Validity of Algorithms for Identification of Individuals Suffering from Chronic Noncancer Pain in Administrative Databases: A Systematic Review

Abstract

Background Secondary analysis of health administrative databases is indispensable to enriching our understanding of health trajectories, health care utilization, and real-world risks and benefits of drugs among large populations. Objectives This systematic review aimed at assessing evidence about the validity of algorithms for the identification of individuals suffering from nonarthritic chronic noncancer pain (CNCP) in administrative databases. Methods Studies reporting measures of diagnostic accuracy of such algorithms and published in English or French were searched in the Medline, Embase, CINAHL, AgeLine, PsycINFO, and Abstracts in Social Gerontology electronic databases without any dates of coverage restrictions up to March 1, 2018. Reference lists of included studies were also screened for additional publications. Results Only six studies focused on commonly studied CNCP conditions and were included in the review. Some algorithms showed a ≥60% combination of sensitivity and specificity values (back pain disorders in general, fibromyalgia, low back pain, migraine, neck/back problems studied together). Only algorithms designed to identify fibromyalgia cases reached a ≥80% combination (without replication of findings in other studies/databases). Conclusions In summary, the present investigation informs us about the limited amount of literature available to guide and support the use of administrative databases as valid sources of data for research on CNCP. Considering the added value of such data sources, the important research gaps identified in this innovative review provide important directions for future research. The review protocol was registered with PROSPERO (CRD42018086402).

Antiepileptic prescribing to persons living with dementia residing in nursing homes: A tale of two indications

“…31 However, researchers note that pain subtypes can be underreported in administrative data, at least compared to self-reports, and that there are low rates of sensitivity for some diagnoses, including neuropathy. [32][33][34] Other methods of inquiry, including qualitative work and chart reviews, along with more claims-based analyses would help gain insights into the clinical decisions that are driving these trends.…”

Chronic opioid use after joint replacement surgery in seniors is associated with increased healthcare utilization and costs: a historical cohort study

“…Administrative databases are generally limited in their ability to identify or quantify pain, with drug prescriptions usually acting as a surrogate for pain. 32 Although chronic postoperative opioid use was associated with higher costs, a causal relationship cannot be concluded, and it is important to determine the resources that lead to the increased costs. It is possible that chronic opioid use is a marker of other conditions or surgical complications that result in increased costs, although opioid use itself can lead to significant complications.…”

Chronic pain patients' willingness to share personal identifiers on the web for the linkage of medico‐administrative claims and patient‐reported data: The chronic pain treatment cohort

“… 9 , 10 , 11 Linkage is also valuable when medico‐administrative data alone make it difficult to identify/characterize patients suffering from specific conditions, notably chronic pain. 12 …”

“…It is therefore beneficial—sometimes crucial—to link patient‐reported data with medico‐administrative databases 9‐11 . Linkage is also valuable when medico‐administrative data alone make it difficult to identify/characterize patients suffering from specific conditions, notably chronic pain 12 …”

“…[9][10][11] Linkage is also valuable when medico-administrative data alone make it difficult to identify/characterize patients suffering from specific conditions, notably chronic pain. 12 Data linkage raises many societal concerns, including informed consent and confidentiality. 10,13,14 For the linkage of medico-administrative and patient-reported data, it is possible to adopt prospective recruitment strategies and make direct requests for consent.…”