Chronic Pain Care for Women Cost Nearly $13 Billion in 2008

Released: 10/20/2011 12:05 PM EDT
Source: Agency for Healthcare Research and Quality (AHRQ)

Newswise — An estimated 12.1 million women age 18 and older reported suffering from chronic pain in 2008 as a result of underlying medical conditions such as chronic fatigue syndrome, endometriosis, fibromyalgia and vulvodynia. Of these women, only 8.7 million reported receiving treatment that year at a total cost of $12.9 billion, according to the latest News and Numbers from the Agency for Healthcare Research and Quality.
Among other findings:
• About 11.2 percent of non-Hispanic white women, 8.3 percent of non-Hispanic black women and 8.2 percent of Hispanic women had one or more of these chronic pain conditions; 8.4 percent, 5.4 percent and 5.5 percent received treatment for them, respectively.
• Of the $12.9 billion in total expenditures, nearly half ($5.7 billion) was spent for treatment in ambulatory settings such as a doctor’s office and another $2.4 billion was spent on prescription medicines.
• Among women age 18 to 64, nearly 15 percent of their medical expenses was paid out of pocket while private insurance paid 68 percent; Medicaid, 10 percent; Medicare, 3 percent; and other sources, 4 percent.
The data in this AHRQ News and Numbers summary are taken from the Medical Expenditure Panel Survey (MEPS), a detailed source of information on the health services used by Americans, the frequency with which they are used, the cost of those services, and how they are paid. For more information, go to Statistical Brief #342: Health Care Use and Expenditures for Pain Conditions among Women 18 and Older, U.S. Civilian Noninstitutionalized Population, 2008 (http://www.meps.ahrq.gov/mepsweb/data_files/publications/st342/stat342.pdf).

Rituximab may treat chronic fatigue syndrome

An anti-cancer drug could hold the key to treating chronic fatigue syndrome (CFS). Symptoms of the disease eased in 10 of 15 patients given rituximab, an anti-lymphoma drug.

Rituximab works by destroying white blood cells that make antibodies, called B cells. The results of the trial therefore strongly suggest that these white blood cells might be involved in causing CFS – a disorder also known as "yuppie flu" or myalgic encephalomyelitis (ME), and one that has so far defied explanation.

The research was jointly led by Øystein Fluge and Olav Mella at the Haukeland University Hospital in Bergen, Norway. Their team discovered by accident that rituximab might work against CFS after seeing symptoms ease in a patient who had both lymphoma and CFS.

"We think it affects all symptoms [of CFS], so it must touch the central pathological mechanism causing the disease," Fluge says.

Two of the 15 people in the trial appear to have completely recovered since they first received the drug three years ago. "Those two are both back at work," Mella says.

Dramatic results

"It's the most encouraging drug result so far in the history of this disease," according to Charles Shepherd, medical adviser to the UK ME Association. "Although it's a small trial, it's produced dramatic results."

The researchers say that following two doses of the drug being given in the first two weeks of the trial, there was a lag of three to eight months before symptoms began to subside. They say this delayed response tallies with the idea that CFS is caused by autoantibodies – antibodies, made by B cells, that mistakenly attack the body's own tissues.

Rituximab is itself an antibody designed to target and destroy B cells. Mella says that all the B cells are gone within two weeks or so of the treatment, but autoantibodies typically survive in the body for another two or three months. "Washing out these antibodies is the most probable explanation for the time lag in benefits," he says.

The researchers found no trace of XMRV, a mouse leukaemia virus once implicated as a possible cause of CFS. The virus has now been virtually eliminated as a possible cause.

Blind alley

"We looked as hard as we could for it, by several methods, but the search was negative," Fluge says. "We think suggestions it was XMRV [causing CFS] have turned out to be a blind alley, caused by contamination of samples."

Last month, one of the authors of the 2009 paper that implicated XMRV retracted his data from that study after acknowledging that the virus was present through contamination.

"XMRV is dead, a sad and disappointing story that raised a lot of false hopes for patients," says Shepherd. He adds that it is important not to raise hopes again by over-hyping the rituximab results. "We're still a long way from making this drug more widely available, but if someone wants to mount a UK trial, we'd look at that," he said.

Encouraged by the extended remission of two of the people in the trial, the Norwegian researchers are now checking whether further, periodic doses of rituximab could permanently keep the symptoms of CFS at bay. Mella says it is possible that the five who saw no benefits from the trial might have done so eventually if they had received further doses.