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Burden of Chronic Low Back Pain with a Neuropathic Pain Component: Retrospective Chart Review and Cross-sectional Survey among Adults Seeking Treatment in the United States

Alesia Sadosky*, Caroline Schaefer, Rachael Mann, Bruce Parsons, Rebecca Baik, Srinivas Nalamachu, Brett R Stacey, Michael Tuchman, Alan Anschel and Edward Nieshoff

Background: Chronic low back pain (CLBP) is highly prevalent, and between 35% and 55% of individuals with CLBP suffer from a neuropathic pain component (CLBP-NeP). Limited data on the economic and patient burden in this CLBP subgroup have been published.

Methods: This observational study aimed to characterize burden among CLBP-NeP subjects (n=106) recruited during routine physician visits in the United States. Subjects completed a questionnaire to capture pain severity, function, health status, sleep, anxiety/depression, lost productivity, demographics, employment status, and out-of- pocket expenses. Investigators completed a 6-month retrospective chart review to capture clinical characteristics and CLBP-NeP-related healthcare resource use. Based on average pain severity scores, subjects were stratified into mild, moderate, and severe pain groups. Summary statistics were calculated, and differences across severity groups were evaluated.

Results: Subjects’ mean (SD) age was 54.1 (11.9) years; 57.5% were female. Most subjects had at least one comorbidity (87.7%); common comorbidities included sleep disturbance/insomnia [58.5%], depressive symptoms [51.9%], headache/migraine [46.2%], and anxiety [45.3%]. Mean (SD) pain severity score was 6.0 (1.77). Outcomes were worse among subjects with greater pain for health status, function, and sleep. Overall, 23.6% of subjects were employed for pay; 32.1% reported being disabled due to CLBP-NeP. Among those employed, lost productivity due to CLBP-NeP (62.3% overall work impairment) was substantial. Nearly all (98.1%) subjects were prescribed one or more medications for CLBP-NeP, including opioids (81.1%), muscle relaxants (33.0%), and antiepileptics (28.3%). Mean adjusted annualized direct and indirect costs per subject were $8,305 and $30,496 (mild), $10,189 and $26,428 (moderate), and $11,880 and $25,051 (severe), respectively, with no significant differences observed.

Conclusions: Patient and economic CLBP-NeP burden is high despite active management. Sub-optimal outcomes were associated with greater pain severity. Findings point to unmet need and indicate CLBP-NeP burden is experienced in terms of poor function and lost productivity.