Br J Anaesth. 2025 Nov 27:S0007-0912(25)00787-1. Revista: 10.1016/j.bja.2025.10.047. Online ahead of print.
BACKGROUND: Pharmacoepidemiological studies show that large proportions of people with neuropathic pain are not prescribed the recommended medications, do not adhere well to these medications, and often discontinue the treatment within 6 months. Identifying what predicts these outcomes can inform a strategy to ensure that people with neuropathic pain 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 neuropathic pain. Electronic searches were conducted in Embase, PubMed, Web of Science, and CINAHL Plus.
RESULTS: We identified 69 relevant studies and divided them into non-mutually exclusive categories based on the outcomes they had investigated. There were 53 studies on prescribing, 14 on adherence, and 27 on discontinuation. Predictors associated with being prescribed recommended neuropathic pain medications included having a mental health disorder, diabetes mellitus, and White race. Predictors associated with better adherence included being prescribed serotonin-norepinephrine reuptake inhibitors compared with gabapentinoids or tricyclic antidepressants, dose titration, and implementing a medicine reminder. Predictors associated with a higher likelihood of discontinuation included being prescribed tricyclic antidepressants rather than other antidepressants and having a combination of neuropathic pain medications rather than monopharmacotherapy.
CONCLUSIONS: There is a need to focus on improving neuropathic pain medication prescribing for ethnic minorities and people without diabetes mellitus. Adherence can be improved by using dose titration and medicine reminders. Prescribing monopharmacotherapy rather than combination pharmacotherapy for neuropathic pain could result in better treatment persistence.
SYSTEMATIC REVIEW PROTOCOL: PROSPERO (CRD42023464307).
PubMed:41314943 | Revista:10.1016/j.bja.2025.10.047