The burden associated with neuropathic pain in Western Europe

Figures & data

Table 1.  Severity and frequency of pain.

Pain severity and frequency	Persons reporting neuropathic pain (%)	Persons not reporting neuropathic pain (%)
Mild	8.31	23.68
Moderate	50.51	60.40
Severe	41.18	15.92
Daily pain	75.04	44.45
4–6 times a week	9.73	11.57
2–3 times a week	9.41	18.03
Weekly or less	5.83	25.95
Mild daily pain	4.00	4.10
Moderate daily pain	32.92	27.68
Severe daily pain	38.12	12.67
Less than daily	24.96	55.55

Note: Estimates weighted by age and gender for each country and combined for the UK, France, Spain, Germany and Italy. Source: NHWS, 2010.

Table 2.  Respondent characteristics.

Respondent characteristics		Persons reporting neuropathic pain (%)	Persons not reporting neuropathic pain (%)
Age	18-39	14.86	27.43
	40-59	47.33	41.80
	60 and over	37.81	30.77
Gender	Female	59.73	59.75
	Male	40.27	40.25
Education level	Less than High School	14.92	14.84
	High School	42.74	48.23
	University	42.34	36.93
Annual household income	Under €20,000	39.50	31.84
	€20,000–49,999	38.93	44.21
	€50,000 or greater	9.99	11.27
	Declined to answer	11.58	12.68
Employment Status	Employed full time	18.96	33.17
	Self-employed	7.75	5.52
	Employed part time	8.85	10.31
	Unemployed	2.86	6.56
	In work force	39.68	55.56
	Not in work force	60.32	44.42
BMI	Underweight	1.74	2.17
	Normal	22.81	30.80
	Overweight	38.68	35.93
	Obese	28.77	24.66
	Morbidly Obese	5.15	3.91
	Not estimated	2.84	2.53
	Current smoker	25.45	23.84
	Use alcohol	8.03	8.25
Charlson comorbidity Index	0	50.99	70.14
	1	27.69	19.76
	2	8.60	6.68
	3	6.74	2.10
	4	3.01	0.70
	5 or more	2.97	0.63
Country	UK	34.80	27.51
	France	16.05	16.80
	Spain	10.39	11.99
	Germany	29.35	32.13
	Italy	9.41	11.56

Note: Estimates weighted by age and gender for each country and combined for the UK, France, Spain, Germany and Italy. Source: NHWS, 2010.

Table 3.  Pain conditions reported.

Pain conditions reported	Persons reporting neuropathic pain (%)	Persons not reporting neuropathic pain (%)
Back pain	59.30	63.58
Joint pain	57.45	47.46
Shoulder pain/stiffness	40.96	30.36
Neck pain	35.48	29.48
Headache	31.27	30.34
Arthritis pain	24.54	19.04
Migraine	17.04	13.54
Fibromyalgia pain	13.30	5.30
Dental problems	12.48	11.53
Surgery or medical procedure pain	11.84	6.48
Other	7.99	7.27
Sprains or strains pain	6.57	8.64
Menstrual cycle	5.93	9.23
Broken bone pain	4.08	3.92
Cancer pain	1.30	0.86
Post herpetic neuralgia pain	1.27	0.27
Persons only reporting neuropathic pain	17.44	n/a

Note: Estimates weighted by age and gender for each country and combined for the UK, France, Spain, Germany and Italy. Source: NHWS, 2010.

Table 4.  Major comorbidities.

Major comorbidities	Persons reporting neuropathic pain (%)	Persons not reporting neuropathic pain (%)
Sleep difficulties	59.14	46.73
Headache	54.08	60.02
Insomnia	45.61	29.78
Anxiety (not otherwise specified)	42.42	31.99
High blood pressure (Hypertension)	38.44	28.88
Depression	35.25	24.03
Heartburn	32.83	33.94
Abdominal bloating	32.72	26.28
Migraine	31.02	29.10
Abdominal pain	30.87	27.78
High cholesterol	27.80	22.89
Arthritis	26.54	21.43
Diabetes (Type 1 or Type 2)	24.97	8.14
Restless Legs Syndrome	22.93	10.59
Irritable bowel syndrome	19.80	10.64
GERD or acid reflux	19.20	11.08
Social anxiety disorder	10.24	6.19
Generalized anxiety disorder	9.90	6.09
Panic disorder	8.51	5.11

Note: Estimates weighted by age and gender for each country and combined for the UK, France, Spain, Germany and Italy. Source: NHWS, 2010.

Table 5.  Health-related quality-of-life and health status.

Pain conditions reported	Persons reporting neuropathic pain	Persons not reporting neuropathic pain
SF-12 PCS (SD)	31.29 (11.05)	41.50 (11.00)
SF-12 MCS (SD)	40.16 (11.51)	43.90 (11.06)
SF-6D utilities (SD)	0.56 (0.11)	0.65 (0.12)
Health status (%)
Excellent	0.30	2.29
Very good	3.84	16.64
Good	21.21	40.77
Fair	43.72	31.33
Poor	30.93	8.98
Total	100.00	100.00

Note: Estimates weighted by age and gender for each country and combined for the UK, France, Spain, Germany and Italy. Source: NHWS, 2010.

Table 6.  Employment status, absenteeism, and presenteeism.

Employment status		Persons reporting neuropathic pain (%)	Persons not reporting neuropathic pain (%)
In work force		39.68	55.56
Not in work force		60.32	44.44
Workplace absenteeism	None	60.22	78.53
	Low (1–10%)	9.22	5.71
	Medium (11–25%)	5.26	5.25
	High (26–100%)	25.31	10.51
Workplace presenteeism	No impact	13.52	33.30
	Low impact	7.67	12.96
	Medium impact	17.72	22.64
	High impact	61.09	31.09

Note: Estimates weighted by age and gender for each country and combined for the UK, France, Spain, Germany and Italy. Source: NHWS, 2010.

Table 7.  Direct medical costs and resource units.

Direct medical costs (6 months)	Persons reporting neuropathic pain (€; SD)	Persons not reporting neuropathic pain (€, SD)
Mean cost (SD)
Traditional provider visits	356.89 (357.29)	205.97 (243.46)
Emergency room visits	58.94 (182.33)	30.71 (110.66)
Hospitalizations	372.35 (969.59)	177.98 (1075.20)
Total direct cost	788.18 (1164.28)	414.66 (1173.75)
Median cost (25th–75th quartile)
Traditional provider visits	240.00 (125.02–466.88)	140.00 (58.68–262.62)
Total direct cost	350.16 (142.88–968.22)	146.70 (60.00–362.98)

Note: Estimates weighted by age and gender for each country and combined for the UK, France, Spain, Germany and Italy; costs assigned are: UK, traditional provider visit €29.18, emergency room visit €109.42, hospitalization €668.79; France, traditional provider visit €20.00, emergency room visit €23.00, hospitalization €1371.50; Germany, traditional provider visit €29.34, emergency room visit €157.60, hospitalization €1022.19; Italy, traditional provider visit €12.91, emergency room visit €61.97, hospitalization €593.31; Spain, traditional provider visit €17.86, emergency room visit €103.60, hospitalization €802.80; SD, standard deviation. Source: NHWS, 2010.

Table 8.  Multivariate regression results:: SF-12 and SF-6D health-related quality-of-life.

Independent variables	SF-12 PCS		SF-12 MCS		SF-6D utilities
	b coeff	95% CI	b coeff	95% CI	b Coeff	95% CI
Presence of neuropathic pain^a	−8.196	−9.053 to −7.339	−3.190	−4.133 to −2.248	−0.078	−0.089 to −0.068
Socio-demographic variables
Age: 40–59 years^b	−5.267	−5.684 to −4.850	1.495	1.037 to 1.954	−0.017	−0.022 to −0.012
Age: 60 years and older^b	−4.860	−5.408 to −4.312	8.066	7.464 to 8.668	0.039	0.033 to 0.046
Gender: male^c	1.361	1.002 to 1.720	1.529	1.134 to 1.923	0.023	0.019 to 0.027
Education: High school completed^d	1.222	0.688 to 1.756	1.025	0.438 to 1.613	0.016	0.009 to 0.022
Education: University or higher^d	2.109	1.556 to 2.662	1.851	1.243 to 2.459	0.027	0.020 to 0.033
Household income: €20,000–€39,9996^e	1.305	0.903 to 1.708	1.807	1.365 to 2.250	0.023	0.018 to 0.028
Household income €40,000 and above^e	2.597	1.977 to 3.216	2.698	2.017 to 3.379	0.040	0.032 to 0.047
In labour force^f	5.387	4.967 to 5.790	2.673	2.221 to 3.125	0.055	0.050 to 0.060
Health risk behaviors
BMI: Underweight^g	−1.210	−2.329 to −0.091	−2.641	−3.871 to −1.410	−0.027	−0.041 to −0.014
BMI: Overweight^g	−1.253	−1.686 to −0.821	0.112	−0.363 to 0.587	−0.006	−0.011 to −0.001
BMI: Obese^g	−3.942	−4.419 to −3.465	−0.776	−1.301 to −0.252	−0.028	−0.034 to −0.023
BMI: Morbidly obese^g	−7.346	−8.228 to −6.465	−1.634	−2.603 to −0.664	−0.055	−0.065 to −0.044
Current smoker^h	−1.256	−1.664 to −0.848	−1.328	−1.777 to −0.880	−0.016	−0.021 to −0.011
Alcohol user^i	0.664	0.013 to 1.314	−0.523	−1.238 to 0.192	0.002	−0.006 to −0.009
Comorbidity
Charlson Comorbidity Index (CCI)	−2.304	−2.494 to −2.113	−1.233	−1.443 to −1.023	−0.022	−0.025 to −0.020
Country ^j
UK	0.637	0.190 to 1.084	1.090	0.599 to 1.581	0.018	0.013 to 0.024
France	0.721	0.220 to 1.222	0.518	−0.032 to 1.069	−0.002	−0.008 to 0.004
Spain	0.770	0.051 to 1.490	0.522	−0.269 to 1.313	0.011	0.003 to 0.020
Italy	−0.684	−1.406 to 0.038	−0.627	−1.421 to 0.167	−0.016	−0.025 to −0.008
Intercept term	42.160	41.380 to 42.950	37.150	36.290 to 38.010	0.595	0.586 to 0.605
Adj R^2	0.291		0.109		0.169
n	12,326		12,326		12,326

Reference categories: ^a absence of neuropathic pain; ^b age under 40 years; ^c female; ^d less than high school completed; ^e household income under €20,000; ^f not in labor force; ^g normal weight; ^h non-smoker; ⁱ no alcohol use; ^j= Germany.

b coeff, mean change in outcome in a given category relative to reference group.

Table 9.  Multivariate regression results: Health status.

Independent variables	Odds ratio	95% CI
Presence of neuropathic pain^a	3.725	3.124–4.441
Socio-demographic variables
Age: 40–59 years^b	2.535	2.333–2.755
Age: 60 years and older^b	1.627	1.460–1.813
Gender: male^c	0.873	0.814–0.937
Education: High school completed^d	0.806	0.727–0.895
Education: University or higher^d	0.673	0.604–0.750
Household income: €20,000–€39,999 ^e	0.732	0.676–0.792
Household income €40,000 and above^e	0.561	0.497–0.633
In labor force^f	0.424	0.391–0.461
Health risk behaviors
BMI: Underweight^g	1.652	1.324–2.063
BMI: Overweight^g	1.262	1.160–1.373
BMI: Obese^g	2.126	1.936–2.334
BMI: Morbidly obese^g	3.067	2.582–3.643
Current smoker^h	1.399	1.292–1.515
Alcohol user^i	1.028	0.907–1.166
Comorbidity
Charlson Comorbidity Index (CCI)	1.661	1.593–1.731
Country^j
UK	0.676	0.620–0.737
France	0.771	0.700–0.849
Spain	1.519	1.317–1.751
Italy	1.046	0.911–1.202
Log-likelihood ratio	−14,924.0
Pseudo R^2	0.105
n	12,326

Reference categories: ^a absence of neuropathic pain; ^b age under 40 years; ^c female; ^d less than high school completed; ^e household income under €20,000; ^f not in labor force; ^g normal weight; ^h non-smoker; ⁱ no alcohol use; ^j Germany.

Table 10.  Multivariate regression results: Labor force status, absenteeism, and presenteeism.

Independent variables	Labor force status		Absenteeism		Presenteeism
	Odds ratio	95% CI	Odds ratio	95% CI	Odds ratio	95% CI
Presence of neuropathic pain^a	0.534	0.432–0.660	2.471	1.775–3.442	2.965	2.221–3.957
Socio-demographic variables
Age: 40–59 years^b	0.896	0.809–0.993	0.826	0.709–0.963	0.812	0.733–0.899
Age: 60 years and older^b	0.064	0.056–0.073	0.844	0.627–1.136	0.666	0.545–0.814
Gender: male^c	1.568	1.428–1.721	0.847	0.731–0.981	0.843	0.765–0.928
Education: High school completed^d	1.280	1.119–1.464	0.922	0.719–1.184	0.859	0.718–1.028
Education: University or higher^d	1.883	1.635–2.167	0.800	0.619–1.033	0.760	0.634–0.910
Household income: €20,000–€39,999 ^e	2.052	1.858–2.267	0.790	0.666–0.938	0.907	0.805–1.022
Household income €40,000 and above^e	3.344	2.827–3.957	0.622	0.488–0.792	0.727	0.621–0.851
Health risk behaviors
BMI: Underweight^f	0.845	0.651–1.097	1.533	1.011–2.323	1.336	0.993–1.797
BMI: Overweight^f	1.104	0.988–1.234	1.532	1.284–1.828	1.040	0.929–1.166
BMI: Obese^f	0.950	0.842–1.072	1.523	1.247–1.859	1.217	1.069–1.387
BMI: Morbidly obese^f	0.774	0.625–0.957	2.507	1.804–3.484	1.704	1.314–2.208
Current smoker^g	1.183	1.068–1.309	1.126	0.964–1.315	0.986	0.887–1.097
Alcohol user^h	0.792	0.668–0.940	0.996	0.742–1.339	1.104	0.911–1.339
Comorbidity
Charlson Comorbidity Index (CCI)	0.797	0.758–0.837	1.321	1.228–1.420	1.381	1.296–1.472
Country^i
UK	0.720	0.644–0.807	0.672	0.558–0.810	0.696	0.616–0.787
France	1.005	0.887–1.140	0.776	0.634–0.950	0.702	0.612–0.804
Spain	1.337	1.110–1.611	1.118	0.862–1.450	0.826	0.680–1.002
Italy	1.262	1.048–1.520	0.873	0.668–1.140	1.096	0.913–1.314
Log-likelihood ratio	12,326.0		−4,346.0		−11,372.0
Pseudo R^2	0.247		0.023		0.015
n	12,326		6,071		5,721

Reference categories: ^a absence of neuropathic pain; ^b age under 40 years; ^c female; ^d less than high school completed; ^e household income under €20,000; ^f normal weight; ^g non-smoker; ^h no alcohol use; ⁱ Germany.

Table 11.  Multivariate regression results: Health costs and traditional provider visits.

Independent variables	Log of total healthcare cost		Log of provider visit cost
	b coeff	95% CI	b coeff	95% CI
Presence of neuropathic pain^a	0.518	0.414–0.622	0.401	0.323–0.480
Socio-demographic variables
Age: 40–59 years^b	0.080	0.028–0.132	0.148	0.109–0.188
Age: 60 years and older^b	−0.077	−0.144–−0.009	0.049	−0.002–0.100
Gender: male^c	−0.138	−0.183–−0.093	−0.180	−0.214–−0.146
Education: High school completed^d	−0.045	−0.112–0.021	−0.030	−0.080–0.020
Education: University or higher^d	−0.038	−0.107–0.030	−0.015	−0.067–0.037
Household income: €20,000–€39,999 ^e	−0.043	−0.093–0.008	−0.038	−0.076–0.000
Household income €40,000 and above^e	−0.094	−0.171–−0.017	−0.100	−0.158–−0.042
In Labor Force^f	−0.280	−0.331–−0.229	−0.219	−0.258–−0.181
Health risk behaviors
BMI: Underweight^g	0.136	−0.007–0.279	0.067	−0.041–0.175
BMI: Overweight^g	0.084	0.030–0.138	0.060	0.019–0.100
BMI: Obese^g	0.171	0.112–0.230	0.164	0.119–0.209
BMI: Morbidly obese^g	0.268	0.159–0.377	0.248	0.165–0.330
Current smoker^h	−0.035	−0.086–0.016	−0.017	−0.056–0.021
Alcohol user^i	0.041	−0.122–0.041	−0.056	−0.117–0.006
Comorbidity
Charlson Comorbidity Index (CCI)	0.292	0.269–0.316	0.211	0.193–0.228
Country^j
UK	−0.442	−0.497–−0.386	−0.453	−0.495–−0.411
France	−0.452	−0.514–−0.390	−0.514	−0.561–−0.467
Spain	−0.391	−0.480–−0.301	−0.603	−0.671–−0.535
Italy	−0.866	−0.954–−0.777	−0.861	−0.928–−0.794
Adjusted R^2	0.131		0.176
n	11,476		11,450

Respondents with zero costs30 are dropped from the analysis.

Reference categories: ^a absence of neuropathic pain; ^b age under 40 years; ^c female; ^d less than high school completed; ^e household income under €20,000; ^f not in labor force; ^g normal weight; ^h non-smoker; ⁱ no alcohol use; ^j Germany.

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