Chronic Pain Treatment and Health Service Utilization of Veterans with Hepatitis C Virus Infection

Abstract

Objectives Hepatitis C virus (HCV) infection is estimated to affect 2% of the general U.S. population and chronic pain is a common comorbidity among persons with HCV. The primary purpose of this study was to compare health service utilization of U.S. military veterans with HCV with and without the presence of comorbid chronic pain. Design Cross-sectional study with retrospective review of patient medical records. Patients One hundred seventy-one U.S. military veterans with confirmed HCV, recruited through a single U.S. Veterans Administration hospital. Outcome Measures Medical service utilization data from the past five years were extracted from participants’ electronic medical records. Results Sixty-four percent of veterans with HCV (n = 110) had chronic pain. Veterans with HCV and chronic pain utilized more health services including total inpatient stays (OR = 2.58 [1.46, 4.56]) and days hospitalized for psychiatric services (OR = 5.50 [3.37, 8.99]), compared to participants with HCV and no chronic pain, after statistically adjusting for demographic, psychiatric, substance use, medical comorbidity, and disability covariates. In addition, those with HCV and chronic pain had more total outpatient visits with primary care providers (OR = 1.73 [1.15, 2.59]), physical therapists (OR = 9.57 [4.79, 19.11]), and occupational therapists (OR = 2.72 [1.00, 7.48]). Conclusions Patients with HCV and chronic pain utilize medical services to a greater extent than patients with HCV but no chronic pain. Future studies that examine the efficacy of both pharmacological and nonpharmacological pain treatment for patients with comorbid HCV and chronic pain appear warranted.

Inflammation, Psychiatric Symptoms, and Opioid Use Are Associated With Pain and Disability in Patients With Cirrhosis

“…The high prevalence of pain was strikingly similar to the rates among patients wait-listed for liver transplantation 2 and Veterans with chronic HCV 25 yet higher than rates of approximately 50% in chronic renal disease. 26 Chronic pain carries a significant burden as shown by pain-related disability in 75% of our patients, even though we excluded individuals with known diseases commonly associated with pain and/or inflammation.…”

Biopsychosocial factors associated with pain in veterans with the hepatitis C virus

“…Relative to patients with HIV alone, those who are co-infected with HCV had higher rates of pain disorders and were more likely to experience pain that interfered with daily living (Tsui et al, 2012). Additionally, patients with HCV and chronic pain utilize more medical services than patients with HCV alone, including overall hospital services, primary care visits, as well as pain specialty services (Lovejoy et al, 2012). …”

Characterising the association between positive hepatitis C virus antibody and pain among people who inject drugs

“…Chronic pain and other pain‐related disorders affect over 60% of those living with HCV and are associated with decreased quality of life, increased health‐care utilisation and increased risk of co‐morbidities . Although the mechanisms and pathways are not clearly known, inflammatory cytokines in HCV are theorised to play a role . Additionally, chronic pain is a common condition among PWID, occurring in one‐third to half of the population .…”