title: Costs of moderate to severe chronic pain in primary care patients - a study of the ACCORD Program.
abstract: BACKGROUND
  The economic burden of chronic noncancer pain (CNCP) remains insufficiently documented in primary care.
  
  
  OBJECTIVE
  To evaluate the annual direct health care costs and productivity costs associated with moderate to severe CNCP in primary care patients taking into account their pain disability.
  
  
  METHODS
  Patients reporting noncancer pain for at least 6 months, at a pain intensity of 4 or more on a 0 (no pain) to 10 (worst possible pain) intensity scale, and at a frequency of at least 2 days a week, were recruited from community pharmacies. Patients' characteristics, health care utilization, and productivity losses (absenteeism and presenteeism) were documented using administrative databases, pharmacies' renewal charts, telephone, and self-administered questionnaires. Patients were stratified by tertile of pain disability measured by the Brief Pain Inventory questionnaire.
  
  
  RESULTS
  Patients (number =483) were, on average, 59 years old, mainly women (67.5%), and suffered from CNCP for a mean of 12 years at an average pain intensity of 6.5±1.9. The annual direct health care costs and productivity costs averaged CAD $9,565 (±$13,993) and CAD $7,072 (±$11,716), respectively. The use of complementary health care services accounted for almost 50% of the direct health care costs. The mean adjusted total direct health care costs (considering pain-related hospitalizations only) and productivity costs increased with more pain disability: low disability, CAD $12,118; moderate, CAD $18,278; and severe, CAD $19,216; P=0.001.
  
  
  CONCLUSIONS
  The economic burden of CNCP is substantial and increases with the level of pain disability, which suggests the need for and potential benefits of improving CNCP management through specific and adapted treatment plans targeting the impact of pain on daily functioning.
authors.affiliation: Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada ; Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada ; Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada ; Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Université de Montréal and Centre de santé et de services sociaux de Laval, QC, Canada.
authors.forename: Lyne
authors.initials: L
authors.lastname: Lalonde
authors.affiliation: Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada ; Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
authors.forename: Manon
authors.initials: M
authors.lastname: Choinière
authors.affiliation: Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada ; Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Martin
authors.affiliation: Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada ; Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.
authors.forename: Djamal
authors.initials: D
authors.lastname: Berbiche
authors.affiliation: Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada ; Sanofi Aventis Endowment Research Chair in Optimal Drug Use, Université de Montréal, Montreal, QC, Canada.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Perreault
authors.affiliation: Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada ; Division of Geriatric Medicine and Alan-Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada ; Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Lussier
keywords: Brief Pain Inventory; cohort study; direct health care costs; noncancer chronic pain; primary care; productivity costs