LONG‑TERM OUTCOMES OF MULTIMODAL ANALGESIC STRATEGIES IN PATIENTS WITH CHRONIC NEUROPATHIC PAIN DISORDERS

Abstract

The effectiveness of multimodal analgesic interventions is not studied in a longitudinal study and chronic neuropathic pain is a significant clinical problem. It was a combination of efficacy, sustainability, safety and cost-effectiveness of multimodal regimens during the long-term in the vast array of etiologies of neuropathic pain. They have done a systematic review and meta-analysis of 47 articles (21 random controlled trials, 18 prospective cohorts, 8 retrospective analyses) that involved 8 342 patients suffering chronic neuropathic pain. The multimodal regimens might be characterized as applying two or more alternative regimens (pharmacological and/or non-pharmacological). The outcomes included intensity of pain, rate of respondents, indices of durability, safety, functionality and cost-effectiveness, 12-60 months follow-ups. Meta-analyses, random-effects meta-analysis and meta-regression as well as phenotypic subgroup analysis were performed.PGB+SNRI+SCS Multimodal regimens (triple and quadruple) were better at long-term effectiveness with PGB+SNRI+SCS regimen the most effective at reducing pain  and highest response rate (64.9) at 24 months. The durability analysis displayed that half-lives of impacts of intensive regimens were higher than those of the two combinations . The overall mean standardized difference between multimodal and monotherapy was found to be 0.68  with a great heterogeneity . Phenotype-treatment matching turned out to be the best response predictor . Regimens containing opioids showed less efficacy (lower efficacy at 12 months) and poorer safety profiles  The  regimen  was the one preferred in the cost effectiveness analysis due to the positive QALY changes , and decreased healthcare usage.The multimodal analgesic regimes and specifically those involving the interventional and non-pharmacological with a phenotype-based selection has improved and sustainable efficacies and is cost effective when it comes to long-term neuropathic pain. The index of phenotype-treatment match is another important aspect of the long-term success, that is why it is necessary to change the paradigm, based on the individual, phenotype-based multimodal strategies.