S-LANSS informed review of pregabalin prescribing for pain

Background
S-LANSS score

The S-LANSSscore, a self-report version of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale,aims toidentify pain of predominantly neuropathic origin, as distinct from nociceptive pain, without the needfor clinical examination.

The S-LANSS score has been shown to be a valid andreliable self-complete instrument for identifying neuropathic pain (NP) in both clinic-based and postal research[1]: it is the tool for assessing NP that has been agreed locally in Doncaster.

Pain management

Pregabalin is one of four first-line options, which the National Institute for Health and Care Excellence(NICE) recommend are offered for the treatment of NP (except trigeminal neuralgia).[2]Pregabalin is third line in the Doncaster and Bassetlaw Primary Care Neuropathic Pain Management Guidance. [3]

Pregabalin [unlicensed] is an established part of the pharmacological repertoire of fibromyalgia management.[4]

Public Health England (PHE) suggests that when pregabalin is prescribed for NP or fibromyalgia and treatment is successful, there should be a reduction on an annual basis to ascertain ongoing effectiveness.4

There is little evidence to support the prescription of pregabalin off-label for
non-neuropathic pain syndromes and PHE recommend that prescribers should consider interventions more likely to help such as physical rehabilitation for back pain and musculoskeletal pain.4

Tapering scheme

PHE suggest reducing the daily dose of pregabalin at a maximum of
50-100mg/week.4

Renal impairment

The dose of pregabalin should be reduced in renal impairment.[5]

Aims

  • Improve painmanagement
  • Reduce inappropriate prescribing of pregabalin
  • Better understand the potential for S-LANSStoinform pain management in general practice
  • Monitor the impact of S-LANSS informed review of pregabalin prescribing for pain on prescribing costs.

Process

Identify patient cohort

  • Create a search to identify patients over 18 years who have a current repeat prescription for pregabalin (Lyrica)prescribed for over one year e.g. 12 or more issues.
  • Exclude patients with a read code for Epilepsy
  • Exclude patients with indications other than pain e.g. generalised anxiety disorder

S-LANSS

  • Post S-LANSS questionnaires with explanatory letter.

Data collection

Data should be inputted electronically.

Collect data for all patients4 weeks after posting S-LANSS questionnaires: please refer to Excel spreadsheet.

Follow-up

Assess the response rate at 4 weeks: (number ofS-LANSS questionnaires returned/number ofS-LANSS questionnaires sent) x100.

Optional follow-up

Repeat the process at month six and with reference to Excel spreadsheet calculate(for the baseline cohort):

  • Change in visual analogue score (VAS).
  • Change in number of patients with S-LANSS 11 or less prescribed pregabalin
  • Change in number of patients prescribed pregabalin for non-neuropathic pain syndromes

Success indicators:

Reduction in VAS score

Reduction in number of patients with S-LANSS 11 or less prescribed pregabalin

Reduction in number of patients prescribed pregabalin for non-neuropathic pain syndromes

Pregabalin cost/PU: please refer to Neuropathy reports available from the General Prescribing Documents section of thePBCi Portal.

References

Author: Sally Porter Checked by: Victoria Walmsley

Authorised By: Mark Randerson Date: September 2015

Review Date: N/A

Version: V1.0

Document in Pregabalin _more amendments.docx

[1] Bennett MI, Smith BH, Torrance N et al. The S-LANSS Score for Identifying Pain of Predominantly Neuropathic Origin: Validation for Use in Clinical and Postal Research.The Journal of Pain 2005; 6 (3): 149-158.

[2] National Institute for Health and Care Excellence. Neuropathic pain - pharmacological management (CG173). Available at:

[3] Doncaster and Bassetlaw Primary Care Neuropathic Pain Management Guidance. Accessed from:

[4] Public Health England. Advice for prescribers on the risk of the misuse of pregabalin and gabapentin. December 2014. Accessed from:

[5]British National Formulary. Online Edition July 2015. UK. Accessed 22 July 2015.