Improving diagnosis and treatment of neuropathic pain in patients with cancer: The quality of national guidelines in Europe

Abstract

In Europe, from 19 to 39% of the patients with cancer pain suffer from neuropathic pain. This pain is difficult to relieve and needs a specific management. To guide practitioners, clinical practice guidelines (CPGs) can be proposed. The aim of this thesis is 1) to assess the quality of development of these European CPGs, 2) to compare diagnosis and treatment between CPGs with their evidence and 3) to evaluate the applicability of these CPGs in practice. All European CPGs about the management of neuropathic cancer pain were collected and assessed with AGREE II instrument to evaluate the quality development. Each reference mentioned in CPGs was registered and each recommendation was compared between CPGs. A case vignette on neuropathic cancer pain was proposed to evaluate the applicability of CPGs. Nine CPGs met the criteria in Europe. Applicability, rigor of development and editorial independence were low. Only 18% of the references collected concerned cancer population. No consensus was found about the diagnosis. Six of the 9 CPGs extrapolated results from non-cancer to cancer patients without reservations. Only 54% of the French pain specialists diagnosed and treated neuropathic pain in a case vignette on cancer. We advise more international central cooperation (clinicians and methodologists) for the development of a European CPG on neuropathic pain in cancer patients: it would help to pool resources into a high quality guideline module.