Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA.
J Pain Res. 2011;4:331-45. doi: 10.2147/JPR.S24170. Epub 2011 Oct 10.
Individuals with pain often present with more than one painful condition. The purpose of this study was to characterize the rates of comorbidity, pain medication use, and health care costs for 23 selected pain conditions in a large health plan using administrative claims data from 2005 to 2007.
Eligible patients included 1,211,483 adults with at least one pain condition during the one-year study period. Pain condition cohorts were classified based on the first diagnosis present in the claims during the study period.
Musculoskeletal pain conditions were among the most prevalent cohorts including low back pain, osteoarthritis, and fibromyalgia. Cancer pain was the least prevalent cohort. Conditions with the lowest illness severity included migraine and painful bladder syndrome cohorts, while cohorts with diabetic neuropathy, human immunodeficiency virus (HIV)-associated pain, and cancer pain were the most severe. Across cohorts, the mean number of comorbid pain conditions ranged from 1.39 (for cancer pain and migraine) to 2.65 (for multiple sclerosis pain). High rates of mental health conditions were found in cohorts with HIV-associated pain and multiple sclerosis pain (42.59% and 34.78%) and were lowest among cohorts with rheumatoid arthritis and psoriatic arthropathy (12.73% and 13.31%), respectively. Rates of sleep disorders ranged from 5.47% (for painful bladder syndrome) to 11.59% (for multiple sclerosis pain). Overall, patients averaged 3.53 unique pain medications during the study period. Considerable annual total health care costs were observed in the cancer pain cohort and the lowest costs were observed in the postherpetic neuropathy, surgically-induced pain, migraine, and irritable bowel syndrome cohorts. Costs attributed to pain were highest among the multiple sclerosis, HIV, and cancer pain cohorts. The highest pharmaceutical costs were observed in the HIV cohort.
These findings underscore the heterogeneity of patients with pain in terms of burden of illness, costs to the health care system, and the complexity of commonly co-occurring disorders.
疼痛患者通常会出现一种以上的疼痛状况。本研究的目的是利用 2005 年至 2007 年的行政索赔数据，从大型健康计划中选择 23 种特定疼痛状况，描述其共病率、疼痛药物使用和医疗保健费用。
符合条件的患者包括在为期一年的研究期间至少有一种疼痛状况的 1211483 名成年人。根据研究期间索赔中出现的首次诊断，将疼痛状况队列分类。
肌肉骨骼疼痛状况是最常见的队列之一，包括下腰痛、骨关节炎和纤维肌痛。癌症疼痛是最不常见的队列。疾病严重程度最低的情况包括偏头痛和疼痛性膀胱综合征队列，而糖尿病性周围神经病变、人类免疫缺陷病毒（HIV）相关疼痛和癌症疼痛队列则最严重。在各个队列中，共病疼痛状况的平均数量范围从 1.39（癌症疼痛和偏头痛）到 2.65（多发性硬化疼痛）。HIV 相关疼痛和多发性硬化疼痛队列中发现了较高的精神健康状况发生率（分别为 42.59%和 34.78%），而类风湿关节炎和银屑病关节炎队列中的发生率最低（分别为 12.73%和 13.31%）。睡眠障碍的发生率范围从 5.47%（疼痛性膀胱综合征）到 11.59%（多发性硬化疼痛）。总体而言，患者在研究期间平均使用 3.53 种独特的疼痛药物。在癌症疼痛队列中观察到相当大的年度总医疗保健费用，而在后疱疹性神经痛、手术引起的疼痛、偏头痛和肠易激综合征队列中观察到最低的费用。多发性硬化症、HIV 和癌症疼痛队列中归因于疼痛的费用最高。HIV 队列的药物成本最高。
这些发现强调了疼痛患者在疾病负担、对医疗保健系统的成本以及常见共病障碍的复杂性方面存在异质性。
