The prevalence of probable neuropathic pain in the US: results from a multimodal general-population health survey

Marco D DiBonaventura, Alesia Sadosky, Kristen Concialdi, Markay Hopps, Ian Kudel, Bruce Parsons, Joseph C Cappelleri, Patrick Hlavacek, Andrea H Alexander, Brett R Stacey, John D Markman, John T Farrar, Marco D DiBonaventura, Alesia Sadosky, Kristen Concialdi, Markay Hopps, Ian Kudel, Bruce Parsons, Joseph C Cappelleri, Patrick Hlavacek, Andrea H Alexander, Brett R Stacey, John D Markman, John T Farrar

Abstract

Background: The prevalence of neuropathic pain (NeP) has been estimated within specific health conditions; however, there are no published data on its broad prevalence in the US. The current exploratory study addresses this gap using the validated PainDetect questionnaire as a screener for probable NeP in a general-population health survey conducted with a multimodal recruitment strategy to maximize demographic representativeness.

Materials and methods: Adult respondents were recruited from a combination of Internet panels, telephone lists, address lists, mall-based interviews, and store-receipt invitations using a random stratified-sampling framework, with strata defined by age, sex, and race/ethnicity. Older persons and minorities were oversampled to improve prevalence estimates. Results were weighted to match the total adult US population using US Census data. Demographic information was collected, and respondents who experienced physical pain in the past 12 months completed the PainDetect and provided additional pain history. A cutoff score of 19 or greater on the PainDetect was used to define probable NeP.

Results: A total of 24,925 respondents (average response rate 2.5%) provided demographic data (52.2% female, mean age 51.5 years); 15,751 respondents reported pain (63.7%), of which 2,548 (15.7%, 95% confidence interval 14.9%-16.5%) had probable NeP based on the PainDetect, which was 10% (95% confidence interval 9.5%-10.5%) of all respondents. Among those reporting pain, the prevalence of probable NeP among Blacks and Hispanics was consistently higher than Whites in each age- and sex group. The highest prevalence among those with pain was among male Hispanics 35-44 years (32.4%) and 45-54 years (24.2%) old. The most commonly used medications reported by those with probable NeP were nonsteroidal anti-inflammatory drugs (44.2%), followed by weak opioids (31.7%), antiepileptics (10.9%), and strong opioids (10.9%).

Conclusion: This is the first study to provide an estimate of the prevalence of probable NeP in the US, showing significant variation by age and ethnicity.

Keywords: epidemiology; neuropathic pain; pain types; prevalence.

Conflict of interest statement

Disclosure AS, MH, BP, JCC, and PH are employees of Pfizer Inc. AHA was employed by Pfizer Inc during and after completion and submission of this study. KC and IK are employees of Kantar Health, which was paid by Pfizer for study design, execution, analysis, and manuscript development. MDD was an employee of Kantar Health at the time of this study. BRS, JDM, and JTF were investigators for the study. They were not financially compensated for their collaborative efforts or publication-related activities, but JTF and JDM have previously served as study design consultant for Pfizer and have received investigator initiated grant funding for studies of pain unrelated to this study. JDM has received research funding from Pfizer for clinical research unrelated to this study. The authors report no other conflicts of interest of this work.

Figures

Figure 1
Figure 1
Study flowchart. Notes: *Weighted data represent the frequency of the sample data after applying sampling weights, which were calculated by incorporating the age, sex, and race/ethnicity of the respondents. The US population is based on the most recent Current Population Survey (June 2015) conducted by the US Census Bureau. **Based on the self-reported question, “Have you experienced any physical pain in the last 12 months?” Patients who responded “Yes” were categorized as having pain for this study. Uppercase N refers to the US population, while lowercase n refers to the sample. Abbreviation: NeP, neuropathic pain.
Figure 2
Figure 2
Distribution of PainDetect scores among those with pain (n=15,749). Notes: Higher scores indicate increased likelihood of neuropathic pain. Respondents who did not self-report experiencing any pain in the past 12 months did not complete the PainDetect (n=9,174). Two respondents with pain in the past 12 months did not complete the PainDetect, and were not included in the PainDetect analyses.
Figure 3
Figure 3
Heat map of the weighted prevalence of probable neuropathic pain, based on the PainDetect, among those with pain by demographic strata.
Figure 4
Figure 4
Weighted comorbidity-prevalence estimates among respondents with probable NeP and respondents with pain but unlikely NeP. Notes: Error bars indicate 95% confidence intervals. Abbreviations: COPD, chronic obstructive pulmonary disease; GERD, gastroesophageal reflux disease; IBS, irritable bowel syndrome; MS, multiple sclerosis; NeP, neuropathic pain; RLS, restless leg syndrome; RA, rheumatoid arthritis; TIA, transient ischemic attack.
Figure 5
Figure 5
Weighted pain-type prevalence among respondents with probable NeP and respondents with pain but unlikely NeP. Notes: Percentage based on those who self-reported having diabetes. Error bars indicate 95% confidence intervals. All pain types were significantly different between groups, with the exception of “Other” (P=0.062). Abbreviation: NeP, neuropathic pain.

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Source: PubMed

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