The prevalence of neuropathic pain approaches 10% in Canada and the United States. Given the aging population and the increasing survival rates following interventions for neuropathic pain, the prevalence of neuropathic pain conditions is expected to rise significantly over the next 20 years. Although pharmacological interventions represent the dominant treatment approach for neuropathic pain, as many as 50% of patients are partially or completely refractory to the available treatments. Pain catastrophizing has been associated with heightened pain experiences in patients with neuropathic pain conditions; however, the clinical relevance of the relationship between catastrophizing and poor treatment outcomes is, to date, unclear. Accordingly, using a numerical rating scale, this study aimed to examine this relationship in patients with varied neuropathic pain conditions who completed a measure of catastrophizing before initiating a course of topical analgesic.BACKGROUND: Previous research suggests that high levels of pain catastrophizing might predict poorer response to pharmacological interventions for neuropathic pain.OBJECTIVE: The present study sought to examine the clinical relevance of the relation between catastrophizing and analgesic response in individuals with neuropathic pain. Clinically meaningful reductions were defined in terms of the magnitude of reductions in pain through the course of treatment, and in terms of the number of patients whose end-of-treatment pain ratings were below 4/10.METHODS: Patients (n=82) with neuropathic pain conditions completed a measure of pain catastrophizing at the beginning of a three-week trial examining the efficacy of topical analgesics for neuropathic pain.RESULTS: Consistent with previous research, high scores on the measure of pain catastrophizing prospectively predicted poorer response to treatment. Fewer catastrophizers than noncatastrophizers showed moderate (≥2 points) or substantial reductions in pain ratings through the course of treatment. Fewer catastrophizers than noncatastrophizers achieved end-of-treatment pain ratings below 4/10.CONCLUSIONS: The results of the present study suggest that the development of brief interventions specifically targeting catastrophic thinking might be useful for enhancing the effects of pharmacological interventions for neuropathic pain. Furthermore, failure to account for the level of catastrophizing might contribute to null findings in clinical trials of analgesic medication.

中文翻译：

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疼痛的突变预测神经性疼痛患者对局部镇痛药的不良反应

在加拿大和美国，神经性疼痛的患病率接近10％。考虑到人口老龄化和神经性疼痛干预后生存率的提高，预计在未来20年内神经性疼痛状况的患病率将显着上升。尽管药理学干预代表了神经性疼痛的主要治疗方法，但多达50％的患者对可用治疗有部分或完全难治性。疼痛的灾难性发作与神经性疼痛患者的疼痛经历增加有关。然而，迄今为止，灾难性和不良治疗结果之间关系的临床相关性尚不清楚。因此，使用数字评分量表，这项研究的目的是检查具有多种神经病理性疼痛状况的患者之间的这种关系，这些患者在开始局部镇痛之前已完成了一定程度的灾难性治疗。目的：本研究旨在探讨神经性疼痛患者的灾难性和镇痛反应之间的关系的临床相关性。根据治疗过程中疼痛减轻的幅度以及治疗结束时疼痛评分低于4/10的患者人数来定义具有临床意义的减轻疼痛的方法。在为期三周的试验开始时，患有神经性疼痛状况的患者（n = 82）完成了一项疼痛灾难性评估，研究了局部镇痛药对神经性疼痛的疗效。结果：与先前的研究一致，在疼痛灾难性评估方面得分高前瞻性地预测对治疗的反应较差。在整个治疗过程中，相比于非灾难性疾病，更少的灾难性疾病表现出中度（≥2分）或显着降低的疼痛评级。相比于非灾难性疾病，难治性病患者的治疗终末疼痛评分低于4/10。结论：本研究的结果表明，针对灾难性思维的简短干预措施的开发可能对增强针对神经性疼痛的药物干预措施的效果有用。此外，