The management of chronic pain in particular neuropathic pain remains extremely difficult. Regarding neuropathic pain, the outcomes of clinical trials have generally shown modest efficacy, with NNTs for 50% pain relief ranging from 6 to 8 for positive studies in one of the latest meta-analyses of neuropathic pain (eg Lancet Neurol 2015). It has been proposed that a more appropriate therapeutic approach should include stratification of patients according to clinical phenotypes (e.g. signs and symptoms) whereas most trials have classified patients based on aetiology. This has to be viewed in the more general context of personalized medical care, i.e. the most effective and tolerable treatment are adapted to patients individual needs (Nature Disease Primer, fev 2017).
Do you think that this approach is premature in pain management ? Do you take into account patients reported outcomes such as signs and symptoms to attempt a more rationale use of drug or non drug therapy in pain patients ?
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