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Polarised views on treating neurogenic pain
Huw T O Davies1, Iain K Crombie, William A Macrae
1Department of Epidemiology and Public Health, University of Dundee, DundeeUK Department of Anaesthetics, Ninewells Hospital and Medical School, DundeeUK.
Pain
|September 1, 1993
Summary
Management of neurogenic pain shows significant expert disagreement on treatment appropriateness. This highlights potential gaps in evidence and knowledge, impacting patient care for nerve pain conditions.
Area of Science:
- Neurology
- Pain Management
- Clinical Practice
Background:
- Neurogenic pain management presents challenges due to varied therapeutic approaches.
- Expert consensus on treatment efficacy for specific nerve pain conditions is often lacking.
Purpose of the Study:
- To identify and quantify areas of disagreement among pain management consultants regarding neurogenic pain treatments.
- To assess the perceived appropriateness of various therapies for distinct neurogenic pain conditions.
Main Methods:
- A questionnaire survey was distributed to 179 chronic pain consultants.
- Respondents rated the appropriateness of 11 treatments for 11 neurogenic pain conditions.
- Response rate was 89%, with detailed analysis of consensus and dissent.
Main Results:
- Significant disagreement was found in nearly all treatment-condition pairings, with over 20% dissent in 48 instances.
- Trigeminal neuralgia, amputation stump pain, and phantom limb pain showed the most disputed treatment appropriateness.
- Antidepressants and anticonvulsants were broadly accepted; strong opioids and neuroablative techniques were mainly for cancer-related nerve pain.
Conclusions:
- Divergence in expert opinion suggests potential deficiencies in robust clinical evidence or professional knowledge.
- Lack of consensus may lead to underutilization of effective treatments or iatrogenic harm for patients with neurogenic pain.
- Further research and evidence dissemination are crucial for optimizing neurogenic pain management strategies.