Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis.
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...Results: Search criteria identified three claims analyses and a modeling study that evaluated patients with NeP and/or FM with and without PA restrictions; three other studies included patients with FM and NeP in plans with ST requirements, and one evaluated a mail order requirement program....
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...Furthermore, some of the ST studies reviewed also showed increases in the utilization of TCAs, topical anesthetics, SNRIs [30], SSRIs [30, 32], non-opioid analgesics (including some nonsteroidal anti-inflammatory drugs [NSAIDs]) [31], and antiepileptic drugs aside from pregabalin [32], which included some medications without an indication for FM or NeP....
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...The Neuropathic Pain Special Interest Group of the IASP published recommendations for the treatment of chronic pain, in which they suggest that the potential long-term safety issues of opioids make them more suitable as second-line therapies for NeP only in patients who have not responded to first-line therapies [6, 7]....
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...(DOCX 12 kb) Additional file 2: Study quality of included studies based on the Newcastle-Ottawa Scale (DOC 78 kb) Abbreviations CDC: Centers for Disease Control and Prevention; CI: confidence interval; FM: fibromyalgia; HCU: healthcare utilization; IASP: International Association for the Study of Pain; IOM: Institute of Medicine; NeP: neuropathic pain; OR: odds ratio; PA: prior authorization; pDPN: painful diabetic peripheral neuropathy; PHN: postherpetic neuralgia; SNRIs: serotonin norepinephrine reuptake inhibitors; SSRI: selective serotonin reuptake inhibitors; ST: step therapy; TCA: tricyclic antidepressants Acknowledgements Medical writing support was provided by Ray Beck, Jr., PhD, of Engage Scientific Solutions and was funded by Pfizer....
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...One study estimated per patient annual costs of neuropathic pain (NeP) in the United States to be $6016 (direct costs to payers), $2219 (direct costs to patients), and $19,000 (indirect costs including lost productivity) [2]....
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