An observational descriptive study of the epidemiology and treatment of neuropathic pain in a UK general population

BMC Family Practice

Research Article

Henry J McQuay¹  Gillian C Hall²  Steve V Morant³  Dawn Carroll⁴  Zahava L Gabriel⁴ 

[1] Emeritus Fellow Balliol College, University of Oxford, Oxford, UK;Grimsdyke House, EN5 4ND, Ravenscroft Park, London, UK;Independent Statistician, Hadenham, Bucks, UK;Outcomes Research and Evidence Based Medicine, Pfizer Ltd, Tadworth, UK;

关键词: Neuropathic pain;    Incidence;    Post-herpetic neuralgia;    Painful diabetic neuropathy;    Phantom limb pain;    Treatment;    Antidepressant;    Antiepileptic;    Primary care;   

DOI  :  10.1186/1471-2296-14-28

 received in 2012-05-28, accepted in 2013-02-15,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundThis study updated our knowledge of UK primary care neuropathic pain incidence rates and prescribing practices.MethodsPatients with a first diagnosis of post-herpetic neuralgia (PHN), painful diabetic neuropathy (PDN) or phantom limb pain (PLP) were identified from the General Practice Research Database (2006 – 2010) and incidence rates were calculated. Prescription records were searched for pain treatments from diagnosis of these conditions and the duration and daily dose estimated for first-line and subsequent treatment regimens. Recording of neuropathic back and post-operative pain was investigated.ResultsThe study included 5,920 patients with PHN, 5,340 with PDN, and 185 with PLP. The incidence per 10,000 person-years was 3.4 (95% CI 3.4, 3.5) for PHN; and 0.11 (95% CI 0.09, 0.12) for PLP. Validation of the PDN case definition suggested that was not sensitive. Incident PHN increased over the study period. The most common first-line treatments were amitriptyline or gabapentin in the PDN and PLP cohorts, and amitriptyline or co-codamol (codeine-paracetamol) in PHN. Paracetamol, co-dydramol (paracetamol-dihydrocodeine) and capsaicin were also often prescribed in one or more condition. Most first-line treatments comprised only one therapeutic class. Use of antiepileptics licensed for neuropathic pain treatment had increased since 2002–2005. Amitriptyline was the only antidepressant prescribed commonly as a first-line treatment.ConclusionThe UK incidence of diagnosed PHN has increased with the incidence of back-pain and post-operative pain unclear. While use of licenced antiepileptics increased, prescribing of therapy with little evidence of efficacy in neuropathic pain is still common and consequently treatment was often not in-line with current guidance.

【 授权许可】

CC BY   
© Hall et al; licensee BioMed Central Ltd. 2013