Socioeconomic value of intervention for chronic pain

A Systematic Review of the Variation in Pain Catastrophizing Scale Reference Scores Based on Language Version and Country in Patients with Chronic Primary (Non-specific) Pain

INTRODUCTION

This systematic review aimed to investigate variations of reference scores for the Pain Catastrophizing Scale (PCS) between language versions and between countries in patients with chronic primary pain (CPP) or chronic primary pain, not otherwise specified (CPP-NOS).

METHODS

Electronic searches of the Ovid/Embase, Ovid/MEDLINE, and Ovid/PsycINFO databases were conducted to retrieve studies assessing PCS scores in adults with CPP or CPP-NOS proposed by the International Classification of Diseases, Eleventh Revision for any country where the translated PCS was available. The protocol for this systematic review was prospectively registered on the International Prospective Register of Systematic Reviews 2018 (registration number: CRD 42018086719).

RESULTS

A total of 3634 articles were screened after removal of duplicates. From these, 241 articles reporting on 32,282 patients with chronic pain were included in the review. The mean (± standard deviation) weighted PCS score across all articles was 25.04 ± 12.87. Of the 12 language versions and 21 countries included in the review, the weighted mean PCS score in Asian languages or Asian countries was significantly higher than that in English, European, and other languages or Western and other countries. The highest mean score of the weighted PCS based on language was in Japanese (mean 33.55), and the lowest was in Russian (mean 20.32). The highest mean score of the weighted PCS based on country was from Japan (mean 33.55), and the lowest was from Australia (mean 19.80).

CONCLUSION

The weighted PCS scores for people with CPP or CPP-NOS were significantly higher in Asian language versions/Asian countries than in English, European and other language versions or Western and other countries.

Cost-effectiveness of a mindfulness-based mental health promotion program: economic evaluation of a nonrandomized controlled trial with propensity score matching

BACKGROUND

Mental health promotion programs have been shown to reduce the burden associated with mental distress and prevent the onset of mental disorders, but evidence of cost-effectiveness is scarce.

OBJECTIVE

To evaluate the cost-effectiveness of a mindfulness-based mental health prevention program provided by health coaches in a multi-site field setting in Germany.

METHODS

The single-study based economic evaluation was conducted as part of a nonrandomized controlled trial, comparing the effects of a group-based prevention program to usual care based on propensity score matching. Participants (N = 1166) were recruited via a large statutory health insurance fund. Health outcome was assessed with the Hospital Anxiety and Depression Scale (HADS). Cost outcomes were actually incurred costs compiled from the health insurance' records. Incremental cost-effectiveness ratios (ICER) were analyzed from a societal and a health care perspective for a 12-month time horizon with sampling uncertainty being handled using nonparametric bootstrapping. A cost-effectiveness acceptability curve was graphed to determine the probability of cost-effectiveness at different willingness-to-pay ceiling ratios.

RESULTS

From a societal perspective, prevention was cost-effective compared to usual-care by providing larger effects of 1.97 units on the HADS (95% CI [1.14, 2.81], p < 0.001) at lower mean incremental total costs of €-57 (95% CI [- 634, 480], p = 0.84), yielding an ICER of €-29 (savings) per unit improvement. From a health care perspective, the incremental health benefits were achieved at additional direct costs of €181 for prevention participants (95% CI [40, 318], p = 0.01) with an ICER of €91 per unit improvement on the HADS. Willingness-to-pay for the prevention program to achieve a 95% probability of being cost-effective compared to usual-care, was estimated at €225 per unit improvement on the HADS score from a societal, and €191 from a health care perspective respectively. Sensitivity analyses suggested differential cost-effect-ratios depending on the initial distress of participants.

LIMITATIONS

Due to the complexity of the field trial, it was not feasible to randomize participants and offer an active control condition. This limitation was met by applying a rigorous matching procedure.

CONCLUSIONS

Our results indicate that universal mental health promotion programs in community settings might be a cost-effective strategy to enhance well-being. Differences between the societal and health care perspective underline the call for joint funding in the dissemination of preventive services.

TRIAL REGISTRATION

German Clinical Trials Registration ID: DRKS00006216 (2014/06/11, retrospective registration).

Cross-sectional International Multicenter Study on Quality of Life and Reasons for Abandonment of Upper Limb Prostheses

Background:

This multicenter study aimed to examine the reasons for prosthesis rejection and assess the quality of life (QOL) among patients with upper limb deficiency.

Methods:

Three rehabilitation centers in Japan and 1 academic medical center in the United States participated. Patients between the age of 12 and 75 years with unilateral or bilateral upper limb absence from the level of wrist to shoulder disarticulation were included. Two questionnaires were used, an original questionnaire on prosthesis use and the EQ-5D, which were completed by both the participant and a live-in proxy.

Results:

Of the 367 patients with upper limb loss invited, 174 patients participated in this study. Eighty percent of the study population were male patients. The most common amputation level was transradial. Trauma was the most common cause of limb loss. The prosthesis rejection rate was 9% (n = 16). The most common reason for abandonment was a lack of prosthesis functionality. Ten of 16 prosthesis nonusers (63%) and 59 prosthesis users (38%) were unemployed or students. The mean EQ-5D utility score was significantly higher in prosthesis users than in nonusers (0.762 versus 0.628, P < 0.01). Live-in proxies significantly overestimated QOL in male patients (0.77 versus 0.807, P=0.01).

Conclusions:

The current prosthesis rejection rate is low. QOL was significantly higher in prosthesis users than in nonusers. More prosthesis users were employed compared with nonusers. Care should be taken not to overestimate the QOL of male patients with upper limb loss as their proxies often did.

Reliability and validity of the Athens Insomnia Scale in chronic pain patients

Purpose

To confirm the psychometric properties of the Athens Insomnia Scale (AIS) among Japanese chronic pain patients.

Patients and methods

In total, 144 outpatients were asked to complete questionnaires comprising the AIS and other study measures. According to the original article, the AIS has 2 versions: the AIS-8 (full version) and the AIS-5 (brief version). To validate the AIS-8 and AIS-5 among chronic pain patients, we confirmed: 1) factor structure by confirmatory factor analysis; 2) internal consistency by Cronbach's a; 3) test-retest reliability using with interclass correlation coefficients; 4) known-group validity; 5) concurrent validity; and 6) cut-off values by receiver operating characteristic analysis. In addition, semi-structured interviews were conducted to assess the participants' sleep disturbance. If the participants had any sleep complaints, including difficulty in initiating sleep, difficulty in maintaining sleep, and early morning awakening, they were defined as insomnia symptoms.

Results

A 2-factor model of the AIS-8 and 1-factor model of the AIS-5 demonstrated good fit. The AIS had adequate internal consistency and test-retest reliability. Patients with insomnia had a higher AIS score than those without insomnia. The sleep disturbance measured by the AIS was positively associated with pain intensity, disability, depression, anxiety, and pain catastrophizing, and negatively associated with pain-related self-efficacy. The cut-off values for detecting insomnia were estimated at 8 points in the AIS-8 and 4 points in the AIS-5.

Conclusion

The AIS-8 and AIS-5 had adequate reliability and validity in chronic pain patients.

The economic and humanistic costs of chronic lower back pain in Japan

Background

Few data are available that provide estimates of the economic impact of chronic lower back pain (CLBP) in Japan. The current study estimated the patient burden and the direct and indirect medical costs associated with CLBP in Japan using data from a large cross-sectional patient survey. CLBP was hypothesized to be associated with a considerable burden of illness and a large economic impact.

Methods

Study participants completed the Japan National Health and Wellness Survey in 2014, which included measures of health-related quality of life (HRQoL), work impairment, impairment to daily activities, and healthcare service use. Data from those reporting CLBP (N=392) were contrasted against those from matched controls without back pain, using age and sex-adjusted models.

Results

CLBP patients reported significantly lower HRQoL relative to matched controls. Age-and sex-adjusted models estimated mean annual per patient direct and indirect costs attributable to CLBP to be ¥1,820,297 ($15,239 or €12,551) and ¥1,479,899 ($12,389 or €10,203), respectively, with the majority of direct costs related to hospital expenses (¥1,584,759, which is equivalent to $13,267 and €10,927). In estimating the economic impact of CLBP on society, the CLBP respondents were estimated to include 1,508,524 individuals when extrapolated to the Japanese population (815,461 of them employed). Ultimately, this represented approximately ¥1.2 trillion ($10 billion and €8.3 billion) per year in lost productivity at the time of this study.

Conclusion

This study of patients with CLBP in Japan has shown it to be associated with a significant burden on patients and to have a considerable negative impact on the Japanese economy primarily driven by lost productivity. Further research on the effectiveness of interventions to improve the outcomes of those with CLBP is warranted.

Impact of Botox-A SNAP-25 protein expression and the mechanism of inhibitory neurotransmitter imbalance in chronic sciatic nerve pain rat model

The Botox-A impact on the expression of SNAP-25 protein in rat chronic sciatic nerve pain model was assessed and the mechanism of inhibitory neurotransmitter imbalance was studied. A chronic constriction injury (CCI) model consisted of 30 healthy male rats. The rats were randomly divided into the sham-operated group, CCI group and BoNT/A intervention group, and during 1, 7 and 14 days we conducted mechanical withdrawal threshold (MWT) test and thermal withdrawal latency (TWL) test before and after operation. After 14 days, the animals were sacrificed. SNAP-25 protein expression level, mRNA subunit NR2B within excitatory neurotransmitter glutamate GLT and protein expression level, as well as GAT mRNA, the inhibitory GABA neurotransmitter transporter and protein expression level were studied by RT-polymerase chain reaction and western blot analysis. The difference between MWT and TWL at each point in time before and after operation showed no statistical significance (P>0.05) in the sham-operated group. For the CCI group at each time point, MWT and TWL were obviously lower than the sham-operated group and the difference was statistically significant (P<0.05) while the internal difference at each time point showed no statistical significance (P>0.05). The expression level of protein of SNAP-25 and NR2B mRNA in the CCI group was clearly higher than sham-operated group. Additionally, the expression level of GAT-1 mRNA and protein in CCI group was apparently lower than the sham-operated group. In conclusion, Botox-A helped reduce SNAP-25 within rat chronic sciatic nerve pain model thereby relieving pain.