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      Estimating the burden of disease in chronic pain with and without neuropathic characteristics: Does the choice between the EQ-5D and SF-6D matter?

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          Summary

          Chronic pain with neuropathic characteristics is associated with significantly lower EQ-5D and Short Form 6D health utilities scores, with 17% reporting health states “worse than death”.

          Abstract

          The EQ-5D and Short Form (SF)12 are widely used generic health-related quality of life (HRQoL) questionnaires. They can be used to derive health utility index scores, on a scale where 0 is equivalent to death and 1 represents full health, with scores less than zero representing states “worse than death.” We compared EQ-5D or SF-6D health utility index scores in patients with no chronic pain, and chronic pain with and without neuropathic characteristics (NC), and to explore their discriminant ability for pain severity. Self-reported health and chronic pain status was collected as part of a UK general population survey (n = 4451). We found moderate agreement between individual dimensions of EQ-5D and SF-6D, with most highly correlated dimensions found for mental health and anxiety/depression, role limitations and usual activities, and pain and pain/discomfort. Overall 43% reported full health on the EQ-5D, compared with only 4.2% on the SF-6D. There were significant differences in mean utilities for chronic pain with NC (EQ-5D 0.47 vs SF-6D 0.62) and especially for severe pain (EQ-5D 0.33 vs SF-6D 0.58). On the EQ-5D, 17% of those with chronic pain with NC and 3% without NC scored “worse than death,” a state which is not possible using the SF-6D. Health utilities derived from EQ-5D and SF-12/36 can discriminate between group differences for chronic pain with and without NC and greater pain severity. However, the instruments generate widely differing HRQoL scores for the same patient groups. The choice between using the EQ-5D or SF-6D matters greatly when estimating the burden of disease.

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          Most cited references36

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          The estimation of a preference-based measure of health from the SF-12.

          The SF-12 is a multidimensional generic measure of health-related quality of life. It has become widely used in clinical trials and routine outcome assessment because of its brevity and psychometric performance, but it cannot be used in economic evaluation in its current form. We sought to derive a preference-based measure of health from the SF-12 for use in economic evaluation and to compare it with the original SF-36 preference-based index. The SF-12 was revised into a 6-dimensional health state classification (SF-6D [SF-12]) based on an item selection process designed to ensure the minimum loss of descriptive information. A sample of 241 states defined by the SF-6D (of 7500) have been valued by a representative sample of 611 members of the UK general population using the standard gamble (SG) technique. Models are estimated of the relationship between the SF-6D (SF-12) and SG values and evaluated in terms of their coefficients, overall fit, and the ability to predict SG values for all health states. The models have produced significant coefficients for levels of the SF-6D (SF-12), which are robust across model specification. The coefficients are similar to those of the SF-36 version and achieve similar levels of fit. There are concerns with some inconsistent estimates and these have been merged to produce the final recommended model. As for the SF-36 model, there is evidence of over prediction of the value of the poorest health states. The SF-12 index provides a useful tool for researchers and policy makers wishing to assess the cost-effectiveness of interventions.
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            Grading the severity of chronic pain.

            This research develops and evaluates a simple method of grading the severity of chronic pain for use in general population surveys and studies of primary care pain patients. Measures of pain intensity, disability, persistence and recency of onset were tested for their ability to grade chronic pain severity in a longitudinal study of primary care back pain (n = 1213), headache (n = 779) and temporomandibular disorder pain (n = 397) patients. A Guttman scale analysis showed that pain intensity and disability measures formed a reliable hierarchical scale. Pain intensity measures appeared to scale the lower range of global severity while disability measures appeared to scale the upper range of global severity. Recency of onset and days in pain in the prior 6 months did not scale with pain intensity or disability. Using simple scoring rules, pain severity was graded into 4 hierarchical classes: Grade I, low disability--low intensity; Grade II, low disability--high intensity; Grade III, high disability--moderately limiting; and Grade IV, high disability--severely limiting. For each pain site, Chronic Pain Grade measured at baseline showed a highly statistically significant and monotonically increasing relationship with unemployment rate, pain-related functional limitations, depression, fair to poor self-rated health, frequent use of opioid analgesics, and frequent pain-related doctor visits both at baseline and at 1-year follow-up. Days in Pain was related to these variables, but not as strongly as Chronic Pain Grade. Recent onset cases (first onset within the prior 3 months) did not show differences in psychological and behavioral dysfunction when compared to persons with less recent onset. Using longitudinal data from a population-based study (n = 803), Chronic Pain Grade at baseline predicted the presence of pain in the prior 2 weeks. Chronic Pain Grade and pain-related functional limitations at 3-year follow-up. Grading chronic pain as a function of pain intensity and pain-related disability may be useful when a brief ordinal measure of global pain severity is required. Pain persistence, measured by days in pain in a fixed time period, provides useful additional information.
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              • Record: found
              • Abstract: not found
              • Article: not found

              Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy.

              (1986)
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                Author and article information

                Contributors
                Journal
                Pain
                Pain
                Pain
                Lippincott Williams & Wilkins
                0304-3959
                1872-6623
                1 October 2014
                October 2014
                : 155
                : 10
                : 1996-2004
                Affiliations
                [a ]Medical Research Institute, University of Dundee, Dundee, Scotland, UK
                [b ]Centre for Research Excellence in the Prevention of Chronic Conditions in Rural and Remote Populations, James Cook University, Townsville City, Australia
                [c ]Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, England, UK
                [d ]Academic Unit of Palliative Care, University of Leeds, Leeds, England, UK
                [e ]School of Medicine, University of Glasgow, Glasgow, Scotland, UK
                Author notes
                [* ]Corresponding author. Address: University of Dundee, Ninewells Hospital and Medical School, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF Scotland, UK. Tel.: +44 (0)1382 383476; fax: +44 (0)1382 383802. n.torrance@ 123456dundee.ac.uk
                Article
                S0304-3959(14)00317-0
                10.1016/j.pain.2014.07.001
                4220009
                25020004
                41655b45-3a8d-4cd3-843d-7cbfe12abf86
                © 2014 The Authors
                History
                : 27 December 2013
                : 23 June 2014
                : 3 July 2014
                Categories
                Article

                Anesthesiology & Pain management
                chronic pain,eq-5d,health-related quality of life,health utilities,neuropathic pain,sf-6d,s-lanss

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