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      Journal of Pain Research (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on reporting of high-quality laboratory and clinical findings in all fields of pain research and the prevention and management of pain. Sign up for email alerts here.

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      Is Open Access

      Costs of moderate to severe chronic pain in primary care patients – a study of the ACCORD Program

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          Abstract

          Background

          The economic burden of chronic noncancer pain (CNCP) remains insufficiently documented in primary care.

          Purpose

          To evaluate the annual direct health care costs and productivity costs associated with moderate to severe CNCP in primary care patients taking into account their pain disability.

          Materials and methods

          Patients reporting noncancer pain for at least 6 months, at a pain intensity of 4 or more on a 0 (no pain) to 10 (worst possible pain) intensity scale, and at a frequency of at least 2 days a week, were recruited from community pharmacies. Patients’ characteristics, health care utilization, and productivity losses (absenteeism and presenteeism) were documented using administrative databases, pharmacies’ renewal charts, telephone, and self-administered questionnaires. Patients were stratified by tertile of pain disability measured by the Brief Pain Inventory questionnaire.

          Results

          Patients (number =483) were, on average, 59 years old, mainly women (67.5%), and suffered from CNCP for a mean of 12 years at an average pain intensity of 6.5±1.9. The annual direct health care costs and productivity costs averaged CAD $9,565 (±$13,993) and CAD $7,072 (±$11,716), respectively. The use of complementary health care services accounted for almost 50% of the direct health care costs. The mean adjusted total direct health care costs (considering pain-related hospitalizations only) and productivity costs increased with more pain disability: low disability, CAD $12,118; moderate, CAD $18,278; and severe, CAD $19,216; P=0.001.

          Conclusion

          The economic burden of CNCP is substantial and increases with the level of pain disability, which suggests the need for and potential benefits of improving CNCP management through specific and adapted treatment plans targeting the impact of pain on daily functioning.

          Most cited references50

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          Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample.

          Chronic pain and psychiatric disorders frequently co-occur. However, estimates of the magnitude of these associations have been biased by the use of select clinical samples. The present study utilized the National Comorbidity Survey [Arch. Gen. Psychiatry 51 (1994) 8-19] Part II data set to investigate the associations between a chronic pain condition (i.e. arthritis) and common mood and anxiety disorders in a sample representative of the general US civilian population. Participants (N=5877) completed the Composite International Diagnostic Interview [World Health Organization (1990)], a structured interview for trained non-clinician interviewers based on the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders [American Psychiatric Association (1987)], and provided self-reports of pain and disability associated with a variety of medical conditions. Significant positive associations were found between chronic pain and individual 12-month mood and anxiety disorders [odds ratios (OR) ranged from 1.92 to 4.27]. The strongest associations were observed with panic disorder (OR=4.27) and post-traumatic stress disorder (OR=3.69). The presence of one psychiatric disorder was not significantly associated with pain-related disability, but the presence of multiple psychiatric disorders was significantly associated with increased disability. The findings of the present study raise the possibility that improved efforts regarding the detection and treatment of anxiety disorders may be required in pain treatment settings.
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            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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              • Article: not found

              The prevalence and characteristics of fibromyalgia in the general population.

              To determine the prevalence and characteristics of fibromyalgia in the general population. A random sample of 3,006 persons in Wichita, KS, were characterized according to the presence of no pain, non-widespread pain, and widespread pain. A subsample of 391 persons, including 193 with widespread pain, were examined and interviewed in detail. The prevalence of fibromyalgia was 2.0% (95% confidence interval [95% CI] 1.4, 2.7) for both sexes, 3.4% (95% CI 2.3, 4.6) for women, and 0.5% (95% CI 0.0, 1.0) for men. The prevalence of the syndrome increased with age, with highest values attained between 60 and 79 years (> 7.0% in women). Demographic, psychological, dolorimetry, and symptom factors were associated with fibromyalgia. Fibromyalgia is common in the population, and occurs often in older persons. Characteristic features of fibromyalgia--pain threshold and symptoms--are similar in community and clinic populations, but overall severity, pain, and functional disability are more severe in the clinic population.
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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
                2014
                07 July 2014
                : 7
                : 389-403
                Affiliations
                [1 ]Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
                [2 ]Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada
                [3 ]Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
                [4 ]Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Université de Montréal and Centre de santé et de services sociaux de Laval, QC, Canada
                [5 ]Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
                [6 ]Sanofi Aventis Endowment Research Chair in Optimal Drug Use, Université de Montréal, Montreal, QC, Canada
                [7 ]Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
                [8 ]Division of Geriatric Medicine and Alan-Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
                [9 ]Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
                Author notes
                Correspondence: Lyne Lalonde, Centre de recherche du Centre hospitalier de l’Université de Montréal, 850 Saint-Denis Street, Tour Saint-Antoine, Room S03.436, Montreal, Quebec, H2X 0A9, Canada, Tel +1 514 890 8000 ext 15491, Fax +1 514 412 7038, Email lyne.lalonde@ 123456umontreal.ca
                Article
                jpr-7-389
                10.2147/JPR.S55388
                4094572
                25045282
                f3624cfc-4ded-4cb8-95c1-efafb2150d5d
                © 2014 Lalonde et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Original Research

                Anesthesiology & Pain management
                noncancer chronic pain,primary care,cohort study,direct health care costs,productivity costs,brief pain inventory

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