Patient Subgroups and Predictors of Improvement in Chronic Neuropathic Pain: A Trajectory-Based Analysis

IF 3.4 2区 医学 Q1 ANESTHESIOLOGY
Xavier Moisset, M. Gabrielle Pagé, Bruno Pereira, Manon Choinière
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引用次数: 0

Abstract

Background

There is limited real-world evidence on predictive factors for good outcomes in patients with chronic neuropathic pain (NP) treated in multidisciplinary tertiary care centres. This study aimed to identify subgroups of NP patients with similar pain trajectories and evaluate associated factors.

Methods

We analysed data from 912 patients with chronic NP (age: 53.6 ± 13.3 years; 51.5% female) enrolled in the Quebec Pain Registry, all of whom reported a baseline pain intensity of ≥ 4/10. Patients completed standardised questionnaires prior to treatment initiation, as well as at 6 and 12 months. Pain trajectories were identified using group-based trajectory modelling (GBTM), with multiple imputation performed to address missing data. The results were confirmed using group-mixture modelling on the non-imputed dataset and using GBTM in the subgroup of patients with complete data.

Results

A three-class trajectory model best fitted the data for both pain intensity and interference. Only 23.1% of patients showed a clear improvement in pain intensity, while 23.5% showed improvement in pain interference. Key predictors of pain intensity improvement included lower baseline pain intensity and interference. Improvement in pain interference was associated with lower baseline interference and depression scores, as well as shorter pain duration. Notably, receiving a strong opioid significantly increased the risk (RR = 1.45 [1.17; 1.78]) of belonging to the persisting severe pain trajectory.

Conclusions

A minority of chronic NP patients demonstrated significant improvement with multidisciplinary treatment. These findings highlight the limitations of current management strategies and emphasise the need for novel therapeutic approaches to address the burden of chronic NP effectively.

Significance

This study highlights the value of trajectory analysis in identifying subgroups of patients with chronic neuropathic pain (NP) who exhibit different patterns of treatment response. Only a minority of patients—approximately 23% for both pain intensity and pain interference—demonstrated meaningful improvement. Lower baseline pain intensity and interference emerged as key predictors of better outcomes, while strong opioid use was associated with persistent severe pain. These findings underscore the importance of trajectory-based approaches for understanding the course of NP and for guiding more personalised and effective management in multidisciplinary care settings.

Abstract Image

慢性神经性疼痛患者亚组和改善的预测因素:基于轨迹的分析。
背景:在多学科三级保健中心治疗慢性神经性疼痛(NP)患者的良好预后的预测因素方面,现实世界的证据有限。本研究旨在确定具有相似疼痛轨迹的NP患者亚组,并评估相关因素。方法:我们分析了魁北克疼痛登记处登记的912例慢性NP患者(年龄:53.6±13.3岁,51.5%为女性)的数据,所有患者均报告基线疼痛强度≥4/10。患者在治疗开始前以及6个月和12个月时完成标准化问卷。使用基于群体的轨迹建模(GBTM)确定疼痛轨迹,并进行多次插入以解决缺失数据。在非输入数据集上使用混合组建模,并在数据完整的患者亚组中使用GBTM来确认结果。结果:三级轨迹模型最适合疼痛强度和干扰数据。只有23.1%的患者疼痛强度有明显改善,而23.5%的患者疼痛干扰有改善。疼痛强度改善的关键预测因素包括较低的基线疼痛强度和干扰。疼痛干扰的改善与较低的基线干扰和抑郁评分以及较短的疼痛持续时间有关。值得注意的是,接受强阿片类药物显著增加了属于持续剧烈疼痛轨迹的风险(RR = 1.45[1.17; 1.78])。结论:少数慢性NP患者在多学科治疗后表现出明显的改善。这些发现突出了当前管理策略的局限性,并强调需要新的治疗方法来有效地解决慢性NP的负担。意义:本研究强调了轨迹分析在识别表现出不同治疗反应模式的慢性神经性疼痛(NP)患者亚组中的价值。只有少数患者(约23%的疼痛强度和疼痛干扰)表现出有意义的改善。较低的基线疼痛强度和干扰是更好结果的关键预测因素,而强烈的阿片类药物使用与持续的严重疼痛相关。这些发现强调了基于轨迹的方法对于理解NP过程的重要性,以及在多学科护理环境中指导更个性化和有效的管理。
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来源期刊
European Journal of Pain
European Journal of Pain 医学-临床神经学
CiteScore
7.50
自引率
5.60%
发文量
163
审稿时长
4-8 weeks
期刊介绍: European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.
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