- Email: [email protected]
Burden of illness in painful diabetic peripheral neuropathy (DPN): The patients’ perspectives
S28 (677) Work related costs of diabetic neuropathic pain in the US: Results from the American Productivity Audit W. Stewart, J. Ricci, E. Chee, N. Brandenburg; Geisinger Clinic, Danville, PA Neuropathic pain, a consequence of poorly managed diabetes, is increasing in the US as diabetes prevalence increases. We used Caremark American Productivity Audit data to estimate its impact in the US workforce. The Audit is a daily telephone survey of a random sample of the U.S. population. Interviews, completed using the Caremark Work and Health Interview, collected data on lost productive time (LPT) in the previous two weeks due to health conditions. A total of 36,634 occupation eligible working adults participated between 2001 and 2003. Analysis was restricted to the 19,075 survey participants 40 to 65 years of age; 1,033 reported a physician diagnosis of diabetes (13 were excluded because of vision and kidney problems). Of these, 38% reported in the affirmative to a question about problems with numbness or tingling in your feet or hands (denoted “diabetes symptom group”) due to diabetes. Poisson and linear regression was used to compare diabetes respondents with and without symptoms to other survey respondents on LPT (i.e., sum of absence time and reduced performance time) and cost (i.e., using self-reported salary data), adjusting for demographic and other (e.g., number of other health conditions) covariates. The adjusted proportion who had ⬎ 2 hours/2-weeks of health related LPT was 18% higher in the diabetes symptom group (p⬍0.05) and 5% higher in the non-symptom group (p⬍0.05) compared to those without diabetes. Similarly, after adjustment, the diabetes symptom group lost an average of 1.3 hours of work/week (p⬍0.005) more than workers who had diabetes without symptoms (p⬍0.06). Extrapolating to the US workforce, the small proportion of those having diabetes with symptoms (i.e., 2%) lose the equivalent of $3.65 billion/year in health related LPT, a per worker cost that is ⬎2.5 times higher than workers having diabetes without symptoms.
(678) Analysis of cutaneous innervation: A useful marker of nervous system response to specific therapy for Fabry disease A. Bertelsen, G. Wilcox; Haukeland University Hospital, Bergen, Norway Fabry disease is an X-linked recessive lysosomal storage disorder caused by the partial or complete deficiency of the lysosomal enzyme alphagalactosidase. This leads to accumulation of glycosphingolipids in visceral tissues and vascular endothelium throughout the body causing organ damage. Debut symptoms, usually in childhood, are hypohidrosis, angiokeratomas and small fiber neuropathy associated with burning pain. These symptoms may go unrecognized until adulthood when more severe organ system damage has already occurred with cardiac and renal involvement. In the last few years enzyme replacement therapy has been available, and seems to improve pain symptoms, peripheral nerve function and further organ damage. However, lack of recovery is reported in patients with abnormal cold or heat pain perception. This association underscores the need for early treatment, prior to irreversible sensory nerve fiber loss. Female and male patients with Fabry gene defect were clinically examined, and multiple skin biopsies were taken from distal leg. Small sensory nerves in the epidermis were quantified and examined qualitatively for co-containment of specific markers. Results (preliminary data): 1. Loss of epidermal innervation at the ankle level was seen in untreated males as well as an adult male who had received enzyme-replacement treatment only in adulthood. 2. High variability was observed in epidermal small fiber density among females. 3. Positive isolectin B4 (IB4) staining was seen in both male and female with Fabry gene. This study shows that epidermal small fiber quantification and lectin staining of cutaneous fibers is a reliable tool in detecting early C- and A-delta fiber dysfunction, and thus in detecting the disease at an early stage. This skin biopsy technique may also be of significance to assess the response of enzyme replacement therapy and to monitor dosage schedules, hence improving the prognoses of both morbidity and mortality in these patients.
Abstracts (679) Pain in a rural sample of persons with Multiple Sclerosis D. Ehde, G. Kraft; University of Washington School of Medicine, Seattle, WA Pain is known to be prevalent in clinic and urban community samples of persons with Multiple Sclerosis (MS). Less is known about pain in persons with MS living in rural regions, where access to specialized MS care is often limited. The aim of this study was to describe the prevalence and nature of pain in a rural MS sample and examine relationships between pain and biopsychosocial variables. A mail survey was completed by 542 community dwelling residents of rural Washington state who had a diagnosis of MS. Data were collected on demographics, MS disease (disease severity, duration, course of illness), depression (CES-D), fatigue, and participation (WHO-DAS-II). Numeric rating scales adapted from the Chronic Pain Grade assessed average pain intensity and pain-related activity interference. Forty-six percent of the sample reported that they had experienced persistent, bothersome pain in the three months prior to completing the survey. When asked about average pain intensity over the past 3 months, participants with pain reported a mean intensity rating of 5.8 (SD ⫽ 2.2) on the 0 (no pain) to 10 (pain as bad as could be) scale; 38% reported severe pain. Of those with pain, 42% rated the interference of their pain with daily activities as none to minimal. However, 35% reported severe interference in activities as a result of pain. Of those with pain, 36% reported that it was a significant problem for them. Depressive symptoms, MS disease severity, fatigue, and social participation were strongly associated with pain. The current study replicates previous research from urban samples of MS indicating that pain is a problem for many persons with MS. These findings draw attention to the need to target and treat pain as an important comorbid condition in persons living with MS in rural areas.
(680) Burden of illness in painful diabetic peripheral neuropathy (DPN): The patients’ perspectives M. Gore, N. Brandenburg, K. Tai; Avalon Health Solutions, Philadelphia, PA The goal of this study was to assess burden of illness due to pain among patients with diabetic peripheral neuropathy (DPN). Endocrinologists, neurologists, anesthesiologists and primary care physicians recruited patients with a known history of painful DPN (N⫽255) between April and October 2003. Patients completed a survey on demographics, disease history, pain experience (Brief Pain Inventory-DPN [BPI-DPN]), health status (the EuroQoL [EQ-5D]), healthcare utilization (consults, prescription [Rx], and over-the-counter [OTC] medications), & work productivity/ functioning. Patients were 61⫾12.8 years old (44.7% male, 51.4% female); had diabetes (type I/II: 13%/86%) for 12⫾10.3 years and painful DPN for 6.4⫾6.4 years; 25.5% and 62.7% had other neuropathic and musculoskeletal pain conditions. Average and worst pain scores (BPIDPN, 0-10 scales) were 5.0⫾2.5 and 5.6⫾2.8, respectively. Over 60% reported moderate to severe levels of pain interference with general activity (60.4%), mood (62.8%), walking ability (71.3%), normal work (67%), sleep (64%) and enjoyment of life (62.8%). The mean EQ-5D utility score was 0.5⫾0.3 (scores range from -0.594 to 1, higher scores indicate better health). Almost two thirds (59.5%) had ⱖ2 & more than a third (41%) had ⱖ4 health professional consults (visits & telephone calls) for painful DPN in the preceding 3 months. A majority (80%) took pain medications (Rx or OTC) in the preceding week: an average of 3.8⫾3.9 Rx and 2.1⫾1.3 OTC medications. During the preceding 3 months: of patients who work (N⫽73), 64.4% reported missing work or decreased work productivity; 59% of all patients reported decreased home productivity and 85.5% reported limited ability to perform important daily activities as a result of painful DPN. Painful DPN imposes a substantial patient burden evidenced by moderate to high pain levels and interference with function, health resource use, and work/activity limitations.
(678) Analysis of cutaneous innervation: A useful marker of nervous system response to specific therapy for Fabry disease A. Bertelsen, G. Wilcox; Haukeland University Hospital, Bergen, Norway Fabry disease is an X-linked recessive lysosomal storage disorder caused by the partial or complete deficiency of the lysosomal enzyme alphagalactosidase. This leads to accumulation of glycosphingolipids in visceral tissues and vascular endothelium throughout the body causing organ damage. Debut symptoms, usually in childhood, are hypohidrosis, angiokeratomas and small fiber neuropathy associated with burning pain. These symptoms may go unrecognized until adulthood when more severe organ system damage has already occurred with cardiac and renal involvement. In the last few years enzyme replacement therapy has been available, and seems to improve pain symptoms, peripheral nerve function and further organ damage. However, lack of recovery is reported in patients with abnormal cold or heat pain perception. This association underscores the need for early treatment, prior to irreversible sensory nerve fiber loss. Female and male patients with Fabry gene defect were clinically examined, and multiple skin biopsies were taken from distal leg. Small sensory nerves in the epidermis were quantified and examined qualitatively for co-containment of specific markers. Results (preliminary data): 1. Loss of epidermal innervation at the ankle level was seen in untreated males as well as an adult male who had received enzyme-replacement treatment only in adulthood. 2. High variability was observed in epidermal small fiber density among females. 3. Positive isolectin B4 (IB4) staining was seen in both male and female with Fabry gene. This study shows that epidermal small fiber quantification and lectin staining of cutaneous fibers is a reliable tool in detecting early C- and A-delta fiber dysfunction, and thus in detecting the disease at an early stage. This skin biopsy technique may also be of significance to assess the response of enzyme replacement therapy and to monitor dosage schedules, hence improving the prognoses of both morbidity and mortality in these patients.
Abstracts (679) Pain in a rural sample of persons with Multiple Sclerosis D. Ehde, G. Kraft; University of Washington School of Medicine, Seattle, WA Pain is known to be prevalent in clinic and urban community samples of persons with Multiple Sclerosis (MS). Less is known about pain in persons with MS living in rural regions, where access to specialized MS care is often limited. The aim of this study was to describe the prevalence and nature of pain in a rural MS sample and examine relationships between pain and biopsychosocial variables. A mail survey was completed by 542 community dwelling residents of rural Washington state who had a diagnosis of MS. Data were collected on demographics, MS disease (disease severity, duration, course of illness), depression (CES-D), fatigue, and participation (WHO-DAS-II). Numeric rating scales adapted from the Chronic Pain Grade assessed average pain intensity and pain-related activity interference. Forty-six percent of the sample reported that they had experienced persistent, bothersome pain in the three months prior to completing the survey. When asked about average pain intensity over the past 3 months, participants with pain reported a mean intensity rating of 5.8 (SD ⫽ 2.2) on the 0 (no pain) to 10 (pain as bad as could be) scale; 38% reported severe pain. Of those with pain, 42% rated the interference of their pain with daily activities as none to minimal. However, 35% reported severe interference in activities as a result of pain. Of those with pain, 36% reported that it was a significant problem for them. Depressive symptoms, MS disease severity, fatigue, and social participation were strongly associated with pain. The current study replicates previous research from urban samples of MS indicating that pain is a problem for many persons with MS. These findings draw attention to the need to target and treat pain as an important comorbid condition in persons living with MS in rural areas.
(680) Burden of illness in painful diabetic peripheral neuropathy (DPN): The patients’ perspectives M. Gore, N. Brandenburg, K. Tai; Avalon Health Solutions, Philadelphia, PA The goal of this study was to assess burden of illness due to pain among patients with diabetic peripheral neuropathy (DPN). Endocrinologists, neurologists, anesthesiologists and primary care physicians recruited patients with a known history of painful DPN (N⫽255) between April and October 2003. Patients completed a survey on demographics, disease history, pain experience (Brief Pain Inventory-DPN [BPI-DPN]), health status (the EuroQoL [EQ-5D]), healthcare utilization (consults, prescription [Rx], and over-the-counter [OTC] medications), & work productivity/ functioning. Patients were 61⫾12.8 years old (44.7% male, 51.4% female); had diabetes (type I/II: 13%/86%) for 12⫾10.3 years and painful DPN for 6.4⫾6.4 years; 25.5% and 62.7% had other neuropathic and musculoskeletal pain conditions. Average and worst pain scores (BPIDPN, 0-10 scales) were 5.0⫾2.5 and 5.6⫾2.8, respectively. Over 60% reported moderate to severe levels of pain interference with general activity (60.4%), mood (62.8%), walking ability (71.3%), normal work (67%), sleep (64%) and enjoyment of life (62.8%). The mean EQ-5D utility score was 0.5⫾0.3 (scores range from -0.594 to 1, higher scores indicate better health). Almost two thirds (59.5%) had ⱖ2 & more than a third (41%) had ⱖ4 health professional consults (visits & telephone calls) for painful DPN in the preceding 3 months. A majority (80%) took pain medications (Rx or OTC) in the preceding week: an average of 3.8⫾3.9 Rx and 2.1⫾1.3 OTC medications. During the preceding 3 months: of patients who work (N⫽73), 64.4% reported missing work or decreased work productivity; 59% of all patients reported decreased home productivity and 85.5% reported limited ability to perform important daily activities as a result of painful DPN. Painful DPN imposes a substantial patient burden evidenced by moderate to high pain levels and interference with function, health resource use, and work/activity limitations.