5. Conclusion
neuropathies, neuropathic pain, subacute pain, pain
CHRONIC PAIN SYNDROMES, RECRUITMENT, NEUROPATHIES, SYNDROMES, CHRONIC PAIN
The participating pain centers considered low enrollment in the PELICAN study, mainly due to insufficient (timely) referral from primary healthcare providers and other specialties, to be the main issue leading to the study's premature cessation. Additionally, poor recruitment was also attributed to the too strict inclusion and exclusion criteria—limiting the inclusion of many patients with neuropathic pain. Third, the reimbursement of high-concentrated capsaicin patches, which was granted after the initiation of the PELICAN study, undoubtedly further reduced the inclusion rate. Patients opted for the reimbursement treatment option rather than going through the burden of the study protocol and uncertainty about the follow-up treatment after the study completion.Based on the findings of this qualitative study, 10 points should be considered important for health policy at the national level as well as for future studies within the specialism of pain treatment as follows:Topical treatment of localized neuropathies often remains (somewhat) unknown (thus, not considered in the treatment regimen).Topical treatment modalities are inadequately used in clinical practice because of reimbursement modalities. This has significantly hampered the introduction of such treatment modalities in routine clinical practice.Faster detection and referral of patients with LNP from primary healthcare providers or other medical specialties to specialized pain centers.Direct inclusion of patients from primary healthcare providers with the active participation of GPs in the development of protocols and recruitment.Training primary healthcare providers and physician specialists to make correct diagnoses (recognition of pain syndromes such as LNP).A better description of the distinction between subacute pain syndromes and chronic pain syndromes and possibly including the two separate cohorts in a future study protocol.Better support should be provided for pain centers with a less well-developed study team, with consideration given to possible financial reimbursement for nursing actions as part of the study.Fundamentally, the problem of an unbalanced focus on invasive treatment techniques versus pharmacological or noninvasive treatment options arises. This is undeniably linked to the underlying funding systems—or lack thereof.Further, simplified and rationalized digital platforms and tracking systems and accommodation of the still significant digitally illiterate group.Need for innovation in pain treatment. There is concern regarding the lack of development of new therapeutic agents or approaches to acute and chronic pain. Therefore, there is a lack of experience in performing applied research in pain centers.The findings of the qualitative study demonstrate the need for further, more varied LNP research in Belgium, not limited to pharmacological studies. It also sheds important light on the recruitment obstacles that may be faced during these studies, which can be overcome in subsequent research by using or at least considering some of the information presented in this paper. Support programs by study sponsors might be helpful for investigators involved in discontinued trials and promote transparency and learning lessons for future studies. Furthermore, our qualitative study explores the various methodologies that may help recruit patients and participants ahead of trials. Future studies may aid this research by offering better proposals for feasibility and recruitment, for instance, by designing and conducting a compelling pilot study or applying social media during the recruitment phase.