Ellen Dukes

The burden of neuropathic pain: results from a cross-sectional survey

Background There are few published data on the treatment patterns and burden of neuropathic pain. We have investigated this in a large, observational, cross‐sectional survey.

Characteristics and healthcare costs of patients with fibromyalgia syndrome.

Purpose:  To examine the characteristics and healthcare costs of fibromyalgia syndrome (FMS) patients in clinical practice.

The health status burden of people with fibromyalgia: a review of studies that assessed health status with the SF‐36 or the SF‐12

Objective:  The current review describes how the health status profile of people with fibromyalgia (FM) compares to that of people in the general population and patients with other health conditions.

How do changes in pain severity levels correspond to changes in health status and function in patients with painful diabetic peripheral neuropathy

&NA; The current analysis compares changes in pain with changes in function and health status in individuals with painful diabetic peripheral neuropathy (DPN). The post hoc analysis is based on a 12 week, multinational, placebo‐controlled trial of pregabalin in which 401 patients were randomized to treatment. Study measures included the Brief Pain Inventory short‐form (BPI‐sf), EQ‐5D and other patient‐reported outcomes. Cutpoints were derived on the BPI‐sf 0–10 average pain numeric rating scale [NRS] to classify pain grades of “mild” (1–3), moderate (4–6) and severe (7–10), adjusting for geographical regions where data were collected. Two different metrics were used to classify the importance of change in pain severity from baseline to 12 weeks: changes in pain severity grades (defined by cutpoint categories) and percent reduction in the NRS (categories ranging from 0–9% to ≥50%). An improvement in one pain grade or a ≥30% reduction in the NRS served as determinants of a clinically important difference. Patients with a one‐grade reduction in pain severity, either from “severe‐to‐moderate” or “moderate‐to‐mild,” had a 3‐point improvement the BPI‐sf Pain Interference Index (PII; a composite measure of function); a reduction from “severe‐to‐mild” pain corresponded to a 6‐point improvement in the PII. Similarly, a reduction in the NRS of ≥30% and ≥50% corresponded to a 3‐point and a 5‐point improvement in the PII, respectively. Changes in pain were also associated with changes in health status. Results suggest that patients whose pain is not reduced to a mild level of severity can still experience clinically important changes in function and health status.

Clinical characteristics and pain management among patients with painful peripheral neuropathic disorders in general practice settings

Alleviating chronic pain is a global healthcare priority. Understanding the medical profile and current treatment patterns in patients with painful neuropathic disorders (PNDs) is crucial to the development of effective pain management strategies. Thus, our objective was to describe the demographic and clinical characteristics of persons with PNDs and their use of pain medications. Using the general practice research database, we categorized PNDs in two ways: Pure PNDs (which include diabetic neuropathy, postherpetic neuralgia, etc.; N = 16,690) and Mixed PNDs (which include back/neck pain with neuropathic involvement; N = 14,309). On average, PND patients were 55 years old (Pure, 55.4 [SD = 16.9] years; Mixed, 54.3 [SD = 16.4] years). Over a third had other chronic pain‐related (Pure, 37.5%; Mixed, 37.1%) and nearly a quarter had non‐pain related (Pure, 28.1%; Mixed, 24.1%) comorbidities. Use of medications with clinically demonstrated efficacy in PNDs was higher among patients with Pure PNDs (tricyclic antidepressants [Pure, 16.6%; Mixed, 10.1%]; 2nd generation antidepressants [Pure, 11.0%; Mixed, 9.7%]; and antiepileptics [Pure, 12.2%; Mixed, 2.6%]), whereas use of NSAIDs (Pure, 43.1%; Mixed, 65.2%) and opioids (Pure, 8.5%; Mixed, 14.3%) was higher among patients with Mixed PNDs. Average daily doses of select neuropathic pain‐related medications among PND patients (Pure and Mixed) were lower than those recommended for neuropathic pain. Among both Pure and Mixed PND patients, use and doses of evidenced‐based neuropathic pain‐related medications was low, and lower than the use of NSAIDs (a medication class with no proven efficacy for PNDs) in each group, suggesting possible sub‐optimal neuropathic pain management among these patients.

The economic burden of fibromyalgia: comparative analysis with rheumatoid arthritis*

ABSTRACT Objective: To quantify and compare direct costs, utilization, and the rate of comorbidities in a sample of patients with fibromyalgia (FM), a poorly understood illness associated with chronic widespread pain that is commonly treated by rheumatologists, to patients with rheumatoid arthritis (RA), a well studied rheumatologic illness associated with inflammatory joint pain. Patients with both illnesses were isolated and reported as a third group. A secondary analysis of work loss was performed for an employed subset of these patients. Research design and methods: Retrospective cohort analysis of Thomson Reuters MarketScan administrative healthcare claims and employer-collected absence and disability data for adult patients with a diagnosis of FM (ICD-9-CM 729.1) and/or RA (ICD-9-CM 714.0x,–714.3x) on at least one inpatient or two outpatient claims during 2001–2004. Main outcome measures: The 12-month healthcare utilization, expenditures, and rates of comorbidities were quantified for all study-eligible patients; absence and short-term disability days and costs were quantified for an employed subset. Results: The sample included 14 034 FM, 7965 RA, and 331 FM + RA patients. Patients with FM had a higher prevalence of several comorbidities and greater emergency department (ED) utilization than those with RA. Mean annual expenditures for FM patients were

Cost-effectiveness analysis of pregabalin versus gabapentin in the management of neuropathic pain due to diabetic polyneuropathy or post-herpetic neuralgia

10 911 (SD = 

Measurement properties of the Medical Outcomes Study Sleep Scale in patients with fibromyalgia

16 075). RA patient annual expenditures were similar to FM:

Clinical and Economic Characteristics of Patients with Painful Neuropathic Disorders in Germany

10 716 (SD =

Characteristics and patterns of healthcare utilization of patients with fibromyalgia in general practitioner settings in Germany

16 860). Annual expenditures were almost double in patients with FM+RA (