167: Factors associated with unsuccessful treatment outcomes in individuals with neuropathic pain

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic neuropathic pain, Pharmacological treatments, Treatment/management

Background and Aims: Neuropathic pain is generally more challenging to manage than other chronic pain conditions, and treatment success rates remain suboptimal. While prior studies have provided insights into chronic pain, data specifically identifying factors associated with outcomes in neuropathic pain are limited. The primary objective of this study was to determine risk factors associated with unsuccessful outcomes in patients with neuropathic pain. Secondary objectives were to evaluate overall treatment effectiveness and to determine the incidence of treatment-related adverse events.

Methods: This prospective cohort study included 205 participants who underwent clinical assessments and completed self-reported questionnaires at baseline and at 3, 6, 9, 12, 18, and 24 months. Data were obtained from the neuropathic pain registry and included adults aged ≥18 years with a diagnosis of neuropathic pain who attended a tertiary pain clinic and completed the study questionnaires. Logistic regression was used to evaluate associations between potential risk factors and unsuccessful treatment outcomes. Adverse events were also recorded.

Results: Among 205 patients, 145 (71%) achieved successful outcomes and 60 (29%) did not. Unsuccessful outcomes were independently associated with NSAIDs (adjusted odds ratio 17.10; 95%CI 2.64–110.92), clonazepam (9.81; 95%CI 1.89–50.97), strong opioids (9.16; 95%CI 1.18–70.98), weak opioids (4.83; 95%CI 1.11–21.04), and pregabalin (3.66; 95%CI 1.57–8.52). Higher baseline Brief Pain Inventory scores predicted success (0.97; 95%CI 0.95–0.99). Age, pain duration, baseline intensity, DN4, psychological factors, quality of life, and pain self-efficacy were not associated with outcome. Constipation and somnolence were the most frequent adverse events without between-group differences.

Conclusions: Several medications commonly prescribed for neuropathic pain were associated with unsuccessful outcomes. These findings underscore the need for individualized treatment strategies and careful reassessment of potentially modifiable factors, including dose reduction or discontinuation of agents linked to unfavorable responses.

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Presenting Author: Pramote Euasobhon
Submitting Author: Pramote Euasobhon

Senior Author: Pramote Euasobhon

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Natcha Khamthed: M.D. - Siriraj Hospital