Prevalence and Cost Analysis of Complex Regional Pain Syndrome (CRPS): A Role for Neuromodulation

Elsamadicy, Aladine A.; Yang, Sheng; Sergesketter, Amanda R.; Ashraf, Bilal; Charalambous, Lefko T; Kemeny, Hanna; Ejikeme, Tiffany; Ren, Xinru; Pagadala, Promila; Parente, Beth; Xie, Jichun; Lad, Shivanand P.

doi:10.1111/ner.12691

Cited by 38 publications

(32 citation statements)

References 29 publications

(56 reference statements)

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“…CRPS is considered an expensive condition [14]. However, in the literature, limited data are available on health care costs associated with CRPS [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Direct Health Care Cost and Work Incapacity Related to Complex Regional Pain Syndrome in Switzerland: A Retrospective Analysis from 2008 to 2015

et al. 2019

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Objective First, to determine the number of accident-related complex regional pain syndrome (CRPS) cases from 2008 to 2015 and to identify factors associated with an increased risk for developing CRPS. Second, to analyze the duration of work incapacity and direct health care costs over follow-up periods of two and five years, respectively. Design Retrospective data analysis. Setting Database from the Statistical Service for the Swiss National Accident Insurances covering all accidents insured under the compulsory Swiss Accident Insurance Law. Subjects Subjects were registered after an accident between 2008 and 2015. Methods Cases were retrospectively retrieved from the Statistical Service for the Swiss National Accident Insurances. Cases were identified using the appropriate International Classification of Diseases, 10th Revision, codes. Results CRPS accounted for 0.15% of all accident cases. Age, female gender (odds ratio [OR] = 1.53, 95% confidence interval [CI] = 1.47–1.60), and fracture of the forearm (OR = 38, 95% CI = 35–42) were related to an increased risk of developing CRPS. Over five years, one CRPS case accumulated average insurance costs of $86,900 USD and treatment costs of $23,300 USD. Insurance costs were 19 times and treatment costs 13 times the average costs of accidents without CPRS. Within the first two years after the accident, the number of days lost at work was 20 times higher in patients with CRPS (330 ± 7 days) than in patients without CRPS (16.1 ± 0.1 days). Two-thirds of all CRPS cases developed long-term work incapacity of more than 90 days. Conclusion CRPS is a relatively rare condition but is associated with high direct health care costs and work incapacity.

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“…CRPS is considered an expensive condition [14]. However, in the literature, limited data are available on health care costs associated with CRPS [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Direct Health Care Cost and Work Incapacity Related to Complex Regional Pain Syndrome in Switzerland: A Retrospective Analysis from 2008 to 2015

et al. 2019

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“…Prognosis of CRPS I in DRF is good if treated early and properly [ 2 ]; however, it becomes poor if managed late. It also exerts a large financial burden on the healthcare system and is a common cause of lawsuits [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Low vitamin D levels in post-menopausal women are associated with complex regional pain syndrome type I in surgically treated distal radius fractures

Lee

et al. 2020

J Orthop Surg Res

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Background Complex regional pain syndrome type I (CRPS I) is a chronic devastating condition and a relatively common complication of distal radius fractures (DRF). The purpose of this study was to investigate the relationship of vitamin D levels in surgically treated post-menopausal women with CRPS I occurrence in DRF. Methods From February 2016 to March 2017, 158 surgically treated post-menopausal patients with DRF were enrolled. Exclusion criteria were (1) patients who had been taking vitamin D or osteoporosis medication at the time of injury; (2) patients with medical factors that may affect vitamin D levels; (3) patients who were reluctant to enroll in the study; and (4) patient with additional fractures, ligamentous injuries, or neuropathy. A total of 107 patients were available for final analysis. We compared the serum vitamin D levels in post-menopausal women with DRF with CRPS I (group 1) and without CRPS I (group 2). Bone mineral density (BMD) of the femur and spine, osteocalcin, alkaline phosphatase (ALP), body mass index (BMI) were also measured. Results The average age at the time of surgery was 66.5 years (range, 39-86 years). The mean follow-up period was 16.3 months after surgery. Among the 107 surgically treated DRF patients, 19 (18%) met the Budapest criteria for CRPS I during the follow-up period. The mean serum vitamin D level in group 1 (15.2 ng/ml) was significantly lower than that in group 2 (20.5 ng/ml, p = 0.027). The mean values of osteocalcin, ALP, BMI, and BMD were not significantly different between the groups. Conclusion Lower vitamin D levels in post-menopausal women can increase CRPS I occurrence in distal radius fractures.

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Recently, we published a study entitled: "Dexmedetomidine vs propofol as sedation for implantation of neurostimulators: A single-center single-blinded randomized controlled trial" in the ActaThis randomized controlled trial compared dexmedetomidine with propofol during the implantation of a neurostimulator. [2][3][4] During the lead implantation of most spinal cord neurostimulators,

LETTER TO THE EDITORConsidering that the mean unit cost of a neurostimulation procedure varied from €5.018,50 for a trial implant to €22.885,33 for a definitive implantation, the sedation costs represented only <0.5% of the total costs associated with a neurostimulation procedure, both for a trial implant and a definitive implant.The cost difference between the use of propofol and dexmedetomidine during the implantation of a neurostimulator is statistically significant but factually small. Based on these considerations and on the benefits to the patient when using dexmedetomidine instead of propofol we believe that the choice for dexmedetomidine as a sedative is preferable and justified.

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mentioning

confidence: 99%

“…This randomized controlled trial compared dexmedetomidine with propofol during the implantation of a neurostimulator. [2][3][4] During the lead implantation of most spinal cord neurostimulators,…”

mentioning

confidence: 99%

“…Second, a European economic evaluation of the use of dexmedetomidine in intensive care units showed unexpectedly that dexmedetomidine sedation was more cost-effective than the standard sedatives propofol and midazolam. 4 This, despite the long required duration of administration compared to that in the implantation of a neurostimulator. 5 Third, although the costs of a procedure are important in themselves, the quality of the health care from the perspective of the patient, is increasingly seen as important.…”

mentioning

confidence: 99%

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Cost analysis of dexmedetomidine versus propofol during the implantation of a neurostimulator

Bruggen

Stronks

Huygen

2020

Acta Anaesthesiol Scand

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Prevalence and Cost Analysis of Complex Regional Pain Syndrome (CRPS): A Role for Neuromodulation

Abstract: Our study demonstrates that there is a significant increase in cost and healthcare resource utilization one-year prior to and around the time of CRPS diagnosis. Furthermore, there is an increased annual cost post-diagnosis compared to baseline costs prior to CRPS diagnosis.

Cited by 38 publications

References 29 publications

Direct Health Care Cost and Work Incapacity Related to Complex Regional Pain Syndrome in Switzerland: A Retrospective Analysis from 2008 to 2015

Direct Health Care Cost and Work Incapacity Related to Complex Regional Pain Syndrome in Switzerland: A Retrospective Analysis from 2008 to 2015

Low vitamin D levels in post-menopausal women are associated with complex regional pain syndrome type I in surgically treated distal radius fractures

Cost analysis of dexmedetomidine versus propofol during the implantation of a neurostimulator

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