Prescription Trends and Clinical Decision-Making in Neuropathic Pain Pharmacological Treatment: Results From a Cross-Sectional Survey by the Spanish Pain Society - PubMed

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Neuropathic pain (NP) is a complex chronic condition with limited therapeutic effectiveness.
A nationwide cross-sectional survey was conducted among members of the Spanish Pain Society in May 2025.
220 pain specialists participated, with 52% female and 28% having over 20 years of experience.
Satisfaction with current pharmacological options was modest, with 52% reporting dissatisfaction or indifference.
Prescribing was mainly guided by clinical experience (43%) and guideline recommendations (36%).
Gabapentin (45%) and pregabalin (40%) were the most frequent first-line choices.
Tramadol dominated second-line use (65%), followed by capsaicin (22%) or lidocaine (5%) patches.
Half of the participants reported tolerance, typically after 3-12 months, managed by dose escalation or switching drug classes.
Dosage practices showed marked heterogeneity, with frequent deviations from recommended titration protocols.
NP management in Spain shows variability and partial alignment with international guidelines.
Gabapentinoids, tricyclic antidepressants, and duloxetine remain preferred treatments.
Reliance on personal experience and awareness of tolerance hinder evidence-based practice.
The survey highlights the need for national consensus, better dosing education, and further research.

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