Objectives:

Latest drugs with an indication for neuropathic pain (NP) in the international guidelines came onto the market more than ten years ago. They recommend starting with monotherapy and place the combined treatment in the second step. A considerable number of patients do not achieve sufficient pain relief or improvement in their quality of life with the available drugs. From this perspective, the NP Working Group (WG) of the Spanish Pain Society (SED) designed a survey to address how NP drugs, off-label treatments and interventional techniques are being used in our setting. In this article we will only discuss the pharmacological treatment options.

Material and methods:

Descriptive study using a self-administered questionnaire distributed by email to SED members in two waves during 2019. At the beginning of the questionnaire, a selection question was asked whether or not they used non-technical or off-label treatments. Only those who answered affirmatively proceeded to the entire set of questions. It was divided into the following blocks: antiepileptics, antidepressants, antipsychotics, anesthetics, anti-nmda, cannabinoids, naltrexone, topical treatments, botulinum toxin, polypharmacy and off-label treatments. Botulinum toxin was included in the topical treatments section.

Results:

The response rate was 13.82 %, being 10.05 % once the invalid ones had been ruled out. 21 % begin the treatment of NP directly on polypharmacy and 43 % do so when they do not respond to a first line. 40 % of those surveyed think that there is insufficient evidence for the use of polypharmacy. 70 % of the participants treated up to 30 % of their NP patients with off-label drugs. 23.3 % used off-label me­dications in between 40 % and 60 % of patients with NP and 6.6 % did so in 70-90 % of patients. The most frequently used off-label treatments according to the responses obtained are, in order: 5 % lidocaine patch, botulinum toxin, lidocaine intravenous infusion, and venlafaxine. This order is altered if those used occasionally are added, this time venlafaxine being the most used, followed by the previous ones in the same order.

Conclusion:

To our knowledge, this is the first time that research has been carried out on the approach to NP with the aim of knowing the need for polypharmacy and the use of off-label drugs. Despite being only a descriptive study, it highlights the gap between clinical guidelines in NP, publications in journals and the reality in daily clinical practice. It is noteworthy that in several groups of drugs there is a discrepancy between the use of some of them and the reasoning about that use based on publications, versus the currently exis­ting publications. Thus, we believe that the information obtained, even having a relative weight, is of utmost importance in order to understand the approach to NP in our environment.

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