Economic burden of neuropathic pain in the United States: BEAT neuropathic pain observational study

Neuropathic pain (NeP) has been associated with incremental direct medical and indirect costs in studies of painful diabetic neuropathy (pDPN) and chronic low back pain (CLBP). This cross-sectional, observational study sought to characterize NeP’s economic burden, by pain severity, across multiple NeP conditions: pDPN, CLBP with NeP, human immunodeficiency virus-related NeP, post-trauma/post-surgical NeP, spinal cord injury-related NeP, and painful peripheral neuropathy with small fiber involvement. A total of 624 subjects recruited during routine office visits completed validated measures of pain severity and productivity and questions about demographics, employment status, healthcare resource use (HRU) and out-of-pocket expenses. Physicians reported clinical characteristics, NeP-related treatments and HRU based on 6-month retrospective chart review. Mean subjects’ age was 55.5 years; 55.4% were male. Moderate to severe pain severity was observed in 80.8% overall, ranging from 75.7%-92.5% across NeP conditions. The most common comorbidities were depressive symptoms (42.6% overall), sleep disturbance/insomnia (42.1% overall), and anxiety (except CLBP-headache/migraine) (35.1% overall); which increased with pain severity (p<0.0038). Overall, 90.2% and 47.8% took ≥1 prescription and non-prescription medication, ranging from 81.3%-98.1% and 38.8%-55.7% across NeP conditions, respectively. Subjects had a mean of 3.3 physician office visits over 6 months. Among employed subjects (18.9% overall), mean overall work impairment was 44.4%. Mean overall activity impairment was 56.5%. Overall, mean annualized direct and indirect costs were $8,201 and $18,546, respectively, with means ranging from $4,654-$12,121 for NeP types for annualized direct costs and $9,632-$30,425 for annualized indirect costs. Overall, medication use, office visits, lost productivity and activity impairment, and costs increased with greater pain severity (p<0.0017). Across NeP types, subjects exhibited high pain levels, which were associated with prevalent medication use and HRU, productivity loss and substantial direct and indirect costs, pointing to potential benefits of more effective NeP management. Study supported by Pfizer, Inc.