A lack of appropriate treatment for neuropathic and psychogenic pain may cause patients with musculoskeletal pain to suffer a more chronic pain course, according to the latest results of an ongoing Japanese epidemiological study.
“Lack of adequate assessment for neuropathic and psychogenic pain during the initial treatment of chronic musculoskeletal pain and the resultant absence of appropriate treatment seem to lead to ‘‘doctor shopping’’ by patients,” note lead author Masaya Nakamura (Keio University, Tokyo) and colleagues.
They also point out that awareness among patients about their condition seemed to be insufficient, with many deciding to discontinue treatment or not seeking help despite their pain having lasted for 3 years or more.
In a follow-up to surveys carried out in 2010 and 2011, 660 individuals identified as suffering from chronic musculoskeletal pain were sent postal questionnaires to determine basic demographic characteristics, the severity, location and duration of musculoskeletal pain and treatment choices. In addition, information was gathered about neuropathic pain using the PainDETECT score and psychogenic pain using the Hospital Anxiety and Depression scale (HADS) and the Pain Catastrophizing Scale (PCS).
Compared with the results of the last survey in 2011, 62% of 588 respondents continued to suffer from chronic musculoskeletal pain. Of these, 35% were still receiving treatment, although 53% had discontinued treatment. The remaining 12% had received no treatment.
Furthermore, the researchers found that 66% of subjects had changed the medical facility they visited to receive treatment at least once, with 18% of patients changing four times or more. The reasons given for this included “treatment was ineffective” and “I thought I could take care of it myself”.
In 20% of cases, PainDETECT scores were suggestive of the involvement of neuropathic pain, with the pain severity rating and the likelihood of changing medical facility increasing in line with these scores.
In terms of the contribution of psychogenic pain, Nakamura and co-workers found a weak but statistically significant correlation between scores on the PCS and pain severity, as rated on a visual analogue (VAS) scale. Patients identified as being anxious by the HADS also had higher VAS scores, whereas those who were classified as depressed did not, but did have a longer duration of pain.
“If treatment is provided in a manner tailored to the status of involvement of psychogenic pain rated by the HADS and PCS, it may become possible to reduce the intensity of pain and shorten the duration of pain”, the researchers write in the Journal of Orthopaedic Science.
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