Oral or Topical Pain Therapy-How Would Patients Decide? A Discrete Choice Experiment in Patients with Peripheral Neuropathic Pain

Is the Capsaicin 179 mg (8% w/w) Cutaneous Patch an Appropriate Treatment Option for Older Patients with Peripheral Neuropathic Pain?

Introduction

Capsaicin 179 mg (8% weight per weight) cutaneous patch ("capsaicin patch") is a recommended topical treatment for peripheral neuropathic pain (PNP). In older patients, topical treatments may be preferred over systemic treatments, but data specific to the older population are scarce.

Methods

We conducted pooled analyses of multiple clinical trials to evaluate efficacy and safety of capsaicin patch in older patients. The analysis of efficacy included four randomized, double-blind, 12-week studies with similar trial design comparing a single treatment of capsaicin 179 mg cutaneous patch vs low-dose control patch in post-herpetic neuralgia. For the safety evaluation, data were pooled from 18 interventional studies in which capsaicin patch was used in PNP with varying etiologies.

Results

Capsaicin patch had similar analgesic efficacy in elderly (n=582) and non-elderly patients (n=545) in terms of change from baseline to 2-12 weeks in the 11-point numeric pain rating scale (NPRS) score for average pain over the previous 24 hours. In both age groups, decrease in NPRS score was significantly greater with capsaicin patch vs control. Older patients treated with capsaicin patch were significantly more likely than those in the control group to achieve responder status (ie mean decrease in NPRS score from baseline to week 2-12 of at least 30% or ≥2 points): 36.1% vs 27.1% (odds ratio [OR] [95% CI] 1.52 [1.06, 2.18]; P=0.0231) and 33.1% vs 20.9% (OR [95% CI] 1.90 [1.30, 2.78]; P=0.0009) for active treatment vs control group, respectively. Similar proportions of non-elderly patients (n=2,311) and elderly patients (n=537) treated with capsaicin patch experienced treatment-emergent adverse events (TEAEs) (81.6% and 78.1%, respectively) and serious TEAEs (8.2% and 7.2%), with application-site reactions the most common TEAEs in both groups.

Conclusion

The capsaicin patch was equally efficacious and well tolerated in older patients as in younger patients.

Public's preferences for health science popularization short videos in China: a discrete choice experiment

Background

Health science popularization short video disseminates health information to the public in an understandable way about health information.

Objective

To investigate the preferences of Chinese residents for health science popularization short videos and provide suggestions for optimizing the production of short videos.

Methods

An online survey of Chinese people was conducted using a self-administered questionnaire, and a discrete choice experiment (DCE) was used to explore the public's preferences for health science popularization short videos.

Results

A total of 618 respondents were included, of which 306 (45.51%) were male and 312 (50.49%) were female, 271 (43.85%) were aged 18-25, 239 (38.67%) were aged 26-60, and 108 (17.48%) were aged 60 and above. Whether the video is charged or not (46.891%) and the account subject (28.806%) were both considered important. The results of the DCE revealed that the participants considered video free of charge as the most significant attribute of health science popularization short videos (OR 3.433, 95% CI 3.243-3.633). Overall, participants preferred and were more willing to pay for health science popularization short videos with a hospital account subject (OR 1.192, 95% CI 1.116-1.274), with the form of graphic narration (OR 1.062, 95% CI 1.003-1.126), free of charge (OR 3.433, 95% CI 3.243-3.633), with the content that satisfies their needs (very much needed: OR 1.253, 95% CI 95% CI 1.197-1.311; generally needed: OR 1.078, 95% CI 1.029-1.129), with platform certification (OR 1.041, 95% CI 1.011-1.073), without commercial advertisements (OR 1.048, 95% CI 1.018-1.080), with simple-to-understand content (OR 1.071, 95% CI 1.040-1.104), and with video content that evokes fear or dread of illness in the viewer (OR 1.046, 95% CI 1.015-1.078).

Conclusion

Participants favor free health popularization short videos, which are hospital accounts, with content that is illustrated, understandable, meets their needs, and can serve as a warning. In the future, the production of health popularization short videos should focus on improving the diversity and relevance of video content, making it as easy to understand to achieve good science popularization effects.

Patient Preferences for Rescue Medications in the Treatment of Breakthrough Cancer Pain

OBJECTIVE

The discrete choice experiment (DCE) is conducted in this study to discuss Chinese cancer patients' risk-benefit preferences for rescue medications (RD) and their willingness to pay (WTP) in the treatment of breakthrough cancer pain (BTcP).

METHOD

Through literature reviews, specialist consultation, and patient surveys, this work finally included five attributes in the DCE questionnaire, i.e., the remission time of breakthrough pain, adverse reactions of the digestive system, adverse reactions of the neuropsychiatric system, administration routes, and drug costs (estimating patients' WTP). The alternative-specific conditional logit model is used to analyze patients' preferences and WTP for each attribute and its level and to assess the sociodemographic impact and clinical characteristics.

RESULTS

A total of 134 effective questionnaires were collected from January, 1 to April, 5 in 2022. Results show that the five attributes all have a significant impact on cancer patients' choice of "rescue medications" (P<0.05). Among these attributes, the remission time after drug administration (10.0; 95%CI 8.5-11.5) is the most important concern for patients, followed by adverse reactions of the digestive system (8.5; 95%CI 7.0-10.0), adverse reactions of the neuropsychiatric system (2.9; 95%CI 1.4-4.3), and administration routes (0.9; 95%CI 0-1.8). The respondents are willing to spend 1182 yuan (95%CI 605-1720 yuan) per month for "rescue medications" to take effect within 15 minutes and spend 1002 yuan (95%CI 605-1760 yuan) per month on reducing the incidence of drug-induced adverse reactions in the digestive system to 5%.

CONCLUSION

For Chinese cancer patients, especially those with moderate/severe cancer pain, the priority is to relieve the BTcP more rapidly and reduce adverse drug reactions more effectively. This study indicates these patients' expectations for the quick control of breakthrough pain and their emphasis on the reduction of adverse reactions. These findings are useful for doctors, who are encouraged to communicate with cancer patients about how to better alleviate the BTcP.

Localized peripheral neuropathic pain: topical treatment with lidocaine 700 mg medicated plaster in routine clinical practice

Aim: To provide real-world evidence for the effectiveness and tolerability of lidocaine 700 mg medicated plaster (LMP) in localized peripheral neuropathic pain (l-PNP) treatment compared with first-line oral medications (OM). Patients & methods: This was a noninterventional, retrospective 6-month cohort study in patients refractory to at least one recommended OM, using anonymized medical care data from the German Pain eRegistry. Treatment groups were matched by propensity scoring, considering seven predefined confounding factors. The primary effectiveness end point was the absolute change in average pain intensity index from baseline at weeks 4, 12 and 24 of treatment and over the treatment period. Results: A total of 3081 datasets were retained per treatment group. LMP provided superior pain reductions and significantly greater improvements in pain-related impairments of daily living and quality of life with significantly better tolerability (p < 0.001 for all parameters) than OM. Conclusion: These real-world data confirm the effectiveness and good tolerability of LMP for l-PNP treatment under routine medical care.