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Epidemiology of physician-diagnosed neuropathic pain in Brazil

Authors Udall M, Kudel I, Cappelleri JC, Sadosky A, King-Concialdi K, Parsons B, Hlavacek P, Hopps M, Salomon PA, DiBonaventura MD, Clark P, Santos Garcia JB

Received 21 December 2017

Accepted for publication 7 August 2018

Published 7 January 2019 Volume 2019:12 Pages 243—253

DOI https://doi.org/10.2147/JPR.S160504

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr E Alfonso Romero-Sandoval


Margarita Udall,1 Ian Kudel,2 Joseph C Cappelleri,3 Alesia Sadosky,1 Kristen King-Concialdi,2 Bruce Parsons,1 Patrick Hlavacek,1 Markay Hopps,1 P Arline Salomon,4 Marco D DiBonventura,2 Patricia Clark,5,6 João Batista Santos Garcia7

1Pfizer Inc, New York, NY, USA; 2Health Outcomes Practice, Kantar Health, New York, NY, USA; 3Pfizer Inc, Groton, CT, USA; 4Pfizer Inc, Bosques de las Lomas, Mexico; 5Clinical Epidemiology Unit, Hospital Infantil de México Federico Gómez, Mexico City, Mexico; 6Faculty of Medicine UNAM, Mexico City, Mexico; 7Pain and Palliative Care Department, Federal University of Maranhão, Maranhão, Brazil

Objectives:
Estimate the prevalence of neuropathic pain (NeP) among chronic pain patients attending Brazilian hospitals and pain clinics in São Paulo, Ceara, and Bahia and explore clinical characteristics by subtypes: painful diabetic peripheral neuropathy (pDPN), central neuropathic pain (CNP), chronic low back pain with a neuropathic component (CLBP-NeP), postherpetic neuralgia (PHN), post-traumatic neuropathic pain (PTN), and post-surgical neuropathic pain (PSN).
Methods: Physicians screened patients reporting chronic pain for ≥3 months (n=2,118) for probable NeP, using the Douleur Neuropathique 4 questionnaire and physician assessment, and reported their NeP subtype(s), symptoms, and medications. Identified NeP patients completed a questionnaire including treatment experiences, quality of life EuroQol 5 Dimensions [EQ-5D]), pain severity and interference (Brief Pain Inventory [BPI]), and Work Productivity and Activity Impairment scales. Descriptive analyses were performed by NeP subtype.
Results: The prevalence of probable NeP was 14.5% (n=307). NeP patients were mostly female (80.5%), middle-aged (mean [M]=52.5, SD=13.9), and Pardo (44.3%). Of those diagnosed with an NeP subtype (n=209), the largest proportions were CLBP-NeP (36.8%), followed by pDPN (18.7%), CNP (17.7%), PTN (17.2%), PSN (13.4%), and PHN (3.3%). Across subtypes, the most widely reported symptoms were numbness (range: 62.2%–89.7%) and hyperalgesia (range: 32.1%–76.9%) and the most commonly prescribed pain analgesics were NSAID (range: 18.2%–57.1%), opioids (range: 0.0%–39.3%), and antiepileptics (range: 18.2%–57.1%). PTN and PSN patients reported the least favorable EQ-5D index scores (M=0.42, SD=0.19) and BPI-Pain Severity scores (M=7.0, SD=1.9), respectively. Those diagnosed with CNP had the least favorable BPI-Pain Interference scores (M=6.0, SD=2.7). Patients with PHN reported the least impairment based on EQ-5D index scores (M=0.60, SD=0.04). Those with pDPN had the most favorable BPI scores (BPI-Pain Severity: M=4.6, SD=2.3; BPI-Pain Interference: M=4.7, SD=2.7).
Conclusion: Evaluation of chronic pain patients in Brazil yielded a 14.5% probable NeP prevalence. NSAIDs and opioids were commonly used, and there was a high incidence of NeP-related symptoms with varying levels of dysfunction across subtypes.

Keywords: neuropathic pain, Brazil, quality of life, pain, work productivity and activity impairment

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