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      Treatment profiles and costs of patients with chronic pain in the population setting

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          Abstract

          Background

          The purpose of this study was to gather information about analgesic drug therapy in patients with chronic pain and perform cost estimates to guide future cost-effectiveness research in the area.

          Methods

          Data from patients aged 44 years and over suffering from any chronic condition and receiving regular analgesic drug therapy (for ≥6 months) who attended health care facilities within the area of Badalona during 2008 were collected in a retrospective study. Morbidity profiles were defined according to treatment setting (pain unit, hospital), World Health Organization analgesic step (1–2 versus 3), and a raw cost model based on resource use and work absenteeism was applied. Patients attending the pain unit or the hospital were considered undertreated if they were on step 1–2 analgesics. Multiple regression was used to compare costs between undertreated and non-undertreated patients among those attending the pain unit or the hospital.

          Results

          Only 410 of 18,157 patients ascertained (2.3%) were on step 3 analgesics. Their direct costs were greater than those of patients on step 1–2 analgesics, although the opposite was true regarding indirect costs. Of patients seen in the pain unit and in the hospital, 2.3% and 20.1%, respectively, were considered undertreated. Regression analyses revealed even greater costs in the subgroup of undertreated patients.

          Conclusion

          Step 3 analgesics are barely used. Up to one-fifth of patients may be undertreated, generating greater costs than those considered to be properly treated. Regression analyses did not clarify the proportion of their cost excess that was attributable to undertreatment.

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          Most cited references 35

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          A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.

          The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.
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            Evidence based medicine: what it is and what it isn't.

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              Opioids in chronic non-cancer pain: systematic review of efficacy and safety.

              Opioids are used increasingly for chronic non-cancer pain. Controversy exists about their effectiveness and safety with long-term use. We analysed available randomised, placebo-controlled trials of WHO step 3 opioids for efficacy and safety in chronic non-cancer pain. The Oxford Pain Relief Database (1950-1994) and Medline, EMBASE and the Cochrane Library were searched until September 2003. Inclusion criteria were randomised comparisons of WHO step 3 opioids with placebo in chronic non-cancer pain. Double-blind studies reporting on pain intensity outcomes using validated pain scales were included. Fifteen randomised placebo-controlled trials were included. Four investigations with 120 patients studied intravenous opioid testing. Eleven studies (1025 patients) compared oral opioids with placebo for four days to eight weeks. Six of the 15 included trials had an open label follow-up of 6-24 months. The mean decrease in pain intensity in most studies was at least 30% with opioids and was comparable in neuropathic and musculoskeletal pain. About 80% of patients experienced at least one adverse event, with constipation (41%), nausea (32%) and somnolence (29%) being most common. Only 44% of 388 patients on open label treatments were still on opioids after therapy for between 7 and 24 months. The short-term efficacy of opioids was good in both neuropathic and musculoskeletal pain conditions. However, only a minority of patients in these studies went on to long-term management with opioids. The small number of selected patients and the short follow-ups do not allow conclusions concerning problems such as tolerance and addiction.
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                Author and article information

                Journal
                Clinicoecon Outcomes Res
                Clinicoecon Outcomes Res
                ClinicoEconomics and Outcomes Research: CEOR
                Dove Medical Press
                1178-6981
                2012
                26 January 2012
                : 4
                : 39-47
                ceor-4-039
                10.2147/CEOR.S26116
                3278199
                22347804
                © 2012 Mainar et al, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Categories
                Original Research

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