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Complexity, comorbidity, and health care costs associated with chronic widespread pain in primary care

Morales-Espinoza, Enma Marianela; Kostov, Belchin; Salami, Daniel Cararach; Perez, Zoe Herreras; Rosalen, Anna Pereira; Molina, Jacinto Ortiz; Paz, Luis Gonzalez-de; Momblona, Josep Miquel Sotoca; Àreu, Jaume Benavent; Brito-Zerón, Pilar; Ramos-Casals, Manuel; Sisó-Almirall, Antoni

doi: 10.1097/j.pain.0000000000000440
Research Paper
Global Year 2016

The objective was to estimate the prevalence of chronic widespread pain (CWP) and compare the quality-of-life (QoL), cardiovascular risk factors, comorbidity, complexity, and health costs with the reference population. A multicenter case–control study was conducted at 3 primary care centers in Barcelona between January and December 2012: 3048 randomized patients were evaluated for CWP according to the American College of Rheumatology definition. Questionnaires on pain, QoL, disability, fatigue, anxiety, depression, and sleep quality were administered. Cardiovascular risk and the Charlson index were calculated. We compared the complexity of cases and controls using Clinical Risk Groups, severity and annual direct and indirect health care costs. CWP criteria were found in 168 patients (92.3% women, prevalence 5.51% [95% confidence interval: 4.75%-6.38%]). Patients with CWP had worse QoL (34.2 vs 44.1, P < 0.001), and greater disability (1.04 vs 0.35; P < 0.001), anxiety (43.9% vs 13.3%; P < 0.001), depression (27% vs 5.8%; P < 0.001), sleep disturbances, obesity, sedentary lifestyle, high blood pressure, diabetes mellitus, and number of cardiovascular events (13.1% vs 4.8%; P = 0.028) and higher rates of complexity, severity, hospitalization, and mortality. Costs were €3751 per year in patients with CWP vs €1397 in controls (P < 0.001). In conclusion, the average patient with CWP has a worse QoL and a greater burden of mental health disorders and cardiovascular risk. The average annual cost associated with CWP is nearly 3 times higher than that of patients without CWP, controlling for other clinical factors. These findings have implications for disease management and budgetary considerations.

Supplemental Digital Content is Available in the Text.Patient's profile with CWP is a sedentary woman with high rates of anxiety and depression, increased cardiovascular risk, higher expected mortality rate and increased costs.

aConsorci d'Atenció Primària de Salut Barcelona Esquerre (CAPS-BE), Transversal Group for Research in Primary Care, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain

bJosep Font Laboratory of Autoimmune Diseases, CELLEX-IDIBAPS, Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain

Corresponding author. Address: Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPS-BE), CAP Les Corts, c/Mejía Lequerica s/n, Barcelona 08028, Spain. Tel.: +34932279924; fax: +34932275597. E-mail address: (A. Sisó-Almirall).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The members of the CPSGPC Study Group (CAPSBE-Chronic Pain Study Group in Primary Care) are listed in Appendix 1.

Received June 10, 2015

Received in revised form November 17, 2015

Accepted November 17, 2015

© 2016 International Association for the Study of Pain
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