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Open Access Highly Accessed Research article

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

Gillian C Hall1*, Steve V Morant2, Dawn Carroll3, Zahava L Gabriel3 and Henry J McQuay4

Author Affiliations

1 Grimsdyke House, Ravenscroft Park, London, EN5 4ND, UK

2 Independent Statistician, Hadenham, Bucks, UK

3 Outcomes Research and Evidence Based Medicine, Pfizer Ltd, Tadworth, UK

4 Emeritus Fellow Balliol College, University of Oxford, Oxford, UK

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BMC Family Practice 2013, 14:28  doi:10.1186/1471-2296-14-28

Published: 26 February 2013

Abstract

Background

This study updated our knowledge of UK primary care neuropathic pain incidence rates and prescribing practices.

Methods

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.

Results

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.

Conclusion

The 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.

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