Pain practice : the official journal of World Institute of Pain
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Faced with rapidly escalating costs, healthcare policy makers are increasingly turning to research evidence to serve as a basis for their population-based decisions on access and funding of new and existing therapies-health technology assessment. A two-stage approach is often used to arrive at a policy recommendation for a given treatment. First, following a systematic review of literature, the "level of evidence" for the treatment is assessed according to epidemiological principles. ⋯ By including randomized controlled trials, a number of these systematic reviews indicate a high grade of evidence. Nevertheless, more pragmatic clinical trials are needed to address the evidence needs of healthcare policy makers. These trials should address a direct comparison of the relative effectiveness of neuropathic pain therapies, particularly in combination with other therapies and at different points in the disease course.
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Although neuropathic pain can be acute in nature, in most patients the pain is persistent (or "refractory"). Patients with chronic neuropathic pain are seen most often in clinical practice. It consists of a number of different disease-specific indications, each of which can have differing diagnostic definitions and cutoffs. ⋯ The burden of neuropathic pain on patients and healthcare systems appears to be potentially large, with an estimated prevalence of 1.5%. Patients with neuropathic pain experience a poor health-related quality of life and consume a high level of healthcare resources, and costs. The future prioritization by healthcare policy makers for neuropathic pain treatment funding requires further data to clarify its epidemiology, the burden on the health of patients, and the demand on healthcare budgets.