Harrisson, Sarah Anne ORCID: https://orcid.org/0000-0002-1304-3443 (2018) Epidemiology of neuropathic pain in primary care patients consulting with low back-related leg pain. Doctoral thesis, Keele University.

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Abstract

Neuropathic pain (pain caused by nerve damage) is considered challenging to manage. One of the most common neuropathic pain conditions is believed to be the presence of sciatica in low back-related leg pain (LBLP). A systematic review of the literature highlighted a paucity of evidence on the prevalence, characteristics and prognosis of LBLP patients with neuropathic pain in primary care. Epidemiological analysis used an existing prospective cohort (n=609) of LBLP patients consulting in primary care, including items from routine clinical examination and self-report at baseline, plus general practice electronic medical and prescribing records of patients with neuropathic pain. Cases of neuropathic pain were identified using three definitions, two based on clinical examination (with or without MRI), and one using the self-report Leeds Assessment for Neurological Symptoms and Signs (s-LANSS). Prevalence estimates varied from 48% to 74% according to definition. At baseline, patients with neuropathic pain (across three definitions) had higher leg pain intensity, poorer pain self-efficacy, more had pain below the knee and sensory loss based on findings from routine neurological examination. The clinical course (pain intensity and LBLP-related disability) of patients with neuropathic pain rapidly improved up to four months after initial consultation; the extent of improvement depended on case definition. The presence of neuropathic pain changed over time, remaining persistent in 16% over three years. The clinical course of patients with persistent neuropathic pain was worse compared to those with non-persistent neuropathic pain; there was no evidence that neurological examination items were associated with persistent neuropathic pain at four months. Pain medication was commonly prescribed to patients with neuropathic pain; 30% were prescribed neuropathic pain medication, patients improved with and without such medication. This thesis provides new evidence that challenges some commonly held perceptions about neuropathic pain, with clear implications for clinical practice and future research.

Item Type: Thesis (Doctoral)
Subjects: R Medicine > RC Internal medicine
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Lisa Bailey
Date Deposited: 07 Feb 2019 09:25
Last Modified: 07 Feb 2019 09:25
URI: http://eprints.keele.ac.uk/id/eprint/5778

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