Adherence of French GPs to chronic neuropathic pain clinical guidelines: results of a cross-sectional, randomized, "e" case-vignette survey

• Published in: PloS one 2014-04, Vol.9 (4), p.e93855-e93855
• Main Authors: Martinez, Valéria, Attal, Nadine, Vanzo, Bertrand, Vicaut, Eric, Gautier, Jean Michel, Bouhassira, Didier, Lantéri-Minet, Michel
• Format: Article
• Language: English
• Subjects: Acetaminophen; Ambulatory care; Anesthesiology; Backache; Cancer; Cancer therapies; Care and treatment; Chronic pain; Chronic Pain - diagnosis; Chronic Pain - therapy; Clinical medicine; Clonazepam; Codeine; Cross-Sectional Studies; Data Collection; Decision Making; Diabetes mellitus; Diabetic neuropathy; Diagnostic software; Diagnostic systems; Duloxetine; Epidemiology; Etiology; Family physicians; France; General Practitioners - statistics & numerical data; Guideline Adherence - statistics & numerical data; Guidelines; Humans; Ibuprofen; Low back pain; Medical diagnosis; Medicine and Health Sciences; Neuralgia - diagnosis; Neuralgia - therapy; Neuropathy; Pain; Pain Management; Pain sensitivity; Participation; Physicians; Physicians (General practice); Practice guidelines (Medicine); Practice Guidelines as Topic; Random Allocation; Research and Analysis Methods; Studies; Surveys
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0093855

The French Pain Society published guidelines for neuropathic pain management in 2010. Our aim was to evaluate the compliance of GPs with these guidelines three years later. We used "e" case vignette methodology for this non interventional study. A national panel of randomly selected GPs was included. We used eight "e" case-vignettes relating to chronic pain, differing in terms of the type of pain (neuropathic/non neuropathic), etiology (cancer, postoperative pain, low back pain with or without radicular pain, diabetes) and symptoms. GPs received two randomly selected consecutive "e" case vignettes (with/without neuropathic pain). We analyzed their ability to recognize neuropathic pain and to prescribe appropriate first-line treatment. From the 1265 GPs in the database, we recruited 443 (35.0%), 334 of whom logged onto the web site (26.4%) and 319 (25.2%) of whom completed the survey. Among these GPs, 170 (53.3%) were aware of the guidelines, 136 (42.6%) were able to follow them, and 110 (34.5%) used the DN4 diagnostic tool. Sensitivity for neuropathic pain recognition was 87.8% (CI: 84.2%; 91.4%). However, postoperative neuropathic pain was less well diagnosed (77.9%; CI: 69.6%; 86.2%) than diabetic pain (95.2%; CI: 90.0%; 100.0%), cancer pain (90.6%; CI: 83.5%; 97.8%) and typical radicular pain (90.7%; CI: 84.9%; 96.5%). When neuropathic pain was correctly recognized, the likelihood of appropriate first-line treatment prescription was 90.6% (CI: 87.4%; 93.8%). The treatments proposed were pregabaline (71.8%), gabapentine (43.9%), amiptriptylline (23.2%) and duloxetine (18.2%). However, ibuprofen (11%), acetaminophen-codeine (29.5%) and clonazepam (10%) were still prescribed. The compliance of GPs with clinical practice guidelines appeared to be satisfactory, but differed between etiologies.