Characteristics of neuropathic pain in Indonesia: A hospital based national clinical survey

We conducted a hospital based study to collect data on the clinical characteristics of neuropathic pain (NP) patients in neurology outpatients in 13 big cities in Indonesia. We aimed to identify the clinical characteristics of NP among patients with the symptoms of pain. A simple questionnaire was conducted to explore the clinical symptoms and signs. Participants who reported of NP symptom was 1,779 (21.8%) among 8,160 patients. The higher prevalence of NP was reported in 41-60 years old (n= 1,030; 57.9%). It was more prevalent in male (n=1,104; 62.1%). The group of patients with low educational level has higher prevalence of pain with NP (n=1,177; 66.1%). There are five main clinical symptoms of NP patients, pinprick sensation (n=589; 33.1%), electric shock like sensation (n=542, 30.5%), burning (n=407, 22.9%), paresthesia (n=401; 22.5%) and hyperalgesia (n=351, 19.7%). In this study, NP was mostly associated with low back pain (n=509, 28,6%), carpal tunnel syndrome (n=343; 19.3%), frozen shoulder syndrome (n=191, 10.7%), diabetic neuropathy (n=170, 9.6%) and brachialgia (n=108, 6.1%). The most frequent modality to treat NP symptoms were adjuvant analgesics, antidepressants or anticonvulsants (n=1,199; 67.4%), non-steroidal anti-inflammatory drugs (n=1,177, 66.2%), non-opioids analgesics (n=606; 34.1%), non-pharmacological treatment (n=366; 20.6%) and opioid treatments (n=100, 5.6%). Neurology Asia 2015; 20(4) : 389 – 394 Address correspondence to: Thomas Eko Purwata, thomaseko2000@yahoo.com INTRODUCTION Indonesia is a big country with total population of 252,124,458 in 2014. Ratio of primary health clinic is 1.08 per 30,000 populations. Total number of hospital is 2,408 and ratio of beds was 1.07 per 1,000 populations. Total general practitioner was 40,787 and total specialist was 46,994. The health facility is not equally distributed. A new health system was implemented in Indonesia since 2013 termed Jaminan Kesehatan Nasional (National Health Insurance). In December 2014 total 53% populations were covered by the National Health Insurance, 1,613 (67%) hospitals were connected with the National Health Insurance. The referral health system is implemented in National Health System. Chronic Pain is the most common reason for visiting the outpatient clinic (number one of 10 common diseases) and pain is a common symptom that was referred to neurologist. Neuropathic pain (NP) is a common symptom in neurology clinics. It can have a significant impact on a person’s quality of life because of its chronicity and difficulty to treat. NP develops as a result of damage to, or dysfunction of the system that normally signals pain. It may arise from disorders that affect the peripheral and or central nervous systems. NP is very challenging to manage because of the heterogeneity of its etiologies, symptoms and underlying mechanisms. Major causes of NP include: diabetes, carpal tunnel syndrome, spinal cord injury, stroke, multiple sclerosis, cancer, and HIV infection, as well as common conditions, such as lumbar or cervical radiculopathies, and traumatic or postsurgical nerve injuries. Typical descriptions of the pain include terms such as shooting, stabbing, electric shock like sensation, burning, tingling, tight, numb, Neurology Asia December 2015 390 prickling, itchy and a sensation of pins and needles. People may also describe symptoms of allodynia (pain caused by a stimulus that normally does not provoke pain) and hyperalgesia (an increased response to a stimulus that is normally painful). NP is often difficult to treat, because it is resistant to many medications and/or because of the adverse effects associated with effective medications. Many people require treatment with more than one drug, but the correct choice of drugs, and the optimal sequence for their use, has been unclear. Clinicians may be guided by a number of published guidelines and algorithms for the management of NP, but these are not consistent regarding the choice of drug treatment. Some study showed the nonspecificities of NP pathophysiological mechanisms and its diagnostic underestimation, particularly in patients having no definite neurological condition. There have been considerable advances in the understanding of NP syndromes but there is still a lack of general epidemiological information. The exact prevalence of NP is not known. The large range of etiologies indicates that the prevalence of NP may be high in neurology clinics but the characteristics is still unclear. A review of the epidemiology of chronic pain found that there is still no accurate estimate available for the population prevalence of NP 6 Two populationbased studies from Europe reported the prevalence of pain of predominantly neuropathic origin or pain with neuropathic characteristics to be 8% and 7%, respectively. A German study reported that 37% of patients with prolonged low back pain had predominantly neuropathic pain. One major reason for the absence of hospitalbased epidemiologic data on NP was the lack of physician’s awareness, or simple clinical instrument that can identify the characteristics of NP. The aim of this study was to identify the most frequent clinical characteristic of NP among neurology outpatients who come with the symptoms of pain.