Painful neuropathic disorders: An analysis of the Régie de l’Assurance Maladie du Québec database
Identifieur interne : 000C87 ( Pmc/Curation ); précédent : 000C86; suivant : 000C88Painful neuropathic disorders: An analysis of the Régie de l’Assurance Maladie du Québec database
Auteurs : J. Lachaine ; A. Gordon [Canada] ; M. Choinière ; Jp Collet [Canada] ; D. Dion ; J-E Tarride [Canada]Source :
- Pain Research & Management : The Journal of the Canadian Pain Society [ 1203-6765 ] ; 2007.
Abstract
Painful neuropathic disorders (PNDs) refer to neurological disorders involving nerves in which pain is a predominant symptom. In most cases, PNDs involve the peripheral nerves. Treatment of PNDs is likely to use large health care resources. However, little is known about the economic burden of PNDs in Canada.
The present study was performed using data from a random sample of patients covered by the Régie de l’Assurance Maladie du Quebec drug plan. Subjects with a diagnosis of a peripheral PND were identified. Comorbidities, pain-related medication use and resource utilization were compared between PND patients and control patients without PNDs matched for age and sex in a 1:1 ratio.
A total of 4912 patients with PNDs were identified. A higher level of comorbidities was found in the PND group (Von Korff chronic disease score 3.91 versus 2.54; P<0.001). The proportion of users of pain-related medications was significantly higher in the PND cohort than in the control group (χ2; P<0.001). The average annual number of physician visits was also significantly higher in the PND group than in the control group (14.7 versus 6.4; P<0.001). From a health ministry perspective, costs of health care resources were significantly higher in the PND group ($4,163 versus $1,846; P<0.001). The proportion of potentially inappropriate medications was 34% among those 65 years of age or older.
PNDs are associated with a higher level of comorbidities, higher medical resources utilization and higher health care costs than non-PND conditions.
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PubMed: 17372632
PubMed Central: 2670723
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J. Lachaine<affiliation><nlm:aff id="af1-prm12031">Faculty of Pharmacy, University of Montreal, Montreal, Quebec</nlm:aff><wicri:noCountry code="subfield">Quebec</wicri:noCountry></affiliation><affiliation><nlm:aff id="af3-prm12031">Department of Anaesthesiology, Faculty of Medicine, University of Montreal, Montreal, Quebec</nlm:aff><wicri:noCountry code="subfield">Quebec</wicri:noCountry></affiliation><affiliation><nlm:aff id="af5-prm12031">Department of Family Medicine, University of Montreal, Montreal, Quebec</nlm:aff><wicri:noCountry code="subfield">Quebec</wicri:noCountry></affiliation>Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Painful neuropathic disorders: An analysis of the Régie de l’Assurance Maladie du Québec database</title><author><name sortKey="Lachaine, J" sort="Lachaine, J" uniqKey="Lachaine J" first="J" last="Lachaine">J. Lachaine</name><affiliation><nlm:aff id="af1-prm12031">Faculty of Pharmacy, University of Montreal, Montreal, Quebec</nlm:aff><wicri:noCountry code="subfield">Quebec</wicri:noCountry></affiliation></author><author><name sortKey="Gordon, A" sort="Gordon, A" uniqKey="Gordon A" first="A" last="Gordon">A. Gordon</name><affiliation wicri:level="2"><nlm:aff id="af2-prm12031">Wasser Pain Management Center, Mount Sinai Hospital and Division of Neurology, University of Toronto, Toronto, Ontario</nlm:aff><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>Wasser Pain Management Center, Mount Sinai Hospital and Division of Neurology, University of Toronto, Toronto</wicri:cityArea></affiliation></author><author><name sortKey="Choiniere, M" sort="Choiniere, M" uniqKey="Choiniere M" first="M" last="Choinière">M. Choinière</name><affiliation><nlm:aff id="af3-prm12031">Department of Anaesthesiology, Faculty of Medicine, University of Montreal, Montreal, Quebec</nlm:aff><wicri:noCountry code="subfield">Quebec</wicri:noCountry></affiliation></author><author><name sortKey="Collet, Jp" sort="Collet, Jp" uniqKey="Collet J" first="Jp" last="Collet">Jp Collet</name><affiliation wicri:level="4"><nlm:aff id="af4-prm12031">Department of Clinical Epidemiology, McGill University, Montreal, Quebec</nlm:aff><orgName type="university">Université McGill</orgName><country>Canada</country><placeName><settlement type="city">Montréal</settlement><region type="state">Québec</region></placeName></affiliation></author><author><name sortKey="Dion, D" sort="Dion, D" uniqKey="Dion D" first="D" last="Dion">D. Dion</name><affiliation><nlm:aff id="af5-prm12031">Department of Family Medicine, University of Montreal, Montreal, Quebec</nlm:aff><wicri:noCountry code="subfield">Quebec</wicri:noCountry></affiliation></author><author><name sortKey="Tarride, J E" sort="Tarride, J E" uniqKey="Tarride J" first="J-E" last="Tarride">J-E Tarride</name><affiliation wicri:level="2"><nlm:aff id="af6-prm12031">At time of study: Pfizer Canada Inc, Kirkland, Quebec; Current affiliation: Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario</nlm:aff><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>At time of study: Pfizer Canada Inc, Kirkland, Quebec; Current affiliation: Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton</wicri:cityArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">17372632</idno><idno type="pmc">2670723</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670723</idno><idno type="RBID">PMC:2670723</idno><date when="2007">2007</date><idno type="wicri:Area/Pmc/Corpus">000C87</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000C87</idno><idno type="wicri:Area/Pmc/Curation">000C87</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000C87</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Painful neuropathic disorders: An analysis of the Régie de l’Assurance Maladie du Québec database</title><author><name sortKey="Lachaine, J" sort="Lachaine, J" uniqKey="Lachaine J" first="J" last="Lachaine">J. Lachaine</name><affiliation><nlm:aff id="af1-prm12031">Faculty of Pharmacy, University of Montreal, Montreal, Quebec</nlm:aff><wicri:noCountry code="subfield">Quebec</wicri:noCountry></affiliation></author><author><name sortKey="Gordon, A" sort="Gordon, A" uniqKey="Gordon A" first="A" last="Gordon">A. Gordon</name><affiliation wicri:level="2"><nlm:aff id="af2-prm12031">Wasser Pain Management Center, Mount Sinai Hospital and Division of Neurology, University of Toronto, Toronto, Ontario</nlm:aff><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>Wasser Pain Management Center, Mount Sinai Hospital and Division of Neurology, University of Toronto, Toronto</wicri:cityArea></affiliation></author><author><name sortKey="Choiniere, M" sort="Choiniere, M" uniqKey="Choiniere M" first="M" last="Choinière">M. Choinière</name><affiliation><nlm:aff id="af3-prm12031">Department of Anaesthesiology, Faculty of Medicine, University of Montreal, Montreal, Quebec</nlm:aff><wicri:noCountry code="subfield">Quebec</wicri:noCountry></affiliation></author><author><name sortKey="Collet, Jp" sort="Collet, Jp" uniqKey="Collet J" first="Jp" last="Collet">Jp Collet</name><affiliation wicri:level="4"><nlm:aff id="af4-prm12031">Department of Clinical Epidemiology, McGill University, Montreal, Quebec</nlm:aff><orgName type="university">Université McGill</orgName><country>Canada</country><placeName><settlement type="city">Montréal</settlement><region type="state">Québec</region></placeName></affiliation></author><author><name sortKey="Dion, D" sort="Dion, D" uniqKey="Dion D" first="D" last="Dion">D. Dion</name><affiliation><nlm:aff id="af5-prm12031">Department of Family Medicine, University of Montreal, Montreal, Quebec</nlm:aff><wicri:noCountry code="subfield">Quebec</wicri:noCountry></affiliation></author><author><name sortKey="Tarride, J E" sort="Tarride, J E" uniqKey="Tarride J" first="J-E" last="Tarride">J-E Tarride</name><affiliation wicri:level="2"><nlm:aff id="af6-prm12031">At time of study: Pfizer Canada Inc, Kirkland, Quebec; Current affiliation: Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario</nlm:aff><country>Canada</country><placeName><region type="province">Ontario</region></placeName><wicri:cityArea>At time of study: Pfizer Canada Inc, Kirkland, Quebec; Current affiliation: Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton</wicri:cityArea></affiliation></author></analytic><series><title level="j">Pain Research & Management : The Journal of the Canadian Pain Society</title><idno type="ISSN">1203-6765</idno><imprint><date when="2007">2007</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>BACKGROUND/OBJECTIVE:</title><p>Painful neuropathic disorders (PNDs) refer to neurological disorders involving nerves in which pain is a predominant symptom. In most cases, PNDs involve the peripheral nerves. Treatment of PNDs is likely to use large health care resources. However, little is known about the economic burden of PNDs in Canada.</p></sec><sec><title>METHOD:</title><p>The present study was performed using data from a random sample of patients covered by the Régie de l’Assurance Maladie du Quebec drug plan. Subjects with a diagnosis of a peripheral PND were identified. Comorbidities, pain-related medication use and resource utilization were compared between PND patients and control patients without PNDs matched for age and sex in a 1:1 ratio.</p></sec><sec><title>RESULTS:</title><p>A total of 4912 patients with PNDs were identified. A higher level of comorbidities was found in the PND group (Von Korff chronic disease score 3.91 versus 2.54; P<0.001). The proportion of users of pain-related medications was significantly higher in the PND cohort than in the control group (χ<sup>2</sup>; P<0.001). The average annual number of physician visits was also significantly higher in the PND group than in the control group (14.7 versus 6.4; P<0.001). From a health ministry perspective, costs of health care resources were significantly higher in the PND group ($4,163 versus $1,846; P<0.001). The proportion of potentially inappropriate medications was 34% among those 65 years of age or older.</p></sec><sec><title>CONCLUSIONS:</title><p>PNDs are associated with a higher level of comorbidities, higher medical resources utilization and higher health care costs than non-PND conditions.</p></sec></div></front></TEI><pmc xml:lang="EN" article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Pain Res Manag</journal-id><journal-id journal-id-type="publisher-id">PGI</journal-id><journal-title>Pain Research & Management : The Journal of the Canadian Pain Society</journal-title><issn pub-type="ppub">1203-6765</issn><publisher><publisher-name>Pulsus Group Inc</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">17372632</article-id><article-id pub-id-type="pmc">2670723</article-id><article-id pub-id-type="publisher-id">prm12031</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Painful neuropathic disorders: An analysis of the Régie de l’Assurance Maladie du Québec database</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Lachaine</surname><given-names>J</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="af1-prm12031">1</xref><xref ref-type="corresp" rid="c1-prm12031"></xref></contrib><contrib contrib-type="author"><name><surname>Gordon</surname><given-names>A</given-names></name><degrees>MD FRCP</degrees><xref ref-type="aff" rid="af2-prm12031">2</xref></contrib><contrib contrib-type="author"><name><surname>Choinière</surname><given-names>M</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="af3-prm12031">3</xref></contrib><contrib contrib-type="author"><name><surname>Collet</surname><given-names>JP</given-names></name><degrees>MD PhD</degrees><xref ref-type="aff" rid="af4-prm12031">4</xref></contrib><contrib contrib-type="author"><name><surname>Dion</surname><given-names>D</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="af5-prm12031">5</xref></contrib><contrib contrib-type="author"><name><surname>Tarride</surname><given-names>J-E</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="af6-prm12031">6</xref></contrib></contrib-group><aff id="af1-prm12031"><label>1</label>Faculty of Pharmacy, University of Montreal, Montreal, Quebec</aff><aff id="af2-prm12031"><label>2</label>Wasser Pain Management Center, Mount Sinai Hospital and Division of Neurology, University of Toronto, Toronto, Ontario</aff><aff id="af3-prm12031"><label>3</label>Department of Anaesthesiology, Faculty of Medicine, University of Montreal, Montreal, Quebec</aff><aff id="af4-prm12031"><label>4</label>Department of Clinical Epidemiology, McGill University, Montreal, Quebec</aff><aff id="af5-prm12031"><label>5</label>Department of Family Medicine, University of Montreal, Montreal, Quebec</aff><aff id="af6-prm12031"><label>6</label>At time of study: Pfizer Canada Inc, Kirkland, Quebec; Current affiliation: Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario</aff><author-notes><corresp id="c1-prm12031">Correspondence and reprints: Dr Jean Lachaine, Faculty of Pharmacy, University of Montreal, PO Box 6128, Station Centre-ville, Montreal, Quebec H3C 3J7. Telephone 514-343-6111 ext 4873, fax 514-343-2102, e-mail
<email>jean.lachaine@umontreal.ca</email></corresp></author-notes><pub-date pub-type="ppub"><season>Spring</season><year>2007</year></pub-date><volume>12</volume><issue>1</issue><fpage>31</fpage><lpage>37</lpage><copyright-statement>© 2007, Pulsus Group Inc. All rights reserved</copyright-statement><copyright-year>2007</copyright-year><abstract><sec><title>BACKGROUND/OBJECTIVE:</title><p>Painful neuropathic disorders (PNDs) refer to neurological disorders involving nerves in which pain is a predominant symptom. In most cases, PNDs involve the peripheral nerves. Treatment of PNDs is likely to use large health care resources. However, little is known about the economic burden of PNDs in Canada.</p></sec><sec><title>METHOD:</title><p>The present study was performed using data from a random sample of patients covered by the Régie de l’Assurance Maladie du Quebec drug plan. Subjects with a diagnosis of a peripheral PND were identified. Comorbidities, pain-related medication use and resource utilization were compared between PND patients and control patients without PNDs matched for age and sex in a 1:1 ratio.</p></sec><sec><title>RESULTS:</title><p>A total of 4912 patients with PNDs were identified. A higher level of comorbidities was found in the PND group (Von Korff chronic disease score 3.91 versus 2.54; P<0.001). The proportion of users of pain-related medications was significantly higher in the PND cohort than in the control group (χ<sup>2</sup>; P<0.001). The average annual number of physician visits was also significantly higher in the PND group than in the control group (14.7 versus 6.4; P<0.001). From a health ministry perspective, costs of health care resources were significantly higher in the PND group ($4,163 versus $1,846; P<0.001). The proportion of potentially inappropriate medications was 34% among those 65 years of age or older.</p></sec><sec><title>CONCLUSIONS:</title><p>PNDs are associated with a higher level of comorbidities, higher medical resources utilization and higher health care costs than non-PND conditions.</p></sec></abstract><trans-abstract xml:lang="FR"><sec><title>HISTORIQUE ET OBJECTIFS :</title><p>Les troubles de douleur neuropathique (TDN) désignent les troubles neurologiques d’origine nerveuse dont la douleur est le principal symptôme. Dans la plupart des cas, les TDN touchent les nerfs périphériques. Selon toute probabilité, il faut faire grand usage des ressources de santé pour les traiter. Cependant, on ne sait pas grand-chose du fardeau économique que représentent les TDN au Canada.</p></sec><sec><title>MÉTHODOLOGIE :</title><p>Pour effectuer la présente étude, on a fait appel aux données d’un échantillon aléatoire de patients couverts par le régime d’assurance-médicaments de la Régie de l’assurance maladie du Québec. On a repéré les sujets atteints de TDN périphériques diagnostiqués. On a ensuite comparé les comorbidités, le recours aux médicaments reliés à la douleur et l’utilisation des ressources entre les patients souffrant de TDN et un groupe témoin ne souffrant pas de telles douleurs, appariés selon l’âge et le sexe, dans un ratio de un pour un.</p></sec><sec><title>RÉSULTATS :</title><p>On a repéré un total de 4 912 patients atteints de TDN. On a constaté un taux plus élevé de comorbidités au sein de ce groupe (indice de maladie chronique de Von Korff: 3,91 par rapport à 2,54; P<0,001). La proportion d’utilisateurs de médicaments reliés à la douleur était considérablement plus élevée au sein de la cohorte souffrant de TDN que du groupe témoin (χ<sup>2</sup>; P<0,001). Le nombre annuel moyen de consultations chez le médecin était également beaucoup plus élevé au sein du groupe souffrant de TDN que du groupe témoin (14,7 par rapport à 6,4; P<0,001). Du point de vue du ministère de la Santé, les coûts de ressources de santé étaient considérablement plus élevés au sein du groupe souffrant de TDN (4 163 $ par rapport à 1 846 $; P<0,001). La proportion de médicaments potentiellement inappropriée était de 34 % chez les patients de 65 ans ou plus.</p></sec><sec><title>CONCLUSIONS :</title><p>Les TDN s’associent à un fort taux de comorbidités, à une plus forte utilisation des ressources médicales et à des coûts de santé plus élevés que les douleurs d’autre origine.</p></sec></trans-abstract><kwd-group><kwd>Comorbidities</kwd><kwd>Cost analysis</kwd><kwd>Inappropriate prescribing</kwd><kwd>Painful neuropathic disorders</kwd></kwd-group></article-meta></front><floats-wrap><fig id="f1-prm12031" position="float"><label>Figure 1)</label><caption><p>Extraction of the study population from the random sample of Régie de l’Assurance Maladie du Québec (RAMQ) patients. PND Painful neuropathic disorder</p></caption><graphic xlink:href="prm120311"></graphic></fig><table-wrap id="t1-prm12031" position="float"><label>TABLE 1</label><caption><p>Characteristics of patients with and without painful neuropathic disorders (PNDs)</p></caption><table frame="above" rules="groups"><thead><tr><th align="center" rowspan="1" colspan="1">Characteristics</th><th align="center" rowspan="1" colspan="1">All patients (n=9824)</th></tr></thead><tbody><tr><td align="left" colspan="2" rowspan="1">Age groups (years), n (%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> <40</td><td align="center" rowspan="1" colspan="1">823 (16.8)</td></tr><tr><td align="left" rowspan="1" colspan="1"> 40–59</td><td align="center" rowspan="1" colspan="1">1662 (33.8)</td></tr><tr><td align="left" rowspan="1" colspan="1"> 60–74</td><td align="center" rowspan="1" colspan="1">1582 (32.2)</td></tr><tr><td align="left" rowspan="1" colspan="1"> ≥75</td><td align="center" rowspan="1" colspan="1">845 (17.2)</td></tr><tr><td align="left" rowspan="1" colspan="1">Average age, years</td><td align="center" rowspan="1" colspan="1">57.4</td></tr><tr><td align="left" colspan="2" rowspan="1">Sex, n (%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Female</td><td align="center" rowspan="1" colspan="1">3018 (61.4)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Male</td><td align="center" rowspan="1" colspan="1">1894 (38.6)</td></tr></tbody></table><table frame="below" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">Patients with PNDs n=4912</th><th align="center" rowspan="1" colspan="1">Patients without PNDs n=4912</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Chronic disease score (mean ± SD)</td><td align="center" rowspan="1" colspan="1">3.91±3.70</td><td align="center" rowspan="1" colspan="1">2.54±3.16</td></tr><tr><td align="left" colspan="3" rowspan="1">PND, n (%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Diabetic neuropathy</td><td align="center" rowspan="1" colspan="1">100 (2.0)</td><td align="center" rowspan="1" colspan="1">n/a</td></tr><tr><td align="left" rowspan="1" colspan="1"> Postherpetic neuralgia</td><td align="center" rowspan="1" colspan="1">5 (0.1)</td><td align="center" rowspan="1" colspan="1">n/a</td></tr><tr><td align="left" rowspan="1" colspan="1"> Back pain with neuropathic involvement</td><td align="center" rowspan="1" colspan="1">1196 (24.3)</td><td align="center" rowspan="1" colspan="1">n/a</td></tr><tr><td align="left" rowspan="1" colspan="1"> Neck pain with neuropathic involvement</td><td align="center" rowspan="1" colspan="1">108 (2.2)</td><td align="center" rowspan="1" colspan="1">n/a</td></tr><tr><td align="left" rowspan="1" colspan="1"> Cancer with neuropathic involvement</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">n/a</td></tr><tr><td align="left" rowspan="1" colspan="1"> Causalgia, reflex sympathetic dystrophy</td><td align="center" rowspan="1" colspan="1">1404 (28.6)</td><td align="center" rowspan="1" colspan="1">n/a</td></tr><tr><td align="left" rowspan="1" colspan="1"> HIV/AIDS with neuropathic involvement</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">n/a</td></tr><tr><td align="left" rowspan="1" colspan="1"> Phantom limb pain</td><td align="center" rowspan="1" colspan="1">0</td><td align="center" rowspan="1" colspan="1">n/a</td></tr><tr><td align="left" rowspan="1" colspan="1"> Trigeminal neuralgia</td><td align="center" rowspan="1" colspan="1">50 (1.0)</td><td align="center" rowspan="1" colspan="1">n/a</td></tr><tr><td align="left" rowspan="1" colspan="1"> Atypical facial pain</td><td align="center" rowspan="1" colspan="1">27 (0.5)</td><td align="center" rowspan="1" colspan="1">n/a</td></tr><tr><td align="left" rowspan="1" colspan="1"> Carpal tunnel syndrome</td><td align="center" rowspan="1" colspan="1">1249 (25.4)</td><td align="center" rowspan="1" colspan="1">n/a</td></tr><tr><td align="left" rowspan="1" colspan="1"> Mononeuritis of upper limb, unspecified</td><td align="center" rowspan="1" colspan="1">861 (17.5)</td><td align="center" rowspan="1" colspan="1">n/a</td></tr><tr><td align="left" rowspan="1" colspan="1"> Other disorders of peripheral nervous system associated with neuropathic pain</td><td align="center" rowspan="1" colspan="1">148 (3.0)</td><td align="center" rowspan="1" colspan="1">n/a</td></tr><tr><td align="left" colspan="3" rowspan="1">Number of PNDs, n (%)</td></tr><tr><td align="left" rowspan="1" colspan="1"> One</td><td align="center" rowspan="1" colspan="1">4683 (95.3)</td><td align="center" rowspan="1" colspan="1">n/a</td></tr><tr><td align="left" rowspan="1" colspan="1"> Two</td><td align="center" rowspan="1" colspan="1">222 (4)</td><td align="center" rowspan="1" colspan="1">n/a</td></tr><tr><td align="left" rowspan="1" colspan="1"> Three</td><td align="center" rowspan="1" colspan="1">7 (0)</td><td align="center" rowspan="1" colspan="1">n/a</td></tr></tbody></table><table-wrap-foot><fn id="tfn1-prm12031"><p>n/a Not applicable</p></fn></table-wrap-foot></table-wrap><table-wrap id="t2-prm12031" position="float"><label>TABLE 2</label><caption><p>The prevalence of chronic comorbidities in patients with and without painful neuropathic disorders (PNDs)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Chronic comorbidities (ICD-9 codes)</th><th align="center" rowspan="1" colspan="1">Patients with PNDs, n (%)</th><th align="center" rowspan="1" colspan="1">Patients without PNDs, n (%)</th><th align="center" rowspan="1" colspan="1">χ<sup>2</sup></th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Fibromyalgia (7291)</td><td align="center" rowspan="1" colspan="1">95 (1.9)</td><td align="center" rowspan="1" colspan="1">21 (0.4)</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Low back pain (7200–7202, 7213, 7220, 7242, 7246, 7247)</td><td align="center" rowspan="1" colspan="1">603 (12.3)</td><td align="center" rowspan="1" colspan="1">50 (1.0)</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Other spinal pain (7200–7249, except code for low back pain)</td><td align="center" rowspan="1" colspan="1">1037 (21.1)</td><td align="center" rowspan="1" colspan="1">85 (1.7)</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Osteoarthritis (7150–7159)</td><td align="center" rowspan="1" colspan="1">411 (8.4)</td><td align="center" rowspan="1" colspan="1">117 (2.4)</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Other arthritis, arthropathies, and musculoskeletal pain (7100–7149, 7160–7199, 7250–7299)</td><td align="center" rowspan="1" colspan="1">1804 (36.7)</td><td align="center" rowspan="1" colspan="1">341 (6.9)</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Headache (3078, 3460–3469, 3490, 6272, 7840)</td><td align="center" rowspan="1" colspan="1">273 (5.6)</td><td align="center" rowspan="1" colspan="1">129 (2.6)</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Coronary heart disease (4100–4149)</td><td align="center" rowspan="1" colspan="1">435 (8.9)</td><td align="center" rowspan="1" colspan="1">281 (5.7)</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Diabetes (2500–2505, 2507–2509)</td><td align="center" rowspan="1" colspan="1">591 (12.0)</td><td align="center" rowspan="1" colspan="1">306 (6.2)</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Depression (2962–2968, 2980, 3004, 3110–3119)</td><td align="center" rowspan="1" colspan="1">311 (6.3)</td><td align="center" rowspan="1" colspan="1">167 (3.4)</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Other mental health disorders including general anxiety disorder, sleep disorders and social phobias (3074, 7805, 3000, 3002)</td><td align="center" rowspan="1" colspan="1">34 (0.7)</td><td align="center" rowspan="1" colspan="1">19 (0.4)</td><td align="center" rowspan="1" colspan="1">P=0.026</td></tr></tbody></table><table-wrap-foot><fn id="tfn2-prm12031"><p>ICD-9 International Classification of Diseases, Ninth Revision</p></fn></table-wrap-foot></table-wrap><table-wrap id="t3-prm12031" position="float"><label>TABLE 3</label><caption><p>Comparative analysis of pain-related medications used by patients with and without painful neuropathic disorders (PNDs)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">Patients with PNDs, n (%)</th><th align="center" rowspan="1" colspan="1">Patients without PNDs, n (%)</th><th align="center" rowspan="1" colspan="1">χ<sup>2</sup></th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Anticonvulsants</td><td align="center" rowspan="1" colspan="1">679 (13.8)</td><td align="center" rowspan="1" colspan="1">136 (2.8)</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Antidepressants</td><td align="center" rowspan="1" colspan="1">1230 (25.0)</td><td align="center" rowspan="1" colspan="1">533 (10.9)</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">NSAIDs</td><td align="center" rowspan="1" colspan="1">2611 (53.2)</td><td align="center" rowspan="1" colspan="1">1411 (28.7)</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Opioids</td><td align="center" rowspan="1" colspan="1">951 (19.4)</td><td align="center" rowspan="1" colspan="1">198 (4.0)</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Benzodiazepines</td><td align="center" rowspan="1" colspan="1">1547 (31.5)</td><td align="center" rowspan="1" colspan="1">1043 (21.2)</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Corticosteroids</td><td align="center" rowspan="1" colspan="1">1032 (21.0)</td><td align="center" rowspan="1" colspan="1">518 (10.5)</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Muscle relaxants</td><td align="center" rowspan="1" colspan="1">477 (9.7)</td><td align="center" rowspan="1" colspan="1">108 (2.2)</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Sedatives and hypnotics</td><td align="center" rowspan="1" colspan="1">205 (4.2)</td><td align="center" rowspan="1" colspan="1">136 (2.8)</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr></tbody></table><table-wrap-foot><fn id="tfn3-prm12031"><p>NSAIDs Nonsteroidal anti-inflammatory drugs</p></fn></table-wrap-foot></table-wrap><table-wrap id="t4-prm12031" position="float"><label>TABLE 4</label><caption><p>Appropriateness of pain-related medications among patients with painful neuropathic disorders (PNDs) older than 65 years of age (n=2043)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Potentially inappropriate medication use in older adults, independent of diagnosis or conditions, according to Beers criteria (<xref ref-type="bibr" rid="b11-prm12031">11</xref>,<xref ref-type="bibr" rid="b12-prm12031">12</xref>)</th><th align="center" rowspan="1" colspan="1">n (%)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Indomethacine</td><td align="center" rowspan="1" colspan="1">31 (1.5)</td></tr><tr><td align="left" rowspan="1" colspan="1">Pentazocine</td><td align="center" rowspan="1" colspan="1">6 (0.2)</td></tr><tr><td align="left" rowspan="1" colspan="1">Muscle relaxants and antispasmodics: methocarbamol, carisoprodol, chlorzoxazone, cyclobenzaprine, oxybutynin</td><td align="center" rowspan="1" colspan="1">138 (6.8)</td></tr><tr><td align="left" rowspan="1" colspan="1">Flurazepam</td><td align="center" rowspan="1" colspan="1">59 (2.9)</td></tr><tr><td align="left" rowspan="1" colspan="1">Amitriptyline</td><td align="center" rowspan="1" colspan="1">229 (11.2)</td></tr><tr><td align="left" rowspan="1" colspan="1">Doxepin</td><td align="center" rowspan="1" colspan="1">17 (0.8)</td></tr><tr><td align="left" rowspan="1" colspan="1">Meprobamate</td><td align="center" rowspan="1" colspan="1">0 (0)</td></tr><tr><td align="left" rowspan="1" colspan="1">Short-acting benzodiazepines at doses greater than: lorazepam 3 mg, oxazepam 60 mg, alprazolam 2 mg, temazepam 15 mg, triazolam 0.20 mg</td><td align="center" rowspan="1" colspan="1">81 (4.0)</td></tr><tr><td align="left" rowspan="1" colspan="1">Long-acting benzodiazepines: chlordiazepoxide, diazepam</td><td align="center" rowspan="1" colspan="1">54 (2.6)</td></tr><tr><td align="left" rowspan="1" colspan="1">Meperidine</td><td align="center" rowspan="1" colspan="1">38 (1.9)</td></tr><tr><td align="left" rowspan="1" colspan="1">Ketorolac</td><td align="center" rowspan="1" colspan="1">5 (0.2)</td></tr><tr><td align="left" rowspan="1" colspan="1">Long-term use of naproxen, oxaprozin or piroxicam</td><td align="center" rowspan="1" colspan="1">144 (7.1)</td></tr><tr><td align="left" rowspan="1" colspan="1">Fluoxetine</td><td align="center" rowspan="1" colspan="1">12 (0.6)</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Potentially inappropriate medication use in older adults considering diagnoses or conditions</bold></td><td align="center" rowspan="1" colspan="1"><bold>n (%)</bold></td></tr><tr><td colspan="2" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Blood clotting disorders or anticoagulant therapy + NSAIDs</td><td align="center" rowspan="1" colspan="1">74 (3.6)</td></tr><tr><td align="left" rowspan="1" colspan="1">Arrhythmias + tricyclic antidepressants</td><td align="center" rowspan="1" colspan="1">15 (0.7)</td></tr><tr><td align="left" rowspan="1" colspan="1">COPD + long-acting benzodiazepines</td><td align="center" rowspan="1" colspan="1">5 (0.2)</td></tr><tr><td align="left" rowspan="1" colspan="1"><bold>Any of above</bold></td><td align="center" rowspan="1" colspan="1"><bold>n (%)</bold></td></tr><tr><td colspan="2" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="center" rowspan="1" colspan="1">690 (33.8)</td></tr></tbody></table><table-wrap-foot><fn id="tfn4-prm12031"><p>COPD Chronic obstructive pulmonary disease; NSAIDs Nonsteroidal anti-inflammatory drugs</p></fn></table-wrap-foot></table-wrap><table-wrap id="t5-prm12031" position="float"><label>TABLE 5</label><caption><p>Comparative analysis of health services resources used by patients with and without painful neuropathic disorders (PNDs)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">Patients with PNDs (mean ± SD)</th><th align="center" rowspan="1" colspan="1">Patients without PNDs (mean ± SD)</th><th align="center" rowspan="1" colspan="1">ANOVA</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Visits to GPs</td><td align="center" rowspan="1" colspan="1">6.7±13.5</td><td align="center" rowspan="1" colspan="1">3.4±8.1</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Visits to specialists</td><td align="center" rowspan="1" colspan="1">8.0±14.0</td><td align="center" rowspan="1" colspan="1">3.0±7.7</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">GP procedures</td><td align="center" rowspan="1" colspan="1">5.4±8.0</td><td align="center" rowspan="1" colspan="1">2.2±3.8</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Specialist procedures</td><td align="center" rowspan="1" colspan="1">10.3±14.8</td><td align="center" rowspan="1" colspan="1">3.6±7.6</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Days of hospitalization</td><td align="center" rowspan="1" colspan="1">2.9±9.4</td><td align="center" rowspan="1" colspan="1">1.1±5.1</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr></tbody></table><table-wrap-foot><fn id="tfn5-prm12031"><p>GP General practitioner</p></fn></table-wrap-foot></table-wrap><table-wrap id="t6-prm12031" position="float"><label>TABLE 6</label><caption><p>Comparative analysis of annual costs of health services resources used by patients with and without painful neuropathic disorders (PNDs)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">Patients with PNDs (mean ± SD)</th><th align="center" rowspan="1" colspan="1">Patients without PNDs (mean ± SD)</th><th align="center" rowspan="1" colspan="1">ANOVA</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Visits to GP</td><td align="center" rowspan="1" colspan="1">$164±285</td><td align="center" rowspan="1" colspan="1">$92±187</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Visits to specialists</td><td align="center" rowspan="1" colspan="1">$292±462</td><td align="center" rowspan="1" colspan="1">$105±255</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">GP procedures</td><td align="center" rowspan="1" colspan="1">$137±223</td><td align="center" rowspan="1" colspan="1">$60±115</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Specialist procedures</td><td align="center" rowspan="1" colspan="1">$416±625</td><td align="center" rowspan="1" colspan="1">$144±420</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Days of hospitalization</td><td align="center" rowspan="1" colspan="1">$1,803±5,876</td><td align="center" rowspan="1" colspan="1">$662±3,212</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Medication cost</td><td align="center" rowspan="1" colspan="1">$1350±1,939</td><td align="center" rowspan="1" colspan="1">$781±1,429</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Total</td><td align="center" rowspan="1" colspan="1">$4,163±7,536</td><td align="center" rowspan="1" colspan="1">$1,846±4,418</td><td align="center" rowspan="1" colspan="1">P<0.001</td></tr></tbody></table><table-wrap-foot><fn id="tfn6-prm12031"><p>GP General practitioner</p></fn></table-wrap-foot></table-wrap></floats-wrap></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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