Abstract
Background Pharmacoepidemiological studies show that large proportions of people with neuropathic pain (NP) are not prescribed the medications recommended for NP, do not adhere well to these medications, and/or often discontinue the treatment within half a year. Identifying what predicts these outcomes can inform a strategy to ensure that people with NP are prescribed recommended medication and continue their treatment when appropriate.
Methods We carried out a systematic review and meta-analysis to identify predictors of pain medication prescribing, adherence, and discontinuation in adults with NP (PROSPERO ID: CRD42023464307). Electronic searches were conducted in Embase, PubMed, Web of Science, and CINAHL Plus.
Results We identified 60 relevant studies and divided them into non-mutually exclusive categories based on the outcomes they had investigated. There were 45 studies on prescribing, 14 on adherence, and 25 on discontinuation. Predictors associated with being prescribed recommended NP medications as the first choice included white ethnicity, having diabetes, and/or having a mental health disorder. Predictors associated with better adherence included being prescribed serotonin-norepinephrine reuptake inhibitors compared to gabapentinoids or tricyclic antidepressants; dose titration, and/or implementing a medicine reminder. Predictors associated with a higher likelihood of discontinuation included being prescribed medications other than second-generation antidepressants and/or having a combination of NP medications rather than a single medication.
Conclusions Thus, there is a need to focus on improving NP medication prescribing for ethnic minorities and people with non-diabetic NP. Adherence and persistence with NP medications could be improved by prioritising the prescribing of serotonin-norepinephrine reuptake inhibitors if indicated.
Competing Interest Statement
This systematic review was conducted as part of a PhD studentship funded by The National Institute of Academic Anaesthesia [British Journal of Anaesthesia / Royal College of Anaesthetists, WKR0-2022-0028]. DS is a fellow on the Multimorbidity Doctoral Training Programme for Health Professionals, which is supported by the Wellcome Trust [223499/Z/21/Z]. LC receives research support funding, on behalf of her institution, from the Advanced Pain Discovery Platform (funded by UK Research and Innovation, Versus Arthritis, Eli Lilly), the Scottish Government (Chief Scientist Office), The Wellcome Trust, and the National Institute of Academic Anaesthesia. She is Vice Chair of Scottish Intercollegiate Guidelines Network (SIGN) Council and is currently chairing the SIGN Guideline Development Group for Management of Chronic Pain. BHS receives research support funding, on behalf of his institution, from UK Research and Innovation (Medical Research Council), Versus Arthritis, the Scottish Government (Chief Scientist Office), Eli Lilly, The Wellcome Trust, and the National Institute of Academic Anaesthesia. HLH has received funding to support research from The National Institute of Academic Anaesthesia [British Journal of Anaesthesia / Royal College of Anaesthetists].
Funding Statement
This systematic review was conducted as part of a PhD studentship funded by The National Institute of Academic Anaesthesia [British Journal of Anaesthesia / Royal College of Anaesthetists, WKR0-2022-0028].
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Data Availability
All data produced in the present work are contained in the manuscript.