Identifying predictors of neuropathic pain medication prescribing, adherence, and discontinuation: a systematic review and meta-analysis
Discuss this preprint
Start a discussion What are Sciety discussions?Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background: Pharmacoepidemiological studies show that large proportions of people with neuropathic pain (NeuP) are not prescribed the medications recommended for NeuP, do not adhere well to these medications, and/or often discontinue the treatment within six months. Identifying what predicts these outcomes can inform a strategy to ensure that people with NeuP are prescribed recommended medication and continue their treatment when appropriate. Methods: We carried out a systematic review and meta-analysis to identify predictors of pain medication prescribing, adherence, and discontinuation in adults with NeuP. Electronic searches were conducted in Embase, PubMed, Web of Science, and CINAHL Plus. Results: We identified 69 relevant studies and divided them into non-mutually exclusive categories based on the outcomes they had investigated. There were 53 studies on prescribing, 14 on adherence, and 27 on discontinuation. Predictors associated with being prescribed recommended NeuP medications included having a mental health disorder, diabetes, and/or white ethnicity. Predictors associated with better adherence included being prescribed serotonin-norepinephrine reuptake inhibitors compared to gabapentinoids or tricyclic antidepressants; dose titration, and/or implementing a medicine reminder. Predictors associated with a higher likelihood of discontinuation included being prescribed tricyclic antidepressants rather than other antidepressants and/or having a combination of NeuP medications rather than monopharmacotherapy. Discussion: There is a need to focus on improving NeuP medication prescribing for ethnic minorities and people without diabetes. Adherence may be improved by using dose titration and/or a medicine reminder. Prescribing monopharmacotherapy rather than combination pharmacotherapy for NeuP may result in better treatment persistence. Systematic review protocol: PROSPERO CRD42023464307.
