Articles: neuralgia.
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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.
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Refractory neuropathic pain can be devastating to a patient's quality of life. Ideally, the primary goal of therapy would be to prevent the pain, yet even the most appropriate treatment strategy may be only able to reduce the pain to a more tolerable level. ⋯ Even so, effective pain relief is achieved in less than half of patients with chronic neuropathic pain. In refractory patients, combination therapy using two agents with synergistic mechanisms of action may offer greater pain relief without compromising the side-effect profile of each agent.
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Neuropathic pain is a condition affecting a significant proportion of the world's population. Many therapeutic drugs have been used. They achieve less than satisfactory results and are associated to common side effects that affect the daily life of patients. ⋯ In clinical trials, pregabalin has been shown to be effective in postherpetic neuralgia and painful diabetic neuropathy at doses ranging from 150-600 mg/day. The analgesic effects of pregabalin occur in the first few days of treatment and are sustained over time. Side effects are few; most are transient and well-tolerated by patients, and the treatment discontinuation rate is minimal.