; OA: osteoarthritis.

Figure 2

Calculated Odds ratios. Odds ratios for the various pathologies having a LANSS score ≥ 12 with 95% CI. Only patients with one cause of pain included (n = 1,510). Scale on x-axis has been cut off at 10 for better visualisation (note the logarithmic scale on the x-axis). Upper limit (UL) of confidence interval for MS = 20, and for SM = 61. DN: diabetic neuropathy, Ca: cancer, LP: lumbar pain, OP: osteoporosis; MS: multiple sclerosis, PHN: post-herpetic neuralgia, CRPS: complex regional pain syndrome; SM: Syringomyelia; CCS: carpal canal syndrome; pCVA: post-cerebrovascular accident; Alc: alcohol abuse; PSL: post-surgical lesions; PTL: post-traumatic lesions.

Figure 3

Use of analgesic agents. Number of pharmacological agents prescribed before and after applying the LANSS pain scale evaluation in LANSS ≥ 12 group.

Figure 4

Current and future drug treatments. Past and future treatment : proportion of patients taking only one drug who (1) will continue this treatment, (2) stop taking it, (3) who were not taking it but will start this treatment (4) who were not taking it and will not take it as new treatment. PAR: paracetamol; AD: antidepressive agent; OPIO: opioids; ASPI: aspirin (= acetylic salicylic acid).