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. 2021 Jul 7;2021(2):19.
doi: 10.5339/qmj.2021.19. eCollection 2021.

Expert review and recommendations for the management of acute, chronic, and neuropathic pain in Qatar

Amr Elmoheen  1 , Abdullah F Nazal  2 , Osman Zubaidi  3 , Urooj A Siddiqui  4 , Mohammed Alhatou  5
Affiliations

Expert review and recommendations for the management of acute, chronic, and neuropathic pain in Qatar

Amr Elmoheen et al. Qatar Med J. .

Abstract

Background: Pain management is an evolving area of expertise in Qatar. Gaps in knowledge, inadequate training for physicians and nurses, and the absence of policies/guidelines are the main barriers to effective pain management in Qatar. In addition, the use of certain pain medication, especially opioids, is highly regulated, limiting their availability in outpatient pain management. These factors are responsible for the undertreatment of pain in Qatar. This study aimed to standardize evidence-based local recommendations for pharmacological treatment of pain in Qatar.

Methods: An expert panel of physicians from different disciplines, with experience in diagnosis and treatment of the three pain types (i.e., acute, chronic, and neuropathic), was convened for two face-to-face meetings in Doha, Qatar, on November 29, 2019, and on February 22, 2020, with subsequent virtual meetings. A literature search was performed on Medline and Google Scholar databases from inception till December 2019, and all relevant articles were selected. Based on these articles and repeated feedback from the authors, the final pain treatment protocols were developed.

Results: Recommendations for the treatment of acute pain, based on pain severity, followed three approaches: acetaminophen/paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) for mild pain and moderate pain and referral to a pain specialist for severe pain. Acetaminophen/paracetamol or NSAIDs is recommended for chronic pain, and the use of opioids was strongly discouraged because of its long-term side effects. For neuropathic pain, tricyclic antidepressants or gabapentin or pregabalin or serotonin-norepinephrine reuptake inhibitors were recommended first-line agents. Non-responders must be referred to neurologists or a pain specialist.

Conclusion: The expert panel provides recommendations for the management of acute, chronic, and neuropathic pain based on international guidelines adapted to local practice and treatment availability in Qatar. More importantly, the panel has recommended taking extreme caution in the use of opioids for long-term management of chronic pain and to refer the patient to a pain specialist clinician as required.

Keywords: acute pain; analgesics; chronic pain; neuropathic pain; pain management.

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Figures

Figure 1.
Figure 1.
Initial management of undifferentiated pain in the emergency department–evidence-based clinical algorithm. ED, emergency department; IM, intramuscular; IV, intravenous; NRS, numerical rating scale; NSAIDs, nonsteroidal anti-inflammatory drugs; VRS, verbal rating scale.
Figure 2.
Figure 2.
Neuropathic pain algorithm. CBC, complete blood count; HbA1c, glycated hemoglobin; HIV, human immunodeficiency virus; SNRI, serotonin–norepinephrine reuptake inhibitor; SSNRI, selective SNRI; TCA, tricyclic antidepressant.
Figure 3.
Figure 3.
Algorithm for trigeminal neuralgia. MRI, magnetic resonance imaging; TCA, tricyclic antidepressant.
Figure 4.
Figure 4.
Algorithm for post-herpetic neuralgia. TCA, tricyclic antidepressant.
See this image and copyright information in PMC

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