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Neuropathic pain in the community: More under-treated than refractory?
Open accessAbstract
Best current estimates of neuropathic pain prevalence come from studies using screening tools detecting pain with probable neuropathic features; the proportion experiencing significant, long-term neuropathic pain, and the proportion not responding to standard treatment are unknown. These "refractory" cases are the most clinically important to detect, being the most severe, requiring specialist treatment. The aim of this study was to estimate the proportion of neuropathic pain in the population that is "refractory," and to quantify associated clinical and demographic features. We posted self-administered questionnaires to 10,000 adult patients randomly selected from 10 general practitioner practices in 5 UK locations. The questionnaire contained chronic pain identification and severity questions, cause of pain, SF-12, EQ-5D, S-LANSS (Self-administered Leeds Assessment of Neuropathic Signs and Symptoms), PSEQ (Pain Self-Efficacy Questionnaire), use of neuropathic pain medications, and health care utilisation. These data were combined to determine the presence and characteristics of "refractory" neuropathic pain according to the defining features identified by a Delphi survey of international experts. Graded categories of chronic pain with and without neuropathic characteristics were generated, incorporating the refractory criteria. Completed questionnaires were returned by 4451 individuals (response rate 47%); 399 had "chronic pain with neuropathic characteristics" (S-LANSS positive, 8.9% of the study sample); 215 (53.9%) also reported a positive relevant history ("Possible neuropathic pain"); and 98 (4.5% of all Chronic Pain) also reported an "adequate" trial of at least one neuropathic pain drug ("Treated possible neuropathic pain"). The most refractory cases were associated with dramatically poorer physical and mental health, lower pain self-efficacy, higher pain intensity and pain-related disability, and greater health care service use.
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![Fig. 2 Proportion of pain respondents who are currently or have ever consulted a health care professional for their chronic pain (n = 1569 individuals without neuropathic characteristics [NC]; n = 215 Possible Neuropathica; n = 98 Treated Possibleb; n = 10 Refractory Possible neuropathicc). aS-LANSS (Self-administered Leeds Assessment of Neuropathic Signs and Symptoms) positive and relevant history and no neuropathic pain (NeuP) medications. bS-LANSS positive and relevant history and adequate trial of at least one NeuP medication. cPossible NeuP (S-LANSS positive and relevant history) and adequate trial of 4 or more drugs and poor QoL OR pain severity >5 and pain duration more than 6 months.](/paper-figures/dd79c4548c134177a1e04f9a565c1890/neuropathic-pain-in-the-community-more-under-treated-than-refractory-figure-2.jpg)
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“Epidemiological surveys have shown that many patients with neuropathic pain do not receive appropriate treatment for their pain.2,6,7”
From Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis (2015) · cites this paper as [7]
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Metadata
- Authors
- Torrance, N., Ferguson, J. A., Afolabi, E., Bennett, M. I., Serpell, M. G., Dunn, K. M., & Smith, B. H.
- Affiliations
- University of Leeds (GB)
- University of Dundee (GB)
- University of Aberdeen (GB)
- University of Glasgow (GB)
- Keele University (GB)
- Corresponding author
- Torrance, Nicola
- Venue
- Pain
- Published
- 2013-05
- Volume
- 154
- Issue
- 5
- Pages
- 690-699
- ISSN
- 0304-3959 (ISSN-L)
- PMC
- PMC3630326
- OpenAlex
- W2026664444
- Cited by
- 188
- References
- 48
- Citations by year
- 2026: 8 · 2025: 14 · 2024: 12 · 2023: 9 · 2022: 7 · 2021: 20 · 2020: 19 · 2019: 13 · 2018: 19 · 2017: 22 · 2016: 12 · 2015: 12 · 2014: 9 · 2013: 12
- FWCI
- 10.42
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Licence
- Locations
- Pain (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (submittedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Funders
- Pfizer UK Ltd. Kate Dunn is supported by the Wellcome Trust (083572)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Keywords
- neuropathic pain, refractory neuropathic pain, undertreatment, prevalence, chronic pain, pain self-efficacy, pain-related disability, health care utilization, physical and mental health, neuropathic pain medications, community-dwelling adults, general practice
- MeSH terms
- Adolescent, Adult, Aged, Analgesics, Data Interpretation, Statistical, Drug Resistance, Humans, Male, Middle Aged, Neuralgia, Pain Measurement, Quality of Life, Surveys and Questionnaires, Socioeconomic Factors, Prevalence, Treatment Outcome, Self Efficacy, Young Adult, Chronic Pain
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