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      Just how much does it cost? A cost study of chronic pain following cardiac surgery

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          Abstract

          Objective

          The study objective was to determine use of pain-related health care resources and associated direct and indirect costs over a two-year period in cardiac surgery patients who developed chronic post-surgical pain (CPSP).

          Methods

          This multicentric observational prospective study recruited patients prior to cardiac surgery; these patients completed research assistant-administered questionnaires on pain and psychological characteristics at 6, 12 and 24 months post-operatively. Patients reporting CPSP also completed a one-month pain care record (PCR) (self-report diary) at each follow-up. Data were analyzed using descriptive statistics, multivariable logistic regression models, and generalized linear models with log link and gamma family adjusting for sociodemographic and pain intensity.

          Results

          Out of 1,247 patients, 18%, 13%, and 9% reported experiencing CPSP at 6, 12, and 24 months, respectively. Between 16% and 28% of CPSP patients reported utilizing health care resources for their pain over the follow-up period. Among all CPSP patients, mean monthly pain-related costs were CAN$207 at 6 months and significantly decreased thereafter. More severe pain and greater levels of pain catastrophizing were the most consistent predictors of health care utilization and costs.

          Discussion

          Health care costs associated with early management of CPSP after cardiac surgery seem attributable to a minority of patients and decrease over time for most of them. Results are novel in that they document for the first time the economic burden of CPSP in this population of patients. Longer follow-up time that would capture severe cases of CPSP as well as examination of costs associated with other surgical populations are warranted.

          Summary

          Economic burden of chronic post-surgical pain may be substantial but few patients utilize resources. Health utilization and costs are associated with pain and psychological characteristics.

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          Most cited references 38

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          Preliminary validity study of the pain disability index.

           C. S. Pollard (1984)
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            I. Defining persistent post-surgical pain: is an update required?

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              Quality of life in chronic pain is more associated with beliefs about pain, than with pain intensity.

              The objectives of this study were to investigate pain cognitions and quality of life of chronic pain patients referred to a multi-disciplinary university pain management clinic and to search for predictors of quality of life. A heterogeneous group of 1208 chronic pain patients referred to the Maastricht university hospital pain clinic participated in this cross-sectional study. At the initial assessment, all patients completed a set of questionnaires on demographic variables, cause, location, pain intensity (McGill pain questionnaire, MPQ), pain coping and beliefs (pain coping and cognition list, PCCL), pain catastrophising (pain catastrophising scale, PCS) and eight dimensions of quality of life (Rand-36). The results showed that the present sample of heterogeneous pain patients reported low quality of life on each domain and significantly lower scores than has been found in previous studies with other Dutch chronic pain populations. Patients with low back pain and multiple pain localisations experienced most functional limitations. Women reported more pain, more catastrophising thoughts about pain, more disability and lower vitality and general health. When tested in a multiple regression analysis, pain catastrophising turned out to be the single most important predictor of quality of life. Especially social functioning, vitality, mental health and general health are significantly associated with pain catastrophising. Patients from a multi-disciplinary university pain clinic experience strikingly low quality of life, whereby low back pain patients and patients with multiple pain localisations have the lowest quality of life. Pain catastrophising showed the strongest association with quality of life, and stronger than pain intensity.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2018
                08 November 2018
                : 11
                : 2741-2759
                Affiliations
                [1 ]Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
                [2 ]Centre de recherche du Centre hospitalier universitaire de Québec, Université Laval, Quebec City, QC, Canada
                [3 ]Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada, manon.choiniere@ 123456umontreal.ca
                [4 ]Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada, manon.choiniere@ 123456umontreal.ca
                [5 ]Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
                [6 ]Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
                Author notes
                Correspondence: Manon Choinière, Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Tour Saint-Antoine, bureau S01-126, 850 rue Saint-Denis, Montréal, QC, H2X 0A9, Canada, Tel +1 514 890 8000 ext 14082, Email manon.choiniere@ 123456umontreal.ca
                [*]

                These authors contributed equally to this work

                Article
                jpr-11-2741
                10.2147/JPR.S175090
                6235323
                © 2018 Guertin et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Original Research

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