Xavier Moisset, M. Gabrielle Pagé, Bruno Pereira, Manon Choinière
{"title":"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。","authors":"Xavier Moisset, M. Gabrielle Pagé, Bruno Pereira, Manon Choinière","doi":"10.1002/ejp.70137","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Significance</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 10","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.70137","citationCount":"0","resultStr":"{\"title\":\"Patient Subgroups and Predictors of Improvement in Chronic Neuropathic Pain: A Trajectory-Based Analysis\",\"authors\":\"Xavier Moisset, M. 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Patient Subgroups and Predictors of Improvement in Chronic Neuropathic Pain: A Trajectory-Based Analysis
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.
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.