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PLoS One. 2014 Apr 18;9(4):e93855. doi: 10.1371/journal.pone.0093855. eCollection 2014.

Adherence of French GPs to chronic neuropathic pain clinical guidelines: results of a cross-sectional, randomized, "e" case-vignette survey.

Author information

  • 1Anesthésiologie-Réanimation, Hôpital Raymond-Poincaré, Garches, France; INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, CHU Ambroise Paré, Boulogne-Billancourt, France.
  • 2INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, CHU Ambroise Paré, Boulogne-Billancourt, France; Université Versailles-Saint-Quentin, Versailles, France.
  • 3General Practitioner, Athis Mons, France.
  • 4Unité de Recherche Clinique - Hôpital Fernand Widal, Paris, France.
  • 5Réseau InterCLUD Languedoc Roussillon, CHRU Montpellier, Montpellier, France.
  • 6CHU de Nice, Centre d'Evaluation et Traitement de la Douleur, Nice, France; INSERM/UdA, U1107, Neuro-Dol, Université de Clermont-Ferrand, Clermont-Ferrand, France.

Abstract

BACKGROUND AND AIMS:

The French Pain Society published guidelines for neuropathic pain management in 2010. Our aim was to evaluate the compliance of GPs with these guidelines three years later.

METHODS:

We used "e" case vignette methodology for this non interventional study. A national panel of randomly selected GPs was included. We used eight "e" case-vignettes relating to chronic pain, differing in terms of the type of pain (neuropathic/non neuropathic), etiology (cancer, postoperative pain, low back pain with or without radicular pain, diabetes) and symptoms. GPs received two randomly selected consecutive "e" case vignettes (with/without neuropathic pain). We analyzed their ability to recognize neuropathic pain and to prescribe appropriate first-line treatment.

RESULTS:

From the 1265 GPs in the database, we recruited 443 (35.0%), 334 of whom logged onto the web site (26.4%) and 319 (25.2%) of whom completed the survey. Among these GPs, 170 (53.3%) were aware of the guidelines, 136 (42.6%) were able to follow them, and 110 (34.5%) used the DN4 diagnostic tool. Sensitivity for neuropathic pain recognition was 87.8% (CI: 84.2%; 91.4%). However, postoperative neuropathic pain was less well diagnosed (77.9%; CI: 69.6%; 86.2%) than diabetic pain (95.2%; CI: 90.0%; 100.0%), cancer pain (90.6%; CI: 83.5%; 97.8%) and typical radicular pain (90.7%; CI: 84.9%; 96.5%). When neuropathic pain was correctly recognized, the likelihood of appropriate first-line treatment prescription was 90.6% (CI: 87.4%; 93.8%). The treatments proposed were pregabaline (71.8%), gabapentine (43.9%), amiptriptylline (23.2%) and duloxetine (18.2%). However, ibuprofen (11%), acetaminophen-codeine (29.5%) and clonazepam (10%) were still prescribed.

CONCLUSIONS:

The compliance of GPs with clinical practice guidelines appeared to be satisfactory, but differed between etiologies.

PMID:
24747826
PMCID:
PMC3991574
DOI:
10.1371/journal.pone.0093855
[PubMed - indexed for MEDLINE]
Free PMC Article
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