Grimsdyke House, Ravenscroft Park, London EN5 4ND, UK.
BMC Fam Pract. 2013 Feb 26;14:28. 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.
本研究更新了我们对英国初级保健神经病理性疼痛发病率和处方实践的认识。
从全科医生研究数据库（2006-2010 年）中确定了带状疱疹后神经痛（PHN）、痛性糖尿病神经病变（PDN）或幻肢痛（PLP）的首次诊断患者，并计算了发病率。从这些疾病的诊断开始，搜索了疼痛治疗的处方记录，并估计了一线和后续治疗方案的持续时间和每日剂量。调查了神经性背痛和术后疼痛的记录。
本研究纳入了 5920 例 PHN 患者、5340 例 PDN 患者和 185 例 PLP 患者。PHN 的发病率为每 10000 人年 3.4（95%CI3.4，3.5）；PLP 的发病率为 0.11（95%CI0.09，0.12）。验证 PDN 的病例定义表明其敏感性不高。研究期间，PHN 的发病率逐渐增加。PDN 和 PLP 队列中最常见的一线治疗药物是阿米替林或加巴喷丁，而 PHN 中最常见的一线治疗药物是阿米替林或可待因（可待因-对乙酰氨基酚）。扑热息痛、可待因-对乙酰氨基酚和辣椒素也常被一种或多种疾病处方。大多数一线治疗只包含一种治疗类别。自 2002-2005 年以来，用于治疗神经病理性疼痛的抗癫痫药物的使用有所增加。阿米替林是唯一一种作为一线治疗药物常用的抗抑郁药。
英国诊断为 PHN 的发病率增加，而背痛和术后疼痛的发病率尚不清楚。尽管已批准的抗癫痫药物的使用有所增加，但在神经病理性疼痛方面疗效证据有限的治疗方法仍很常见，因此治疗通常不符合当前指南。
