title: An observational descriptive study of the epidemiology and treatment of neuropathic pain in a UK general population.
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.
  
  
  CONCLUSIONS
  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.
authors: Grimsdyke House, Ravenscroft Park, London EN5 4ND, UK. gillian_hall@gchall.demon.co.uk
authors: Gillian C
authors: GC
authors: Hall
authors: Steve V
authors: SV
authors: Morant
authors: Dawn
authors: D
authors: Carroll
authors: Zahava L
authors: ZL
authors: Gabriel
authors: Henry J
authors: HJ
authors: McQuay
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000588:Amines / Q000627:therapeutic use; D000639:Amitriptyline / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D002211:Capsaicin / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003061:Codeine / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D003929:Diabetic Neuropathies / Q000188:drug therapy / Q000453:epidemiology*; D004338:Drug Combinations; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D000077206:Gabapentin; D006801:Humans; D006853:Hydrocodone / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D051474:Neuralgia, Postherpetic / Q000188:drug therapy / Q000453:epidemiology*; D010591:Phantom Limb / Q000188:drug therapy / Q000453:epidemiology*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011320:Primary Health Care / Q000639:trends*; D018689:Sensory System Agents / Q000627:therapeutic use; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000927:Anticonvulsants; D003509:Cyclohexanecarboxylic Acids; D004338:Drug Combinations; D018689:Sensory System Agents; C526278:acetaminophen, codeine drug combination; C083640:acetaminophen, hydrocodone drug combination; D000639:Amitriptyline; D000082:Acetaminophen; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D006853:Hydrocodone; D002211:Capsaicin; D003061:Codeine