背景:神经根性疼痛是成人莱姆病(LNB)患者中最主要的症状,但诊断前后的持续时间尚不清楚。我们旨在调查LNB患者在诊断前后的镇痛药获得量是否增加以及持续多长时间。
方法:我们在全国范围内进行了一次,以人口为基础,配对队列研究(2009-2021年)。纳入了所有患有LNB(伯氏疏螺旋体鞘内抗体指数检测和脑脊液胞质增多)的丹麦居民.要形成比较队列,从普通人群中随机抽取个体,在年龄和性别上与LNB患者进行10:1匹配.结果是获得简单的镇痛药,抗癫痫药,三环抗抑郁药,5-羟色胺和去甲肾上腺素再摄取抑制剂,曲马多,和其他阿片类药物。我们计算了获得镇痛药和绝对风险差异的个体的每月和六个月比例。
结果:纳入1,056例LNB患者和10,560例对照队列成员。LNB患者在纳入研究前3个月获得镇痛药的比例增加,尤其是简单的镇痛药,曲马多,和其他阿片类药物。纳入研究后的0-1个月内,LNB患者最常获得简单镇痛药(15%),抗癫痫药(11%),曲马多(10%)。此后,止痛药的获得在几个月内下降。LNB患者在诊断后2.5年内获得抗癫痫药的比例略高。
结论:诊断前3个月,LNB之前增加了镇痛药的获得,这表明诊断延迟。重要的是,大多数LNB患者在病程结束后没有获得镇痛药,尽管在2.5年后获得的频率更高。
BACKGROUND: Radicular pain is the most predominant symptom among adults with Lyme neuroborreliosis (LNB) but the duration preceding and following diagnosis remains unknown. We aimed to investigate whether patients with LNB have increased obtainment of analgesics before and after diagnosis and for how long.
METHODS: We performed a nationwide, population-based, matched cohort study (2009-2021). all Danish residents with LNB (positive Borrelia burgdorferi intrathecal antibody index test and cerebrospinal fluid pleocytosis) were included. To form a comparison cohort, individuals from the general population were randomly extracted and matched 10:1 to patients with LNB on age and sex. Outcomes were obtainment of simple analgesics, antiepileptics, tricyclic antidepressants, serotonin and noradrenaline reuptake inhibitors, tramadol, and other opioids. We calculated monthly and six-monthly proportions of individuals with obtainment of analgesics and absolute risk differences.
RESULTS: 1,056 patients with LNB and 10,560 comparison cohort members were included. An increased proportion of patients with LNB obtained analgesics from 3 months before study inclusion, especially simple analgesics, tramadol, and other opioids. Within the 0-1-month period after study inclusion, patients with LNB most frequently obtained simple analgesics (15 %), antiepileptics (11 %), and tramadol (10 %). Thereafter, obtainment of analgesics declined within a few months. A slightly larger proportion of patients with LNB obtained antiepileptics up to 2.5 years after diagnosis.
CONCLUSIONS: Up to 3 months preceding diagnosis, LNB was preceded by increased obtainment of analgesics, which suggests diagnostic delay. Importantly, most patients with LNB did not obtain analgesics after the immediate disease course, although obtainment remained more frequent up to 2.5 years after.