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The Impact of Chronic Discogenic Low Back Pain: Costs and Patients’ Burden 时间:2018-10-01 16:38   来源:未知   作者:admin   点击: 次 Abstract:Introduction. Chronic discogenic low back pain (CDP) is frequently diagnosed in patients referred to specialized pain clinics for their back pain. The aim of this study is to assess the impact of CDP both on the individual patient and on society. Materials and Methods. Using the baseline records of 80 patients in a randomized trial assessing the effectiveness of a new intervention for CDP, healthcare and societal costs related to back pain are calculated. Furthermore, the impact of the condition on perceived pain, disability, health-related quality of life, Quality of life Adjusted Life Years (QALY), and QALY loss is assessed. Results. Using the friction costs approach, we found that the annual costs for society are €7,911.95 per CDP patient, 51% healthcare and 49% societal costs. When using the human capital approach, total costs were €18,940.58, 22% healthcare and 78% societal costs. Healthcare costs were mainly related to pain treatment. Mean pain severity was 6.5 (0–10), and 46% suffered from severe pain (≥7/10). Mean physical limitations rate was 43.7; 13.5% of the patients were very limited to disabled. QALY loss compared to a healthy population was 64%. Discussion. This study shows that in patients with CDP referred to a pain clinic, costs for society are high and the most used healthcare resources are pain therapies. Patients suffer severe pain, are physically limited, and experience a serious loss in quality of life.
1. Introduction
  Low back pain is one of the most common disabling conditions worldwide [1]. Approximately 70 to 85% of the western population will develop low back pain at least once during their lifetime [2]. Of the people that consult their general practitioner for low back pain, one year later about 60% still report pain [3]. The prevalence of chronic low back pain (CLBP) is globally calculated to be 9442.5 per 100,000 (9%) [4]. CLBP is a common, long-lasting, and disabling condition with high costs for society [5–7]. In 2007, the costs for CLBP represented 0.6% of the gross national product in the Netherlands [7]. Direct healthcare costs are, for instance, caused by patients searching for pain treatment [2, 5, 8, 9]. Indirect (societal) costs represent secondary consequences of CLBP, the losses resulting from morbidity or disability, mainly caused by work absenteeism and informal caregiving [10, 11]. Although indirect costs are known to be the highest cost factor for CLBP, direct healthcare costs, like medical specialist care and hospital costs, for low back pain are high as well [5, 8, 11].
  CLBP may emerge from several different etiologies but about 40 to 50% of CLBP, treated in specialized pain or orthopedic clinics, is alleged to be of discogenic origin [12–14]. Disk degeneration involves structural disruption and cell-mediated changes in composition of the disk, particularly annular fissures reaching the outer annulus [15]. Provocation discography is, up to now, the only test that with some reliability can distinguish pain of discogenic origin from other sources of CLBP [15, 16]. Patients with chronic discogenic low back pain (CDP) in clinical practice differ from other CLBP patients in that the chronic pain is located more axial and the pain is severe [17]. There is evidence that CDP more often starts at a younger age than other types of chronic pain. A study reports that if the CLBP starts at a young age, the more likely the pain is discogenic in origin [14, 18]. Although most CDP patients are amenable for pain intervention therapies, up till now there is no evidence for a longer term beneficial treatment [19].
   Little is known about the specific impact of CDP on patients and its burden for society. About the impact of CLBP in general, there is more information [12, 13, 20] and some is known about the impact of radicular syndromes [21].