{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T17:25:54Z","timestamp":1789925154971,"version":"4.0.1"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2019,4,29]],"date-time":"2019-04-29T00:00:00Z","timestamp":1556496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>This research compared health care resource use (HCRU) and costs for pharmacotherapy prescribing that was adherent vs nonadherent to published pain management guidelines. Conditions included osteoarthritis (OA) and gout (GT) for nociceptive\/inflammatory pain, painful diabetic peripheral neuropathy (pDPN) and post-herpetic neuralgia (PHN) for neuropathic pain, and fibromyalgia (FM) for sensory hypersensitivity pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cohort study used claims from MarketScan Commercial and Medicare Databases identifying adults newly diagnosed with OA, GT, pDPN, PHN, or FM during July 1, 2006, to June 30, 2013, with 12-month continuous coverage before and after initial (index) diagnosis. Patients were grouped according to their pharmacotherapy pattern as adherent, nonadherent, or \u201cunsure\u201d according to published pain management guidelines using a claims-based algorithm. Adherent and nonadherent populations were compared descriptively and using multivariate statistical analyses for controlling bias.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Final cohort sizes were 441,465 OA, 76,361 GT, 10,645 pDPN, 4,010 PHN, and 150,321 FM, with adherence to guidelines found in 51.1% of OA, 25% of GT, 59.5% of pDPN, 54.9% of PHN, and 33.5% of FM. Adherent cohorts had significantly (P\u2009&lt;\u20090.05) fewer emergency department (ED) visits and lower proportions with hospitalizations or ED visits. Mean health care costs increased following diagnosis across all conditions; however, adherent cohorts had significantly lower increases in adjusted costs pre-index to postindex (OA $5,286 vs $9,532; GT $3,631 vs $7,873; pDPN $9,578 vs $16,337; PHN $2,975 vs $5,146; FM $2,911 vs $3,708; all P\u2009&lt;\u20090.001; adherent vs nonadherent, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Adherence to pain management guidelines was associated with significantly lower HCRU and costs compared with nonadherence to guidelines.<\/jats:p><\/jats:sec>","DOI":"10.1093\/pm\/pnz085","type":"journal-article","created":{"date-parts":[[2019,4,11]],"date-time":"2019-04-11T19:57:18Z","timestamp":1555012638000},"page":"1907-1918","source":"Crossref","is-referenced-by-count":14,"title":["Economic Impact of Adherence to Pain Treatment Guidelines in Chronic Pain Patients"],"prefix":"10.1093","volume":"20","author":[{"given":"Jay M","family":"Margolis","sequence":"first","affiliation":[{"name":"IBM Watson Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Princic","sequence":"additional","affiliation":[{"name":"IBM Watson Health, Cambridge, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M","family":"Smith","sequence":"additional","affiliation":[{"name":"IBM Watson Health, Cambridge, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Abraham","sequence":"additional","affiliation":[{"name":"Pfizer Ltd, Tadworth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph C","family":"Cappelleri","sequence":"additional","affiliation":[{"name":"Pfizer Inc, Groton, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonali N","family":"Shah","sequence":"additional","affiliation":[{"name":"Self-employed, formerly Pfizer Inc, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5536-1928","authenticated-orcid":false,"given":"Peter W","family":"Park","sequence":"additional","affiliation":[{"name":"Pfizer Inc, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,4,29]]},"reference":[{"issue":"8","key":"2019100908590162800_pnz085-B1","doi-asserted-by":"crossref","first-page":"620","DOI":"10.7556\/jaoa.2013.023","article-title":"Caring for patients with chronic pain: Pearls and pitfalls","volume":"113","author":"Debono","year":"2013","journal-title":"J Am Osteopath Assoc"},{"key":"2019100908590162800_pnz085-B2","author":"Chronic Pain Medical Treatment Guidelines Medical Treatment Utilization Schedule"},{"issue":"12","key":"2019100908590162800_pnz085-B3","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1016\/j.jpain.2011.06.006","article-title":"Pain education in North American medical schools","volume":"12","author":"Mezei","year":"2011","journal-title":"J Pain"},{"issue":"2","key":"2019100908590162800_pnz085-B4","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1097\/00000441-200702000-00005","article-title":"Physicians' comfort in caring for patients with chronic nonmalignant pain","volume":"333","author":"O'Rorke","year":"2007","journal-title":"Am J Med Sci"},{"issue":"2","key":"2019100908590162800_pnz085-B5","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.berh.2011.02.005","article-title":"Central pain mechanisms in chronic pain states\u2014maybe it is all in their head","volume":"25","author":"Phillips","year":"2011","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"2019100908590162800_pnz085-B6","volume-title":"Vadivelu N, Urman R, Hines R (Eds.). Essentials of Pain Management","author":"Mirchandani","year":"2011"},{"key":"2019100908590162800_pnz085-B7","volume-title":"Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research","author":"Institute of Medicine","year":"2011"},{"issue":"22","key":"2019100908590162800_pnz085-B8","doi-asserted-by":"crossref","first-page":"2793","DOI":"10.2169\/internalmedicine.50.5266","article-title":"Management and treatment of osteoporosis in patients receiving long-term glucocorticoid treatment: Current status of adherence to clinical guidelines and related factors","volume":"50","author":"Kirigaya","year":"2011","journal-title":"Intern Med"},{"issue":"2","key":"2019100908590162800_pnz085-B9","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1111\/1475-6773.12098","article-title":"Health care utilization and costs associated with adherence to clinical practice guidelines for early magnetic resonance imaging among workers with acute occupational low back pain","volume":"49","author":"Graves","year":"2014","journal-title":"Health Serv Res"},{"key":"2019100908590162800_pnz085-B10","doi-asserted-by":"crossref","DOI":"10.1155\/2012\/503821","article-title":"Physicians\u2019 perceptions and adherence to guidelines for the management of hypertension: A national, multicentre, prospective study","volume":"2012","author":"Theodorou","year":"2012","journal-title":"Int J Hypertens"},{"key":"2019100908590162800_pnz085-B11","doi-asserted-by":"crossref","first-page":"60.","DOI":"10.1186\/1471-2261-12-60","article-title":"Utilization of evidence-based treatment in elderly patients with chronic heart failure: Using Korean Health Insurance claims database","volume":"12","author":"Kim","year":"2012","journal-title":"BMC Cardiovasc Disord"},{"key":"2019100908590162800_pnz085-B12","first-page":"431","article-title":"Long-acting bronchodilator use after hospitalization for COPD: An observational study of health insurance claims data","volume":"9","author":"Baker","year":"2014","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"issue":"4","key":"2019100908590162800_pnz085-B13","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/j.joca.2010.01.013","article-title":"OARSI recommendations for the management of hip and knee osteoarthritis Part III: Changes in evidence following systematic cumulative update of research published through January 2010","volume":"18","author":"Zhang","year":"2010","journal-title":"Osteoarthritis Cartilage"},{"issue":"4","key":"2019100908590162800_pnz085-B14","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1002\/acr.21596","article-title":"American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee","volume":"64","author":"Hochberg","year":"2012","journal-title":"Arthritic Care Res (Hoboken)"},{"issue":"10","key":"2019100908590162800_pnz085-B15","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1002\/acr.21772","article-title":"American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and therapeutic approaches to hyperuricemia","volume":"64","author":"Khanna","year":"2012","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"10","key":"2019100908590162800_pnz085-B16","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1136\/ard.2006.055269","article-title":"EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)","volume":"65","author":"Zhang","year":"2006","journal-title":"Ann Rheum Dis"},{"key":"2019100908590162800_pnz085-B17","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1093\/rheumatology\/kem056a","article-title":"British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of gout","volume":"46","author":"Jordan","year":"2007","journal-title":"Rheumatology"},{"issue":"9","key":"2019100908590162800_pnz085-B18","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1111\/j.1468-1331.2010.02999.x","article-title":"EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision","volume":"17","author":"Attal","year":"2010","journal-title":"Eur J Neurol"},{"key":"2019100908590162800_pnz085-B19","year":"2011"},{"issue":"3","key":"2019100908590162800_pnz085-B20","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1111\/papr.12085","article-title":"Neuropathic pain and pharmacological treatment","volume":"14","author":"Jongen","year":"2014","journal-title":"Pain Pract"},{"issue":"3","key":"2019100908590162800_pnz085-B21","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.pain.2007.08.033","article-title":"Pharmacologic management of neuropathic pain: Evidence based medicine","volume":"132","author":"Dworkin","year":"2007","journal-title":"Pain"},{"issue":"3","key":"2019100908590162800_pnz085-B22","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1155\/2013\/918216","article-title":"Canadian guidelines for the diagnosis and management of fibromyalgia syndrome. Canadian Fibromyalgia Guidelines Committee (CFGC)","volume":"18","author":"Fitzcharles","year":"2012","journal-title":"Pain Res Manag"},{"key":"2019100908590162800_pnz085-B23","doi-asserted-by":"crossref","first-page":"327","DOI":"10.2147\/JPR.S118248","article-title":"Development of a novel algorithm to determine adherence to chronic pain treatment guidelines using administrative claims","volume":"10","author":"Margolis","year":"2017","journal-title":"J Pain Res"},{"key":"2019100908590162800_pnz085-B24"},{"issue":"6","key":"2019100908590162800_pnz085-B25","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/0895-4356(92)90133-8","article-title":"Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases","volume":"45","author":"Deyo","year":"1992","journal-title":"J Clin Epidemiol"},{"issue":"2","key":"2019100908590162800_pnz085-B26","first-page":"110","article-title":"A comparison of comorbidity measurements to predict healthcare expenditures","volume":"12","author":"Farley","year":"2006","journal-title":"Am J Manag Care"},{"key":"2019100908590162800_pnz085-B27","volume-title":"Fundamentals of Biostatistics","author":"Rosner","year":"2010","edition":"7th ed"},{"key":"2019100908590162800_pnz085-B28","doi-asserted-by":"crossref","DOI":"10.1201\/9780367807849","volume-title":"An Introduction to Generalized Linear Models","author":"Dobson","year":"2008","edition":"3rd ed"},{"key":"2019100908590162800_pnz085-B29","doi-asserted-by":"crossref","first-page":"28.","DOI":"10.1186\/1471-2288-5-28","article-title":"Causal inference based on counterfactuals","volume":"5","author":"Hofler","year":"2005","journal-title":"BMC Med Res Methodol"},{"issue":"1","key":"2019100908590162800_pnz085-B30","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1111\/j.1475-6773.2008.00900.x","article-title":"What\u2019s the risk? A simple approach for estimating adjusted risk measures from nonlinear models including logistic regression","volume":"44","author":"Kleinman","year":"2009","journal-title":"Health Serv Res"},{"issue":"6","key":"2019100908590162800_pnz085-B31","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/j.jpain.2013.01.425","article-title":"Assessing chronic pain treatment practices and evaluating adherence to chronic pain clinical guidelines in outpatient practices in the United States","volume":"14","author":"Rasu","year":"2013","journal-title":"J Pain"},{"key":"2019100908590162800_pnz085-B32","first-page":"68","article-title":"The ongoing challenge of pain medications","volume":"6","author":"Berger","year":"2014","journal-title":"Am J Pharm Benefits"}],"container-title":["Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/painmedicine\/article-pdf\/20\/10\/1907\/30101785\/pnz085.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/painmedicine\/article-pdf\/20\/10\/1907\/30101785\/pnz085.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,6]],"date-time":"2020-12-06T03:35:19Z","timestamp":1607225719000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/painmedicine\/article\/20\/10\/1907\/5481414"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,29]]},"references-count":32,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2019,4,29]]},"published-print":{"date-parts":[[2019,10,1]]}},"URL":"https:\/\/doi.org\/10.1093\/pm\/pnz085","relation":{},"ISSN":["1526-2375","1526-4637"],"issn-type":[{"value":"1526-2375","type":"print"},{"value":"1526-4637","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,10]]},"published":{"date-parts":[[2019,4,29]]}}}