Burden of illness

Overview

Consequences of Unrelieved Pain Acute pain Impaired physical function Dependence Extended recovery time Increased risk of developing chronic pain Reduced mobility On medication Hospital readmissions Speaker’s Notes Unrelieved acute pain can result in a number of physical, psychological, emotional and social issues that negatively influence a patient’s life. It can also result in progression to chronic pain. Reference Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. The National Academies Press; Washington, DC: 2011. Disturbed sleep On family members/other caregivers Economic costs Immune impairment Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. The National Academies Press; Washington, DC: 2011.

Is pain important to patients? 59% of patients considered pain to be their most significant fear about surgery 8% had delayed an operation because of this Speaker’s Notes Post-operative pain is associated with significant unnecessary physical, psychological and emotional distress and has persistently been reported to be undermanaged. In recognition of the biopsychosocial aspects of pain, it should be given that despite the (un)anticipated challenges, patients need to be better and adequately educated on acute pain management to improve the recovery duration and quality of recovery, and decrease financial burdens and mortality. References Apfelbaum JL et al. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003; 97(2):534-40. Filos KS et al. Current concepts and practice in postoperative pain management: need for a change? Eur Surg Res 1999; 31(2):97-107. Polomano RC et al. Perspective on pain management in the 21st century. 2008; 23(1 Suppl):S4-14. Apfelbaum JL et al. Anesth Analg 2003; 97(2):534-40; Filos KS et al. Eur Surg Res 1999; 31(2):97-107; Polomano RC et al. J Perianesth Nurs 2008; 23(1 Suppl):S4-14.

Physical Burden

Impact of Acute Pain on Daily Activities Speaker’s Notes The data in this slide suggest that acute pain negatively impacts on daily activities and under-treatment/insufficient relief of acute pain decreases the patient’s quality of life at both the physical and emotional levels. Survey participants in this study were aged 18 years or older, experienced moderate to moderately severe pain at least 2–3 times per month, and had taken combination opioid products for any reason within the previous 6 months. A total of 247 participants were classified as acute pain sufferers whose pain was managed through limiting strenuous activities, undergoing physical therapy and pharmacotherapy. Inadequate pain control was a major concern of these participants. It should be noted that the chart shown on this slide is based on self-reported data gathered through an internet survey, rather than a true quality of life study. Reference McCarberg BH et al. The impact of pain on quality of life and the unmet needs of pain management: results from pain sufferers and physicians participating in an Internet survey. Am J Ther 2008; 15(4):312-20. *Patients who responded “Sometimes”, “Often” or “Always” Adapted from: McCarberg BH et al. Am J Ther. 2008; 15(4):312-20.

Musculoskeletal Pain Frequently Associated with Disability Extent of Pain-Related Disability among Adults with Pain in the United States, 2009 Type of pain Difficulty with basic actions* (%) Complex activity limitation** (%) Low back pain 51.6 55.0 Neck pain 30.2 34.4 Knee pain 37.3 38.6 Shoulder pain 17.7 21.4 Finger pain 14.3 16.3 Hip pain 15.0 18.4 Speaker’s Notes Pain is a major contributor to work disability and lost work days. Pain-related conditions and back/spine problems account for the top two causes of disability. Reference Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. The National Academies Press; Washington, DC: 2011. *Defined as having difficulties in one or more of the following areas: movement, emotional, seeing, hearing or cognition **Defined as having limitations in one or more of the following areas: self-care, social or work Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. The National Academies Press; Washington, DC: 2011.

Postsurgical Pain Interferes with Daily Functioning Speaker’s Notes In this study, 89 day-surgery patients were asked to complete self-administered questionnaires before and after (24, 48 and 72 hours) being discharged. Inadequate pain control within the first few hours post-surgery was the best predictor of severe post-discharge pain and, even though pain-associated activity impairments diminished with time, these debilitations were still evident up to at least a week post-discharge. Of note, the majority of patients indicated satisfaction with pain management although they experienced high levels of pain. Collectively, these results suggest that patients need to be adequately educated on the importance of controlling pain immediately after surgery and how adequate and timely pain management can affect post-operative quality of life and recovery duration. Reference Beauregard L et al. Severity and impact of pain after day-surgery. Can J Anaesth 1998; 45(4):304-11. Beauregard L et al. Can J Anaesth 1998; 45(4):304-11.

Economic Burden

Pain: Most Common Reason for Return to Hospital Post-surgery 38% Pain accounted for 38% of unanticipated admissions or readmissions following surgery. Speaker’s Notes This was a retrospective database study that evaluated the rate of unanticipated admissions and readmissions after same-day surgery at an academic medical center. Of the 20,817 patients who underwent same-day surgery, 5.7% returned to the hospital within 30 days of the index same-day surgery procedure or were admitted directly after surgery. Pain accounted for 38% of unanticipated admissions or readmissions, with surgical complications second and representing 21% of the encounters. Approximately 68% of patients with pain returned to the hospital within 7 days compared with 65% of patients who had other problems. Whether improved pain management immediately following surgery impacts hospital return rates following surgery remains to be determined. Reference Coley KC et al. Retrospective evaluation of unanticipated admissions and readmissions after same day surgery and associated costs. J Clin Anesth 2002; 14(5):349-53. Coley KC et al. J Clin Anesth 2002; 14(5):349-53.

Comorbidities

Greater Acute Pain Intensity May Be Associated with Post-traumatic Stress Disorder Symptoms Immediately post-injury* 3 months post-injury 12 months post-injury Pain severity Pain severity Pain severity 0.36 0.47 0.20 0.15 0.16 Catastrophizing Catastrophizing 0.51 0.18 Speaker’s Notes Intensity of acute pain has been shown to predict post-traumatic stress disorder symptoms in various pain conditions, suggesting that there may be a causal relationship between pain and the emergence of post-traumatic stress disorder symptoms. Since pain is more easily evaluated than the majority of post-traumatic stress disorder symptoms, it may be prudent to monitor individuals who report pain for symptoms of post-traumatic stress disorder. References Carty J et al. Predicting posttraumatic stress disorder symptoms and pain intensity following severe injury: the role of catastrophizing. Eur J Psychotraumatol 2011; 2. McGhee LL et al. The relationship of early pain scores and posttraumatic stress disorder in burned soldiers. J Burn Care Res 2011; 32(1):46-51. Opsteegh L et al. Symptoms of acute posttraumatic stress disorder in patients with acute hand injuries. J Hand Surg Am 2010; 35(6):961-7. 0.20 Post-traumatic stress disorder severity Post-traumatic stress disorder severity Post-traumatic stress disorder severity 0.40 0.52 0.14 Figure displays standardized path coefficients between measures of post-traumatic stress disorder, catastrophizing and pain severity *Mean = 6.1 days Carty J et al. Eur J Psychotraumatol 2011; 2; McGee LI et al. Burn Care Res 2011; 32(1):46-51; Opsteegh L et al. J Hand Surg Am 2010; 35(6):961-7.

Post-operative Pain and Other Pain Comorbidities Speaker’s Notes Individuals with pain often present with more than one painful condition. Using administrative claims data from Thomson Reuters’ MarketScan United States Commercial and Medicare Supplemental retrospective claims databases covering the years 2005–2007, the investigators of this study performed a retroactive analysis of rates of comorbidity, analgesic use and health care costs of 1,211,483 adults with at least one pain condition during the one-year study period. This slide summarizes the rates of pain comorbidities amongst patients with surgery-associated pain. Osteoarthitis, the second most prevalent pain condition across all the cohorts examined, was also the most common comorbidity reported by patients with post-surgery pain. Reference Davis JA et al. Incidence and impact of pain conditions and comorbid illnesses. J Pain Res 2011; 4:331-45. Mean number of pain conditions: 1.4 Notes: infrequent comorbid conditions were omitted. Davis JA et al. J Pain Res 2011; 4:331-45.

Post-operative Pain and Sleep and Mental Health Comorbidities Mean number of mental health conditions: 1.5 Speaker’s Notes Individuals with pain often present with more than one painful condition. Using administrative claims data from Thomson Reuters’ MarketScan United States Commercial and Medicare Supplemental retrospective claims databases covering the years 2005–2007, the investigators of this study performed a retroactive analysis of rates of comorbidity, analgesic use and health care costs of 1,211,483 adults with at least one pain condition during the one-year study period. This slide summarizes the incidence of sleep and mental health comorbidities amongst patients with surgery-associated pain. Reference Davis JA et al. Incidence and impact of pain conditions and comorbid illnesses. J Pain Res 2011; 4:331-45. MDD = major depressive disorder Davis JA et al. J Pain Res 2011; 4:331-45.

Summary

Burden of Illness of Acute Pain: Summary Acute pain can interfere with daily functioning Individuals suffering from acute pain have higher rates of absenteeism Unrelieved pain can also lead to higher use of health care resources Speaker’s Notes This slide can be used to summarize the key messages of this section.