Incidence and impact of pain conditions and comorbid illnesses.
Incidence and impact of pain conditions and comorbid illnesses.
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DOI：
10.2147/jpr.s24170
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发表时间：
2011
影响因子：
2.7
通讯作者：
Xie J
中科院分区：
文献类型：
--
作者：
Davis JA;Robinson RL;Le TK;Xie J
患有疼痛的人通常会出现不止一种疼痛症状。本研究的目的是利用 2005 年至 2007 年的行政索赔数据，描述一项大型健康计划中 23 种选定疼痛病症的合并症发生率、止痛药使用情况和医疗保健费用。符合条件的患者包括 1,211,483 名在一年的研究期间至少患有一种疼痛病症的成年人。根据研究期间索赔中的首次诊断对疼痛状况队列进行分类。肌肉骨骼疼痛是最常见的疾病之一，包括腰痛、骨关节炎和纤维肌痛。癌症疼痛是最不常见的群体。疾病严重程度最低的疾病包括偏头痛和膀胱疼痛综合征队列，而糖尿病神经病变、人类免疫缺陷病毒（HIV）相关疼痛和癌症疼痛的队列最严重。在各队列中，共病疼痛的平均数量范围为 1.39（癌症疼痛和偏头痛）到 2.65（多发性硬化症疼痛）。 HIV相关疼痛和多发性硬化症疼痛队列中精神健康状况的发生率较高（42.59%和34.78%），类风湿性关节炎和银屑病关节病队列中精神健康状况最低（分别为12.73%和13.31%）。睡眠障碍的发生率从 5.47%（膀胱疼痛综合征）到 11.59%（多发性硬化症疼痛）不等。总体而言，研究期间患者平均使用 3.53 种独特的止痛药。在癌症疼痛队列中观察到相当大的年度总医疗保健费用，在带状疱疹后神经病变、手术引起的疼痛、偏头痛和肠易激综合征队列中观察到费用最低。在多发性硬化症、艾滋病毒和癌症疼痛人群中，疼痛造成的成本最高。在艾滋病毒队列中观察到最高的药品成本。这些发现强调了疼痛患者在疾病负担、医疗保健系统成本以及常见并发疾病的复杂性方面的异质性。
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.