Abstract
BackgroundBetween 1992 and 2001 the UK general practice incidence of post-herpetic neuralgia and trigeminal neuralgia declined, whilst the incidence of painful diabetic neuropathy increased. The most common first line treatments were compound analgesics. As therapeutic options have subsequently changed, this study presents updated data on incidence and prescribing patterns in neuropathic pain.MethodsA descriptive analysis of the epidemiology and prescription treatment at diagnosis of incident post-herpetic neuralgia (n = 1,923); trigeminal neuralgia (1,862); phantom limb pain (57) and painful diabetic neuropathy (1,444) using computerised UK general practice records (THIN): May 2002 to July 2005.ResultsPrimary care incidences per 100,000 person years observation of 28 (95% confidence interval (CI) 27–30) for post-herpetic neuralgia, 27 (95%CI 26–29) for trigeminal neuralgia, 0.8 (95%CI 0.6–1.1) for phantom limb pain and 21 (95%CI 20–22) for painful diabetic neuropathy are reported. The most common initial treatments were tricyclic antidepressants (post-herpetic neuralgia) or antiepileptics (trigeminal neuralgia and painful diabetic neuropathy) and opioid analgesics (phantom limb pain). The mean number of changes before a stable drug regimen was 1.2 to 1.5 for trigeminal neuralgia, painful diabetic neuropathy and post-herpetic neuralgia, and 2.4 for phantom limb pain.ConclusionThe incidence of phantom limb pain and post-herpetic neuralgia are decreasing whilst painful diabetic neuropathy plateaued and trigeminal neuralgia remained constant. Despite more frequent use of antidepressants and antiepileptics for first line treatment, as opposed to conventional non-opioid analgesics, changes to therapy are common before a stable regimen is reached.
Highlights
Between 1992 and 2001 the United Kingdom (UK) general practice incidence of post-herpetic neuralgia and trigeminal neuralgia declined, whilst the incidence of painful diabetic neuropathy increased
There were 1,923 incident cases of post-herpetic neuralgia, incidence 28.2 per 100,000 person years and 1,862 cases of trigeminal neuralgia, incidence 27.3 and 57 of phantom limb pain, incidence 0.8
The incidence of painful diabetic neuropathy was 27.2, n = 1,867, and 26.1 per 100,000 person years when the stricter definition was used excluding those whose pain treatment did not start at the time of the first diagnosis record
Summary
Between 1992 and 2001 the UK general practice incidence of post-herpetic neuralgia and trigeminal neuralgia declined, whilst the incidence of painful diabetic neuropathy increased. As therapeutic options have subsequently changed, this study presents updated data on incidence and prescribing patterns in neuropathic pain. One UK General Practice Research Database study investigated the epidemiology and treatment of four neuropathic pain syndromes; post-herpetic neuralgia, trigeminal neuralgia, phantom limb pain and painful diabetic neuropathy [8]. Data from 1992 to 2002 showed trends in incidence of disease, with painful diabetic neuropathy and trigeminal neuralgia increasing over the ten years while post-herpetic neuralgia and phantom limb pain decreased. Within the more commonly prescribed therapies, those patients who received an antiepileptic or an antidepressant at the time of diagnosis were shown to be less likely to switch therapy
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