Chronic pain affects many people and the available treatments may not help control the pain. There are many reasons why people develop a pain disorder from back problems to migraines. In this study we would like to understand the characterstics of patients suffering chronic pain. We will use the clinical practice research datalink (CPRD) data to describe the age range, sex, social deprivation of people with chronic pain. We will examine how often chronic pain patients see a GP or go to Accident and Emergency or to a hospital outpatient clinic. We will also investigate how long patients with chronic pain continue to take painkiller drugs after they are first started. We will then try to assess if particular factors might influence how long painkiller drugs are taken. We believe our study will help in better understanding how chronic pain affects different people and why some people seem to suffer with chronic pain for longer. This may help to develop better ways of helping people with chronic pain.
Chronic pain represents an area of significant unmet medical need. The current range of pharmacological treatments for chronic pain including opiates can be associated with harmful effects and/or have limited long-term effectiveness. In this study we aim to better characterise patients suffering with chronic pain defined by recurring analgesic prescriptions for at least 3 months. We are using analgesic prescriptions to define the study population since we are interested in chronic pain broadly rather than a specific pain condition. We will then conduct a descriptive study of the whole chronic pain cohort as well as stratified groups - with patients stratified on the basis of sex and based on strong opioid analgesic use. We will report clinico-demographic features, analgesic prescriptions, non-analgesic pain treatments and healthcare resource utilisation (HCRU). We will make use of linked HES data in order to describe the number of Accident and Emergency attendances, Admitted Patient Care and Outpatient attendances in order to capture the range of HCRU in chronic pain. We will also use Practice Level Index of Multiple Deprivation to ensure we include deprivation in our cohort summary statistics and as an important covariate in our regression analyses. We will perform univariable Kaplan-Meier and multivariable Cox proportional hazard regression analysis to investigate clinic-demographic factors that might influence the time for which a patient is on continuous analgesic prescriptions. We will also perform Chi-2 tests for categorical variables and t-tests for continuous variables for statistical comparisons between relevant subgroups of the chronic pain study population e.g. patients prescribed strong opioids compared to patients not prescribed these medications.
Primary Outcomes:
1. Clinico-demographic features (descriptive variables): age; sex; IMD status; ethnicity; BMI; smoking status; alcohol use; chronic pain diagnoses; comorbidities
2. Treatment and health care resource utilisation (HCRU) features (descriptive variables): analgesic prescriptions; strong opioid analgesic prescriptions; non-analgesic pain treatment prescriptions; chronic pain diagnoses; comorbidities; GP consultations (all-cause and pain specific); all cause A&E admissions; all cause and neurology related outpatient referrals; all cause in-patient admissions.
Secondary Outcome:
1. Duration of continuous analgesic prescriptions after chronic pain onset
Usha Gungabissoon - Chief Investigator - GSK
Zameel Cader - Corresponding Applicant - University of Oxford
Jessica Chao - Collaborator - GlaxoSmithKline LLC (USA)
Jonathan Davitte - Collaborator - GlaxoSmithKline LLC (USA)
Paul Wilson - Collaborator - GlaxoSmithKline Services Unlimited (UK)
Usha Gungabissoon - Collaborator - GSK
Victoria Tribble - Collaborator - GlaxoSmithKline Services Unlimited (UK)
David Webb - Collaborator - GlaxoSmithKline Research & Development Limited (UK)
Victoria Tribble - Collaborator - GlaxoSmithKline Services Unlimited (UK)
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;Practice Level Index of Multiple Deprivation