{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T05:54:03Z","timestamp":1781243643620,"version":"3.54.1"},"reference-count":48,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Neuropathic pain (NP) is a complex chronic condition with limited therapeutic effectiveness. Despite multiple drug classes and international guidelines, real\u2010world adherence remains inconsistent, and data on prescribing practices among pain specialists is scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a nationwide cross\u2010sectional survey among members of the Spanish Pain Society in May 2025. A structured 62\u2010item questionnaire assessed prescribing habits, decision\u2010making criteria, guideline adherence, dosage patterns, and the recognition and management of tolerance. Sociodemographic and professional data were also collected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 220 pain specialists (52% female) completed the survey; 28% had over 20\u2009years of clinical 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\u2010line choices, followed by tricyclic antidepressants (amitriptyline; 9%), duloxetine (5%) and venlafaxine (1%). Tramadol dominated second\u2010line use (65%), followed by capsaicin (22%) or lidocaine (5%) patches. Half of the participants reported tolerance, typically after 3\u201312\u2009months, managed mainly by dose escalation or switching drug classes. Dosage practices for gabapentinoids and antidepressants showed marked heterogeneity, with frequent deviations from recommended titration protocols.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>NP management in Spain shows variability and partial alignment with international guidelines. Gabapentinoids, tricyclic antidepressants and duloxetine remain preferred treatments, but reliance on personal experience and awareness of tolerance hinder evidence\u2010based practice. Quantifying Spanish pain specialists' views on tolerance supports calls for national consensus, better dosing education and further research to harmonise care and improve outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>This nationwide survey provides the first systematic assessment of neuropathic pain management in Spain, revealing marked variability, only partial adherence to international guidelines, and persistent reliance on clinical experience over evidence. It confirms gabapentinoids, tricyclic antidepressants and duloxetine as preferred treatments, identifies continued tramadol use despite conflicting recommendations, and quantifies for the first time clinicians' perception and management of tolerance. These findings fill a major evidence gap and directly inform future national consensus, educational initiatives and clinical practice improvement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejp.70246","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T04:39:46Z","timestamp":1773203986000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prescription Trends and Clinical Decision\u2010Making in Neuropathic Pain Pharmacological Treatment: Results From a Cross\u2010Sectional Survey by the Spanish Pain Society"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2842-0085","authenticated-orcid":false,"given":"Miguel \u00c1.","family":"Huerta","sequence":"first","affiliation":[{"name":"Neuropathic Pain Working Group Spanish Society of Pain (GTDN\u2010SED)  Madrid Spain"},{"name":"Department of Pharmacology University of Granada  Granada Spain"},{"name":"Biosanitary Research Institute ibs.GRANADA  Beiro (Granada) Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8883-8673","authenticated-orcid":false,"given":"M\u00f3nica","family":"Mayo\u2010Moldes","sequence":"additional","affiliation":[{"name":"Neuropathic Pain Working Group Spanish Society of Pain (GTDN\u2010SED)  Madrid Spain"},{"name":"Pain Unit, Service of Anaesthesiology and Resuscitation, University Hospital Complex of Vigo Galician Healthcare Service (SERGAS)  Vigo Pontevedra Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6910-0494","authenticated-orcid":false,"given":"Miguel M.","family":"Garcia","sequence":"additional","affiliation":[{"name":"Neuropathic Pain Working Group Spanish Society of Pain (GTDN\u2010SED)  Madrid Spain"},{"name":"Area of Pharmacology, Nutrition and Bromatology, Department of Basic Health Sciences, Unidad Asociada de I+D+i al Instituto de Qu\u00edmica M\u00e9dica (IQM) CSIC\u2010URJC Universidad Rey Juan Carlos  Alcorc\u00f3n (Madrid) Spain"},{"name":"High Performance Experimental Pharmacology Research Group Universidad Rey Juan Carlos (PHARMAKOM)  Alcorc\u00f3n (Madrid) Spain"},{"name":"High Performance Environmental Risk for Health and the Environment Research Group Universidad Rey Juan Carlos (RIsAMa)  Alcorc\u00f3n (Madrid) Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4458-2711","authenticated-orcid":false,"given":"Beliu","family":"Garc\u00eda\u2010Parra","sequence":"additional","affiliation":[{"name":"Neuropathic Pain Working Group Spanish Society of Pain (GTDN\u2010SED)  Madrid Spain"},{"name":"Clinical Neurophysiology Section, Neurology Service, Hospital Universitari de Bellvitge Universitat de Barcelona\u2010Health Campus, IDIBELL  L'Hospitalet de Llobregat (Barcelona) 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Universidad Rey Juan Carlos (NEUGUT)  Alcorc\u00f3n (Madrid) Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6121-4446","authenticated-orcid":false,"given":"Nancy","family":"Paniagua","sequence":"additional","affiliation":[{"name":"Neuropathic Pain Working Group Spanish Society of Pain (GTDN\u2010SED)  Madrid Spain"},{"name":"Area of Pharmacology, Nutrition and Bromatology, Department of Basic Health Sciences, Unidad Asociada de I+D+i al Instituto de Qu\u00edmica M\u00e9dica (IQM) CSIC\u2010URJC Universidad Rey Juan Carlos  Alcorc\u00f3n (Madrid) Spain"},{"name":"High Performance Experimental Pharmacology Research Group Universidad Rey Juan Carlos (PHARMAKOM)  Alcorc\u00f3n (Madrid) 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Madrid Spain"},{"name":"Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences Universitat de Girona  Girona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8965-8815","authenticated-orcid":false,"given":"Jos\u00e9 A.","family":"Valencia","sequence":"additional","affiliation":[{"name":"Neuropathic Pain Working Group Spanish Society of Pain (GTDN\u2010SED)  Madrid Spain"},{"name":"Service of Anaesthesia, Reanimation and Pain Treatment Hospital General Universitario Reina Sof\u00eda de Murcia  Murcia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4697-8819","authenticated-orcid":false,"given":"Silvia","family":"Pico","sequence":"additional","affiliation":[{"name":"Neuropathic Pain Working Group Spanish Society of Pain (GTDN\u2010SED)  Madrid Spain"},{"name":"Pain Unit Hospital Universitario Rio Hortega  Valladolid 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