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(719)
S32
C13 - Pain in Women (714) Work status and symptoms severity in fibromyalgia J Souza, P Bourgault, J Charest, S Marchand; Faculte´ de me´decine, Fleurimont, QC, Canada Fibromyalgia (FM) is a chronic pain syndrome most frequently present in women. FM is characterized by chronic widespread pain, soreness at tender points, and is usually associated with sleep disturbance, fatigue, visceral pain and depression. The prevalence is between 3 and 5% of the population, representing an important socio-economic impact. Considering the variability in treatment outcomes, the hypotheses of sub-types of FM have been proposed and may explain the variability in work status. In this study we evaluated the influence of the work status on symptoms of 76 women with FM, 55% of whom had stopped working for reasons related to FM symptoms. Dependent variables were: pressure pain threshold of tender points (TTP), Physical (P-SF36) and Mental (M-SF36) and general (SF-36) quality of life, Self-management of FM symptoms (SMFM), Fibromyalgia Impact Questionnaire (FIQ), Multidimensional Pain Inventory (MPI), ratings of clinical pain (RCP) and physical energy (RCE) and Pain Catastrophyzing Scale (PCS). Non-workers with FM had a significantly poorer level of TTP, SF-36, M-SF36, SMFM and a higher FIQ, MPI and RCP. Interestingly, women reporting that pain both influenced work performance and was influenced by stress, present significantly higher PCS and lower TTP and M-SF36. Our results support that working status is related to the severity of symptoms. Parttime workers present less severe symptoms as compared to full-time workers and non-workers. The patients that are able to work seem to do better when working part-time, probably because of the possibility to reduce their symptoms by modulating their work and rest periods.
Abstracts (716) Refer to Oral Paper Session 306
C14 - Postherpetic Neuralgia (717) Healthcare expenditures in patients with herpes zoster pain and postherpetic neuralgia R Dworkin, R White, K Hawkins; The MEDSTAT Group, Ann Arbor, MI Because existing data on medical costs associated with acute and persisting pain associated with herpes zoster are limited, healthcare expenditures were estimated in patients covered by commercial, Medicare, and Medicaid insurance. The MEDSTAT Group’s Marketscan Databases, composed of medical, pharmacy, and enrollment information, were used. Patients were included if they had evidence of a claim with a primary diagnosis of herpes zoster accompanied by a pain medication prescription or with a primary diagnosis of postherpetic neuralgia (PHN). The index date was first evidence of such a claim from 7/1/2001-12/31/2003. Patient demographics and healthcare expenditures were measured in the 6 months prior to the index date and the following 12 months for the commercial and Medicare cohorts; for the Medicaid cohort, follow-up was only 6 months because data were limited. A propensity score model was used to match controls to each insured cohort, controlling for differences in patient demographics (age, gender, location, insurance type, index year) and health status (Charlson Comorbidity Index, psychiatric diagnostic groups). A total of 1,032 commercial, 811 Medicare, and 604 Medicaid patients with herpes zoster pain or PHN were studied. Prior to matching, the cohorts and controls were significantly different in terms of demographics and health status. After matching, patient demographics were similar, but the health status of the cohorts was still significantly different, with the pain cohorts having greater comorbidities. The difference in average annual healthcare expenditures between the pain cohorts and their matched controls were $4,916 (p⬍0.01) in a commercial population, $2,695 (p⬍0.01) in a Medicare population, and $9,312 (p⬍0.01) in a Medicaid population. The additional healthcare expenditures associated with herpes zoster pain and PHN are considerable, averaging between $2,695 and $9,312 per year per patient depending on the population. Sponsored by grants from Endo Pharmaceuticals to The MEDSTAT Group and the University of Rochester.
(715) Is clinical pain consistent with experimental one in IBS women complaining of abdominal pain?
(718) Refer to Oral Paper Session 306
P Bourgault, D St-Cyr-Tribble, G Devroede, J Barcellos, S Marchand; Faculte´ de me´decine, Fleurimont, QC, Canada Women with Irritable Bowel Syndrome (IBS) seek help when their abdominal pain (AP) becomes unbearable. Many researchers identified that process, but few of them specifically measured pain. Aiming to theorize help seeking processes, we used a mixed methodological design (quantitative and qualitative) to study pain perception of 19 women (18-65 years). Our sample was divided into two groups: Women (n⫽11) who had consulted a physician and women (n⫽8) that didn’t (NC). Clinical pain was assessed with the use of a daily pain diary and pain recall. Since it is well documented that patients tend to exaggerate past pain, we asked the participants to use a pain diary to describe their AP intensity during every awake hour on 3 consecutive days. We also use pain recall, where women were asked to report the mean AP intensity for the last week. Experimental pain consisted of a cold pressure test where the left arm was completely immersed into circulating water (12°C) for 2 minutes using spatial summation paradigm. Meanwhile, pain perception ratings were obtained every 15 seconds using a numeric scale rated from 0 (non pain) to 100 (worse pain). The results showed that consultants report higher levels of pain than NC for daily pain (29.9/100 vs 9.9/100), for mean pain recall (48.2/100 vs 27.5/100, p⫽0,073), but not for experimental pain (40.1/100 for both groups). These results confirm that AP is a predictor of help seeking in IBS. In contrast to current common thinking, the present experimental pain findings imply that consultants are not complaining more than the NC. In conclusion, these results suggest that help seeking is predicted by AP. Moreover, consultants are not oversensitive to pain when compared to NC, implying that the presence of pain in consultants is real, not amplified or used to get attention.
(719) Refer to Oral Paper Session 306 (720) Refer to Oral Paper Session 306
C13 - Pain in Women (714) Work status and symptoms severity in fibromyalgia J Souza, P Bourgault, J Charest, S Marchand; Faculte´ de me´decine, Fleurimont, QC, Canada Fibromyalgia (FM) is a chronic pain syndrome most frequently present in women. FM is characterized by chronic widespread pain, soreness at tender points, and is usually associated with sleep disturbance, fatigue, visceral pain and depression. The prevalence is between 3 and 5% of the population, representing an important socio-economic impact. Considering the variability in treatment outcomes, the hypotheses of sub-types of FM have been proposed and may explain the variability in work status. In this study we evaluated the influence of the work status on symptoms of 76 women with FM, 55% of whom had stopped working for reasons related to FM symptoms. Dependent variables were: pressure pain threshold of tender points (TTP), Physical (P-SF36) and Mental (M-SF36) and general (SF-36) quality of life, Self-management of FM symptoms (SMFM), Fibromyalgia Impact Questionnaire (FIQ), Multidimensional Pain Inventory (MPI), ratings of clinical pain (RCP) and physical energy (RCE) and Pain Catastrophyzing Scale (PCS). Non-workers with FM had a significantly poorer level of TTP, SF-36, M-SF36, SMFM and a higher FIQ, MPI and RCP. Interestingly, women reporting that pain both influenced work performance and was influenced by stress, present significantly higher PCS and lower TTP and M-SF36. Our results support that working status is related to the severity of symptoms. Parttime workers present less severe symptoms as compared to full-time workers and non-workers. The patients that are able to work seem to do better when working part-time, probably because of the possibility to reduce their symptoms by modulating their work and rest periods.
Abstracts (716) Refer to Oral Paper Session 306
C14 - Postherpetic Neuralgia (717) Healthcare expenditures in patients with herpes zoster pain and postherpetic neuralgia R Dworkin, R White, K Hawkins; The MEDSTAT Group, Ann Arbor, MI Because existing data on medical costs associated with acute and persisting pain associated with herpes zoster are limited, healthcare expenditures were estimated in patients covered by commercial, Medicare, and Medicaid insurance. The MEDSTAT Group’s Marketscan Databases, composed of medical, pharmacy, and enrollment information, were used. Patients were included if they had evidence of a claim with a primary diagnosis of herpes zoster accompanied by a pain medication prescription or with a primary diagnosis of postherpetic neuralgia (PHN). The index date was first evidence of such a claim from 7/1/2001-12/31/2003. Patient demographics and healthcare expenditures were measured in the 6 months prior to the index date and the following 12 months for the commercial and Medicare cohorts; for the Medicaid cohort, follow-up was only 6 months because data were limited. A propensity score model was used to match controls to each insured cohort, controlling for differences in patient demographics (age, gender, location, insurance type, index year) and health status (Charlson Comorbidity Index, psychiatric diagnostic groups). A total of 1,032 commercial, 811 Medicare, and 604 Medicaid patients with herpes zoster pain or PHN were studied. Prior to matching, the cohorts and controls were significantly different in terms of demographics and health status. After matching, patient demographics were similar, but the health status of the cohorts was still significantly different, with the pain cohorts having greater comorbidities. The difference in average annual healthcare expenditures between the pain cohorts and their matched controls were $4,916 (p⬍0.01) in a commercial population, $2,695 (p⬍0.01) in a Medicare population, and $9,312 (p⬍0.01) in a Medicaid population. The additional healthcare expenditures associated with herpes zoster pain and PHN are considerable, averaging between $2,695 and $9,312 per year per patient depending on the population. Sponsored by grants from Endo Pharmaceuticals to The MEDSTAT Group and the University of Rochester.
(715) Is clinical pain consistent with experimental one in IBS women complaining of abdominal pain?
(718) Refer to Oral Paper Session 306
P Bourgault, D St-Cyr-Tribble, G Devroede, J Barcellos, S Marchand; Faculte´ de me´decine, Fleurimont, QC, Canada Women with Irritable Bowel Syndrome (IBS) seek help when their abdominal pain (AP) becomes unbearable. Many researchers identified that process, but few of them specifically measured pain. Aiming to theorize help seeking processes, we used a mixed methodological design (quantitative and qualitative) to study pain perception of 19 women (18-65 years). Our sample was divided into two groups: Women (n⫽11) who had consulted a physician and women (n⫽8) that didn’t (NC). Clinical pain was assessed with the use of a daily pain diary and pain recall. Since it is well documented that patients tend to exaggerate past pain, we asked the participants to use a pain diary to describe their AP intensity during every awake hour on 3 consecutive days. We also use pain recall, where women were asked to report the mean AP intensity for the last week. Experimental pain consisted of a cold pressure test where the left arm was completely immersed into circulating water (12°C) for 2 minutes using spatial summation paradigm. Meanwhile, pain perception ratings were obtained every 15 seconds using a numeric scale rated from 0 (non pain) to 100 (worse pain). The results showed that consultants report higher levels of pain than NC for daily pain (29.9/100 vs 9.9/100), for mean pain recall (48.2/100 vs 27.5/100, p⫽0,073), but not for experimental pain (40.1/100 for both groups). These results confirm that AP is a predictor of help seeking in IBS. In contrast to current common thinking, the present experimental pain findings imply that consultants are not complaining more than the NC. In conclusion, these results suggest that help seeking is predicted by AP. Moreover, consultants are not oversensitive to pain when compared to NC, implying that the presence of pain in consultants is real, not amplified or used to get attention.
(719) Refer to Oral Paper Session 306 (720) Refer to Oral Paper Session 306