Clinical risk factors for unscheduled health care attendance for chronic pain management, and associated treatment costs.

Introduction: Effective community-based chronic noncancer pain (CNCP) management could improve treatment outcomes and reduce the burden placed on unscheduled care (USC) services. Objectives: We aimed to characterise the extent of this burden and identify patients requiring additional scheduled community-based care to achieve effective pain management. Methods: We identified a random sample of 4,400 adults from the general population and electronically linked health care datasets (USC, prescribing and Scottish Morbidity Registers) spanning a 12-month observation period. Results: All-cause USC presentation was higher in those with CNCP (75.4%) than in those with no evident pain (26.4%), and two-thirds of the former reported pain as a primary symptom at presentation. Risk factors for attendance for pain management, explaining 35% of the effect variance, were transitioning from opioid to nonopioid analgesics (OR = 3.96; P = 0.004), recent analgesic dose decrease (OR = 12.17; P < 0.001), and anxiety disorders (OR = 2.27; P = 0.079). Risk factors for attendance for nonurgent pain management, explaining 47% of the effect variance, were transitioning from opioid to nonopioid analgesics (OR = 3.88; P = 0.008), recent analgesic dose decrease (OR = 13.29; P < 0.001) and insomnia (OR = 3.27; P = 0.037). The cost of CNCP management was second only to that of cardiovascular disease. The total annual cost of pain management in the cohort was £144,584 ($181,785). Based on this finding, the projected national annual cost is estimated to fall at around £178 million ($224m). Conclusion: Pain management confers a substantial burden on USC services-particularly in the presence of opioid analgesic tapering, anxiety disorders and insomnia-that could be reduced by effective community-based pain management.