1. 2025;28;E157-E164Neuropathic Pain Management in France: A Comparison of French Recommendations Using Case-Vignette Surveys
   Questionnaire
   Paul Elhomsy, MD, Stephane Sanchez, MD, Catherine Doussot, MD, and Philippe Rault, MD.

BACKGROUND: Despite the availability of clinical practice guidelines, suboptimal adherence among general practitioners (GPs) in pain management remains a concern. The French Pain Society issued revised guidelines for pain management in 2020.

OBJECTIVES: This study aimed to evaluate the current adherence of French doctors to the updated guidelines for pain management.

STUDY DESIGN: A non-interventional, cross-sectional study.

SETTING:  A panel of doctors from France, participated in an online questionnaire.

METHODS: Two selected vignettes describing patients with chronic neuropathic pain (central and peripheral) were completed. The ability to correctly prescribe appropriate first- and second-line treatments according to the 2020 French Pain Society guidelines was assessed.

RESULTS: A total of 191 physicians were recruited from a database of 3,380, representing a response rate of 5.7%. Of the participants, 182 (95.3%) completed the survey correctly and were included in the final analysis. Among those participants, 64% were general practitioners (GPs). Adherence to the guidelines for the management of l ocalized peripheral neuropathic pain was reported by 15.38% of participants, while 21% reported adherence for central neuropathic pain. A significant disparity was observed in the prescription of medications, with pregabalin being prescribed by 32.9% of participants and gabapentin by 22.5% for localized neuropathic pain. For central neuropathic pain, pregabalin use was reported by 30.7% of respondents and gabapentin by 26.3%. Following the failure of a second-line therapy, 66% of participants considered reorientation to be a viable treatment option for localized peripheral neuropathic pain, compared to 45% for central neuropathic pain.

LIMITATIONS: The number of participants is one of the main limitations in this study.

CONCLUSIONS: Despite the participants’ low adherence to guidelines, substantial variation in medication use, and limited support for reorientation after failed treatment, this study offers insight into management practices for neuropathic pain among French GPs in Burgundy.

KEY WORDS: Chronic pain, diagnosis, therapy, decision making, France, general practitioners, statistics & numerical data, guideline adherence, neuralgia, pain management