Transcript Osteoarthritis Pain Intensity and Locations in People with Diabetes

Osteoarthritic Pain Intensity and
Location in People with Diabetes Using
A Clinical Data Repository System
Aqeel Alenazi
Background:
• Diabetes  9.3% of Americans (Cowie CC et al. 2009)
– Complications affecting body organs & systems
– Diabetes cost in 2012 was $245 billion (American Diabetes Association, 2012)
• Hyperglycemia  cellular functions & tissue damage including
musculoskeletal system
(Vogt et al.1982; Alikhani et al.2007; Arkkila et al.2003)
– Production of advanced glycation end product (AGE)
• Affect joint properties
–  stiffness and fragility of bone and cartilage
» Pain intensity and pain locations?
• Osteoarthritis (OA)  13.9% of Americans (Lawrence et al.2008)
– Leading cause of disability (Pereira et al.2011; Felson et al.2000)
– Functional limitations
(Nuesch et al.2011)
Background:
• DM is an independent risk factor for
– Joint replacement & OA progression for knee and hip joints
• OA  more comorbidity,  Quality of life,  physical
functions
– Progression and disability due to pain
•  medical cost and burdens
• Pain in patients with OA:
– First reason for seeing medical professionals
Purpose:
• The purpose of this study is examine pain
intensity and pain locations among patients
with DM and OA compared to patients with OA
without DM
• We hypothesized that total pain intensity score
[H1] and pain intensity based on locations (local
pain intensity) [H2] will be higher in patients with
DM and OA compared to patients with OA only.
Also, females will show higher total and local pain
intensity [H3]
Methods:
• Retrospective study using de-identified data
for patients with either diabetes (DM) and
localized primary osteoarthritis (OA)
diagnoses or OA diagnosis only:
– DM and OA (n=870)
– OA only (n=2505)
• Patients were selected using a clinical data
repository system (i2b2) at the KU
Methods:
• Variables:
– OA diagnoses codes using ICD-9 and ICD-10
– DM diagnoses codes using ICD-9 and ICD-10
– Pain intensity:
• From flowsheet; vitals; pain vitals
• Pain intensity using numeric rating scale from 0-10
– Pain location:
• From flowsheet; vitals; pain vitals
• Pain location such as knee, hip, ankle, hand, fingers,
wrist, elbow, shoulder, back, pelvis, groin, …etc
Methods:
Pain location
Pain intensity
DM diagnoses
"02. Ankle"
"03. Arm"
"04. Back"
"06. Buttocks"
"08. Coccyx"
"10. Elbow"
"13. Finger"
"14. Foot"
"16. Groin"
"17. Hand"
"19. Hip"
"22. Knee"
"23. Leg"
"29. Pelvis"
"37. Shoulder”
\i2b2\Flowsheet\KU\IR RN VITALS
PAIN INTRA PROCEDURAL T:673\KU
IP GRP PAIN G:1221 I#2\KU IP ROW
INTENSITY PAIN SCALE 0-10 M:1226
I#4\
ICD-9:
\i2b2\Diagnoses\ICD9\A18090800
\A8359006\A8359307\A15573936
\A8352361\
• 250 Diabetes mellitus
• 004- #1226 Intensity Pain Scale 0[2,180,435 facts; 75,653
10 (Pain 1) > [4,370,249 facts]
patients]
ICD-10:
\i2b2\Diagnoses\ICD10\A2009849
2\A18921516\A18916268\A17825
389\
• E11 Type 2 diabetes mellitus
Data analysis:
• Link pain scores to pain locations
• Average pain scores for every patient
• Gender
Results:
OA only group:
• patients count based on location= 3816 from 2505
patients
• Average pain intensity= 5.76
DM and OA group:
• patients count based on location= 1817 from 870
patients
• Average pain intensity=6.04
•
Females with DM and OA have higher pain intensity
(mean=6.30) compared to males with DM and OA
(mean=5.78), males with OA only (mean=5.81) and females
with OA only (mean=5.72)
Table 1: Pain intensity based on OA and DM diagnoses, gender and locations:
Discussion/conclusion:
• Partial support to our hypothesis:
– DM shows more pain in people with OA
• Pathophysiological changes that DM might add to OA
• Advanced glycation end products, reactive oxygen species
and vascular change due to DM
– Females with DM had higher pain intensity
• The prevalence of OA is higher in females
• Hormonal changes & DM may contribute to higher pain
intensity
• DM might be associated with higher pain
intensity in people with OA
Limitations:
• Other associated factors have not been examined
– Medications, surgery or injections
– BMI, neuropathy, dyslipidemia and hypertension
• Pain intensity scores were averaged for every
patients
– The range was extremely wide and it might affect the
overall pain scores
– Combined in-patient and outpatient data
– frequent and different OA locations within the same
subject such as leg & knee
Future directions:
• Pain intensity with more strict definition:
– Using index dates such as first 3 scores within the first 3
months each year
– Evaluate the temporal relationship and trajectory of pain
over time
• Examine pain description including burning, tingling and
numbness that are associated with neuropathy
• Evaluate medications prescribed & surgical or intraarticular injections that may affect pain
• Examine the association between glycemic control and
pain characteristics
• Examine generalized vs localized OA pain among patients
with DM
Thank you
Results:
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Results:
OA diagnoses codes
"M16.1 Unilateral primary osteoarthritis of hip [7,216 facts; 1,607
patients]"
"M16.0 Bilateral primary osteoarthritis of hip [884 facts; 272
patients]"
"M17.10 Unilateral primary osteoarthritis, unspecified knee [5,368
facts; 1,642 patients]"
"Primary osteoarthritis of right knee [1,801 facts; 612 patients]"
"Unilateral primary osteoarthritis, right knee [427 facts; 203
patients]"
"Primary localized osteoarthrosis, lower leg, right [243 facts; 128
patients]"
"Primary osteoarthritis of knee, right [18 facts; 13 patients]"
"M17.12 Unilateral primary osteoarthritis, left knee [4,226 facts; 866
patients]"
"Primary osteoarthritis of both knees [2,988 facts; 1,022 patients]"
"Osteoarthritis of both knees [822 facts; 215 patients]"
"Degenerative arthritis of knee, bilateral [72 facts; 26 patients]"
"M18 Osteoarthritis of first carpometacarpal joint [2,485 facts; 383
patients]"
"M19.01 Primary osteoarthritis, shoulder [7,392 facts; 1,528
patients]"
"M19.03 Primary osteoarthritis, wrist [4,300 facts; 693 patients]"
"M19.07 Primary osteoarthritis ankle and foot [3,631 facts; 929
patients]"
"M19.04 Primary osteoarthritis, hand [8,127 facts; 1,479 patients]"
"M19.02 Primary osteoarthritis, elbow [1,302 facts; 251 patients]"
"AC (acromioclavicular) joint arthritis [135 facts; 27 patients]"
"1St MTP arthritis [21 facts; 12 patients]"
"AC (acromioclavicular) arthritis [82 facts; 34 patients]"
"E11 Type 2 diabetes mellitus [1,234,653 facts; 59,354 patients]”
"715.11 Osteoarthrosis, localized, primary, shoulder region
[1,672 facts; 447 patients]"
"715.12 Osteoarthrosis, localized, primary, upper arm [83
facts; 33 patients]"
"715.13 Osteoarthrosis, localized, primary, forearm [371 facts;
103 patients]"
"715.14 Osteoarthrosis, localized, primary, hand [3,039 facts;
954 patients]"
"250 Diabetes mellitus [2,180,435 facts; 75,653 patients]"
"004- #1226 Intensity Pain Scale 0-10 (Pain 1) > [4,370,249
facts]"
"02. Ankle [39,847 facts; 7,335 patients]"
"03. Arm [84,066 facts; 15,656 patients]"
"04. Back [398,291 facts; 47,636 patients]"
"06. Buttocks [18,621 facts; 4,077 patients]"
"08. Coccyx [4,859 facts; 988 patients]"
"10. Elbow [7,551 facts; 1,850 patients]"
"13. Finger (Comment Which One) [7,972 facts; 3,131
patients]"
"14. Foot [60,445 facts; 9,263 patients]"
"16. Groin [27,713 facts; 7,602 patients]"
"17. Hand [32,576 facts; 8,270 patients]"
"19. Hip [119,920 facts; 11,799 patients]"
"22. Knee [105,185 facts; 11,871 patients]"
"23. Leg [252,018 facts; 25,325 patients]"
"29. Pelvis [10,142 facts; 3,690 patients]"
"37. Shoulder [72,337 facts; 14,902 patients]"
"42. Toe (Comment Which One) [4,229 facts; 1,492 patients]"
"46. Wrist [10,122 facts; 3,131 patients]"