Most patients with neuropathic pain symptoms present and are managed in primary care, with only a minority being referred for specialist clinical assessment and diagnoses. Previous reviews have focused mainly on specific neuropathic pain conditions based in specialist settings. This is the first systematic review of epidemiological studies of neuropathic pain in the general population. Electronic databases were searched from January 1966 to December 2012, and studies were included where the main focus was on neuropathic pain prevalence and/or incidence, either as part of a specific neuropathic pain-related condition or as a global entity in the general population. We excluded studies in which data were extracted from pain or other specialist clinics or focusing on specific population subgroups. Twenty-one articles were identified and underwent quality assessment and data extraction. Included studies differed in 3 main ways: method of data retrieval, case ascertainment tool used, and presentation of prevalence/incidence rates. This heterogeneity precluded any meta-analysis. We categorised comparable incidence and prevalence rates into 2 main subgroups: (1) chronic pain with neuropathic characteristics (range 3–17%), and (2) neuropathic pain associated with a specific condition, including postherpetic neuralgia (3.9–42.0/100,000 person–years [PY]), trigeminal neuralgia (12.6–28.9/100,000 PY), painful diabetic peripheral neuropathy (15.3–72.3/100,000 PY), glossopharyngeal neuralgia (0.2–0.4/100,000 PY). These differences highlight the importance of a standardised approach for identifying neuropathic pain in future epidemiological studies. A best estimate of population prevalence of pain with neuropathic characteristics is likely to lie between 6.9% and 10%.

/pdf/neuropathic-pain-in-the-general-population-a-systematic-y9gq8optf0.pdf

Neuropathic pain in the general population: A systematic review of epidemiological studies

Multimorbidity in General Practice: Prevalence, Incidence, and Determinants of Co-Occurring Chronic and Recurrent Diseases

Background: As a result of increasing urbanisation, people face the prospect of living in environments with few green spaces. There is increasing evidence for a positive relation between green space in people’s living environment and self-reported indicators of physical and mental health. This study investigates whether physicianassessed morbidity is also related to green space in people’s living environment. Methods: Morbidity data were derived from electronic medical records of 195 general practitioners in 96 Dutch practices, serving a population of 345 143 people. Morbidity was classified by the general practitioners according to the International Classification of Primary Care. The percentage of green space within a 1 km and 3 km radius around the postal code coordinates was derived from an existing database and was calculated for each household. Multilevel logistic regression analyses were performed, controlling for demographic and socioeconomic characteristics. Results: The annual prevalence rate of 15 of the 24 disease clusters was lower in living environments with more green space in a 1 km radius. The relation was strongest for anxiety disorder and depression. The relation was stronger for children and people with a lower socioeconomic status. Furthermore, the relation was strongest in slightly urban areas and not apparent in very strongly urban areas. Conclusion: This study indicates that the previously established relation between green space and a number of self-reported general indicators of physical and mental health can also be found for clusters of specific physicianassessed morbidity. The study stresses the importance of green space close to home for children and lower socioeconomic groups.

/pdf/morbidity-is-related-to-a-green-living-environment-4mcjwobkbe.pdf

Morbidity is related to a green living environment

Use and expenditure on complementary medicine in England: a population based survey

Objectives: To examine the effect of patients9 expectations for medication and doctors9 perceptions of patients9 expectations on prescribing when patients present with new conditions. Design: Questionnaire study of practitioners and patients. Setting: General practice in Newcastle, Australia. Subjects: 22 non-randomly selected general practitioners and 336 of their patients with a newly diagnosed medical condition. Main outcome measures: Prescription of medication and expectation of it. Results: Medication was prescribed for 169 (50%) patients. After controlling for the presenting condition, patients who expected medication were nearly three times more likely to receive medication (odds ratio=2.9, 95% confidence interval 1.3 to 6.3). When the general practitioner thought the patient expected medication the patient was 10 times more likely to receive it (odds ratio=10.1, 5.3 to 19.6). A significant association existed between patients9 expectation and doctors9 perception of patients9 expectation (χ2=52.0, df=4, P=0.001). For all categories of patient expectation, however, patients were more likely to receive medication when the practitioner judged the patient to want medication than when the practitioner ascribed no expectation to the patient. Conclusions: Although patients brought expectations to the consultation regarding medication, the doctors9 opinions about their expectations were the strongest determinants of prescribing. Key messages This study showed that patients who expected medications were three times more likely to be prescribed medicines for new conditions If the general practitioner thought that the patient expected medication, patients were ten times more likely to be prescribed medication Although patients brought expectations to the consultation regarding medication, it was the doctors9 opinions about patients9 expectations that were the strongest determinants of prescribing With the increasing promotion of rational prescribing, practitioners need to be aware of these influences on prescribing

Prescribing behaviour in clinical practice: patients' expectations and doctors' perceptions of patients' expectations—a questionnaire study

“Health for all by year 2000” was the subject of the WHO Conference at Alma-Ata in 1978. It was evident that good primary care was a requirement to reach this goal. However, knowledge about this wa...

International classification of primary care.

An International Glossary for Primary Care

Observations in epidemiological, operational or sociomedical research often need to be related to a denominator to obtain a measure of rate. Defining the denominator for a particular population at risk is a difficult task. The basis of this study was a census track study combined with a survey questionnaire which included every household in a part of Nes municipality, in Norway. This meant it was possible to define the population at risk nearly perfectly. The results were compared with official records and the records of general practitioners. Some of the pitfalls in deciding on the population at risk are discussed: the newborn and the dead, the migrants, the institutionalized, the incomplete census tract, patients in contact with other physicians, the non-attenders, including 'the forgotten'. Eight different approaches to the estimation of the denominator are briefly commented on.

The pitfalls of the denominator: towards an accurate estimation of a population at risk.

In many countries there is a recognized specialist education for general practice, corresponding to those offered for organ specialities. Why, then, is general practice not recognized everywhere as a full speciality?It has been suggested that general practice is characterized by an easily available, continuous, personal, binding and comprehensive care. However, there are also other aspects which characterize this discipline.Firstly it is based on an overall view of health and disease, in which physical, mental, and social factors must be taken into account simultaneously.Secondly the epidemiological world, as seen by the primary physician, is different from those of all traditional specialities. This gives rise to considerable consequences in diagnostic and therapeutic work, as reflected in the predictive values of tests and for symptoms in general practice, when contrasted with specialist practice.Thirdly, the approach to problem solving is also very different. In general practice, it is characterized by...

https://www.tandfonline.com/doi/pdf/10.3109/02813438409017695

Bent Guttorm Bentsen

Papers

International classification of primary care.

An International Glossary for Primary Care

The pitfalls of the denominator: towards an accurate estimation of a population at risk.

Fundamentals of General Medical Practice

A revolution in primary care of Norway