title: The burden of chronic low back pain: clinical comorbidities, treatment patterns, and health care costs in usual care settings.
abstract: METHODS
  Retrospective analysis of an insurance claims database.
  
  
  OBJECTIVE
  To examine the comorbidities, treatment patterns, health care resource utilization, and direct medical costs of patients with chronic low back pain (CLBP) in clinical practice.
  
  
  BACKGROUND
  Although the socioeconomic impact of CLBP is substantial, characterization of comorbidities, pain-related pharmacotherapy, and health care resource use/costs of patients with CLBP relative to non-CLBP controls have been infrequently documented.
  
  
  METHODS
  Using the LifeLink Health Plan Claims Database (IMS Health Inc., Watertown, MA), patients with CLBP, defined using the International Classification of Diseases, Ninth Revision, Clinical Modification, were identified and matched (age, sex, and region) with non-CLBP individuals. Comorbidities, pain-related pharmacotherapy, and health care service use/costs (pharmacy, outpatient, inpatient, total) were compared for the 2 groups during 2008.
  
  
  RESULTS
  A total of 101,294 patients with CLBP and controls were identified (55% women; mean age was 47.2 ± 11.6 years). Relative to controls, patients with CLBP had a greater comorbidity burden including a significantly higher (P < 0.0001) frequency of musculoskeletal and neuropathic pain conditions and common sequelae of pain such as depression (13.0% vs. 6.1%), anxiety (8.0% vs. 3.4%), and sleep disorders (10.0% vs. 3.4%). Pain-related pharmacotherapy was significantly greater (P < 0.0001) among patients with CLBP including opioids (37.0% vs. 14.8%; P < 0.0001), nonsteroidal anti-inflammatory drugs (26.2% vs. 9.6%; P < 0.0001), and tramadol (8.2% vs. 1.2%; P < 0.0001). Prescribing of "adjunctive" medications for treating conditions associated with pain (i.e., depression, anxiety, and insomnia) was also significantly greater (P < 0.0001) among patients with CLBP; 36.3% of patients received combination therapy. Health care costs were significantly higher in the CLBP cohort (P < 0.0001), reflecting greater resource utilization. Total direct medical costs were estimated at $8386 ± $17,507 in the CLBP group and $3607 ± $10,845 in the control group; P < 0.0001).
  
  
  CONCLUSIONS
  Patients with CLBP are characterized by greater comorbidity and economic burdens compared with those without CLBP. This economic burden can be attributed to greater prescribing of pain-related medications and increased health resource utilization.
authors.affiliation: Avalon Health Solutions, Inc., Philadelphia, PA 19102, USA. mgore@avalonhealthsolutions.com
authors.forename: Mugdha
authors.initials: M
authors.lastname: Gore
authors.forename: Alesia
authors.initials: A
authors.lastname: Sadosky
authors.forename: Brett R
authors.initials: BR
authors.lastname: Stacey
authors.forename: Kei-Sing
authors.initials: KS
authors.lastname: Tai
authors.forename: Douglas
authors.initials: D
authors.lastname: Leslie
mesh_terms: D000328:Adult; D001416:Back Pain / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D059350:Chronic Pain; D015897:Comorbidity; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D019547:Neck Pain / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D009437:Neuralgia / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D012189:Retrospective Studies