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

• Published in: BMC family practice Vol. 14; no. 1; p. 28
• Main Authors: Hall, Gillian C, Morant, Steve V, Carroll, Dawn, Gabriel, Zahava L, McQuay, Henry J
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 26-02-2013; BioMed Central
• Subjects: Acetaminophen - therapeutic use; Adolescent; Adult; Aged; Amines - therapeutic use; Amitriptyline - therapeutic use; Analgesics, Non-Narcotic - therapeutic use; Analgesics, Opioid - therapeutic use; Anticonvulsants - therapeutic use; Antidepressants; Capsaicin - therapeutic use; Care and treatment; Child; Child, Preschool; Codeine - therapeutic use; Cyclohexanecarboxylic Acids - therapeutic use; Diabetic neuropathies; Diabetic Neuropathies - drug therapy; Diabetic Neuropathies - epidemiology; Drug Combinations; Drug Prescriptions - statistics & numerical data; Drug therapy; Epidemiology; Epilepsy; Family medicine; Female; Gabapentin; gamma-Aminobutyric Acid - therapeutic use; Health aspects; Health care; Humans; Hydrocodone - therapeutic use; Incidence; Infant; Male; Medical research; Medicine, Experimental; Middle Aged; Neuralgia, Postherpetic - drug therapy; Neuralgia, Postherpetic - epidemiology; Online databases; Pain; Pain management; Peripheral nerve diseases; Phantom Limb - drug therapy; Phantom Limb - epidemiology; Pharmaceutical industry; Practice Patterns, Physicians' - trends; Prescription writing; Primary care; Primary health care; Primary Health Care - trends; Sensory System Agents - therapeutic use; Statistics; United Kingdom - epidemiology; Young Adult; United Kingdom; United Kingdom > UK
• ISSN: 1471-2296; 1471-2296
• DOI: 10.1186/1471-2296-14-28

This study updated our knowledge of UK primary care neuropathic pain incidence rates and prescribing practices.
Patients 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.
The 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.
The UK incidence of diagnosed PHN has increased with the incidence of back-pain and post-operative pain unclear. While use of licensed 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.