Complexity, comorbidity, and health care costs associated with chronic widespread pain in primary care

Abstract

The objective was to estimate the prevalence of chronic widespread pain (CWP) and compare the quality-of-life (QoL), cardiovascular risk factors, comorbidity, complexity, and health costs with the reference population. A multicenter case-control study was conducted at 3 primary care centers in Barcelona between January and December 2012: 3048 randomized patients were evaluated for CWP according to the American College of Rheumatology definition. Questionnaires on pain, QoL, disability, fatigue, anxiety, depression, and sleep quality were administered. Cardiovascular risk and the Charlson index were calculated. We compared the complexity of cases and controls using Clinical Risk Groups, severity and annual direct and indirect health care costs. CWP criteria were found in 168 patients (92.3% women, prevalence 5.51% [95% confidence interval: 4.75%-6.38%]). Patients with CWP had worse QoL (34.2 vs 44.1, P < 0.001), and greater disability (1.04 vs 0.35; P < 0.001), anxiety (43.9% vs 13.3%; P < 0.001), depression (27% vs 5.8%; P < 0.001), sleep disturbances, obesity, sedentary lifestyle, high blood pressure, diabetes mellitus, and number of cardiovascular events (13.1% vs 4.8%; P = 0.028) and higher rates of complexity, severity, hospitalization, and mortality. Costs were &OV0556;3751 per year in patients with CWP vs &OV0556;1397 in controls (P < 0.001). In conclusion, the average patient with CWP has a worse QoL and a greater burden of mental health disorders and cardiovascular risk. The average annual cost associated with CWP is nearly 3 times higher than that of patients without CWP, controlling for other clinical factors. These findings have implications for disease management and budgetary considerations.

Predictors of chronic pain intensity, spread, and sensitivity in the general population: A two-year follow-up study from the SWEPAIN cohort

“…Traumatic injuries, RA/OA, GI disorders, pulmonary disorders, CVD and/or CNS disorders were predictors of changes in pain intensity and spread of pain in the final models in this study (Tables II and III, model 2). These comorbidities have been related to CP intensity and spread (17,18,33,66) and change in intensity (45,67) and spread of pain (68,69). Previous studies found pulmonary diseases to be associated with pain intensity (19) and GI disorders, such as irritable bowel disease and spread of pain (70).…”

“…However, other comorbidities, e.g. heart disease, hypertension, diabetes and pulmonary disease, have also been as-sociated with CP (5,(17)(18)(19), and some of these are more frequent in widespread pain than in local pain (14). Moreover, some studies provide prediction models after adjustment for baseline pain (4,5,7), while others do not (6).…”

Biological mechanism of post‐herpetic neuralgia: Evidence from multiple patho‐psychophysiological measures

“…Indeed, the reciprocal relationship between chronic pain and its comorbidities could be further investigated using longitudinal studies (Fishbain et al, 1997;Mossey and Gallagher, 2004;Tunks et al, 2008;Kroenke et al, 2011). It should be noted that in clinical situations, difficulties of relieving pain without eliminating its comorbidities have been increasingly recognized (Fishbain, 1999;Mcgrath and Dade, 2004;Ballantyne and Sullivan, 2015;Morales-Espinoza et al, 2015;Dale and Stacey, 2016).…”

A qualitative study of professional stakeholders’ perceptions about the implementation of a stepped care pain platform for people experiencing chronic widespread pain

“…Individuals experiencing CWP frequently experience additional clinical comorbidities such as irritable bowel syndrome, chronic fatigue syndrome, joint pain and headaches [3]. CWP is associated with poor quality of life [4–7] and many people are likely to be experiencing a mental health disorder such as depression, generalised anxiety disorder or panic attacks [8, 9]. In many cases complete relief from symptoms is unlikely but with appropriate treatment the impact upon quality of life, functioning and mental health symptoms can be significantly reduced.…”