A registry of the aetiology and costs of neuropathic pain in pain clinics : results of the registry of aetiologies and costs (REC) in neuropathic pain disorders study.

OBJECTIVE: The aim of this study was to determine health resource consumption and costs in patients with neuropathic pain managed in pain clinics in Spain.
METHODS: This was a retrospective, cross-sectional study performed in 2004 in 18 pain clinics across Spain. Consecutive neuropathic pain patients were recruited between April and December 2004. Demographic data, type and cause of neuropathic pain, source of referral and utilisation of health resources (treatments, medical visits, hospital admissions, etc.) were collected. Direct medical costs were estimated using 2004 prices. Descriptive statistics and ANCOVA models were used for significance.
RESULTS: The study included 504 patients with neuropathic pain of broad aetiologies (44% radiculopathies, 21% neuralgias, 11% neuropathies, 7% entrapment syndromes, 5% complex regional painful syndrome, 4% central pain), aged 57.8 +/- 0.7 years (mean +/- SE), 57.6% of whom were women. The mean time since diagnosis was 23.7 +/- 26.8 months. Two groups of patients according to type of pain management were also identified: those referred to pain clinics for pain control from primary-care/other specialists (r-PC, n = 326) and those primarily managed at pain clinics (p-PC, n = 178). The adjusted mean monthly total cost was 363 euros per patient with no statistically significant differences between type of care: 376 euros (p-PC) versus 344 euros (r-PC) [p = 0.626]. Acquisition monthly mean drug costs were higher in the p-PC group: 131 euros (34.8% of total costs) versus 80 euros (23.3%) per patient (p = 0.0001). However, emergency-room visits, primary-care visits and number of treatment drugs were significantly higher in the r-PC group: 0.27, 0.20 and 2.90 visits/drugs per patient per month versus 0.13, 0.10 and 2.50, respectively (p < 0.01 in all cases). There were also more diagnostic tests and specialised physician visits and higher hospitalisation costs in r-PC subjects (differences not statistically significant).
CONCLUSIONS: Neuropathic pain results in a substantial utilisation of health resources, particularly by patients referred by primary-care/other specialists to pain clinics for pain control. However, compared with subjects whose pain is primarily managed in pain clinics, the extra health costs arising from drug acquisition observed in such patients are offset by lower costs of the other components of pain management, producing similar mean monthly total costs.