Burden and Treatment Preference of Probable Neuropathic Pain in 13 592 people: A Cross-Sectional and Discrete Choice Experiment in the General Population in Malaysia

Abstract

Background and Aim

Neuropathic pain (NeuP) is widely underdiagnosed, and treatment-related adverse events often drive nonadherence. We investigated the probable NeuP prevalence, symptoms recognition, and treatment preferences among the general population in Malaysia.

Methods

We utilized a digital ID-Pain questionnaire across nine tertiary hospitals to screen for probable NeuP. We also designed a discrete choice experiment (DCE) to assess participants' ability to differentiate NeuP from nociceptive symptoms and to evaluate treatment preferences across five attributes (perceived pain reduction, time to effect, proven effectiveness, risk of common side effects, and cost) among the general population.

Results

The screening cohort included 13 592 adults (17.1% with diabetes). The overall prevalence of screen-positive for probable NeuP was 18.3% in the general population, increasing to 40.1% among people with diabetes. In the DCE cohort (n = 3999), 82.1% of participants demonstrated poor-to-moderate NeuP symptom recognition. Regarding treatment preferences, avoiding a high risk of common side effects was the primary driver of choice (coefficient −1.744, 95% CI −1.820, −1.669), followed by the desire for strong scientific evidence (coefficient 1.237, 95% CI 1.182, 1.291). Apart from clinical attributes, participants showed significant cost sensitivity (coefficient −5.565, 95% CI −6.909, −4.221).

Interpretation

Despite a high prevalence of probable NeuP, poor symptom recognition creates a significant diagnostic challenge. Given that aversion to side effects is prioritized over other attributes, clinicians need to focus on tolerable anti-neuropathic agents and employ proactive side-effect management to optimize NeuP treatment adherence.