January 20, 2015
MDH releases first statewide report on chronic pain procedures
The Minnesota Department of Health has found that about 83,000 Minnesotans a year received chronic pain procedures during a three-year period.
MDH was able to conduct this analysis for the Legislature by analyzing Minnesota's All Payer Claims Database, a comprehensive dataset of health care services delivered to Minnesota residents with health insurance. Although the database was established by the Pawlenty administration as part of Minnesota's 2008 bipartisan health reforms, MDH's use of it for statewide analyses such as this, was only recently authorized.
"This report is significant because it helps us understand a major driver of health care costs - chronic pain," said Minnesota Commissioner of Health Dr. Ed Ehlinger. "It is also a first of its kind report that shows the potential that this database has to answer important questions about Minnesota's health care system." MDH analyzed data from 2010 to 2012.
Chronic pain is a substantial public health concern that is costly and affects the quality of life of individuals and their families. The Institute of Medicine estimates about 100 million Americans are affected by chronic pain, more than those affected by heart disease, diabetes and cancer combined. Pain-associated economic costs reach approximately $600 billion per year nationally. This Minnesota report does not estimate the cost of chronic pain in Minnesota but further analysis of the Minnesota All Payer Claims Database could answer that question.
Chronic pain is most often associated with musculoskeletal disorders, inflammation, or neurological conditions including back disorders, fibromyalgia, rheumatoid arthritis, and other joint disorders. Most procedures provide temporary pain relief with injections that block nerves; though some procedures, such as spinal column or disc surgery, can provide more long-term relief.
Back disorders caused the highest volume of chronic pain procedures. They included spinal stenosis 30.0 percent, disc degeneration 10.3 percent, and cervical disc disorders (neck pain) 8.4 percent. Spondylosis, a form of osteoarthritis, was the second more common primary diagnosis, at 17.2 percent. The four most common procedures (paravertebral facet joint injections, 18.2 percent; transforaminal epidural injections, 16.4 percent; interlaminar epidural injections, 16.1 percent; and tendon injections, 10.8 percent) accounted for 60.8 percent of all delivered chronic pain procedures.
The overall volume of chronic pain procedures has increased from 2010 to 2012 by 13.2 percent. In 2012, 518 chronic pain procedures were performed for every 10,000 covered Minnesotans within the state, or roughly one procedure for every 19 persons. The analysis also showed that female patients accounted for 62 percent of procedures, and patients over age 60 accounted for 44 percent. The analysis did not include treatments for acute pain, such as that experienced after surgery.
The MN APCD was created by the Legislature in 2008, with uses specified by legislative direction. The MN APCD supports efforts to improve health care in Minnesota and increase price transparency by filling critical information gaps related to health care costs, quality, and use. The MN APCD does not collect patient identifiers such as names, social security numbers or addresses. Instead, the database collects de-identified medical care claims transactions for public and private insurance. Ten other states also collect APCD data.
More information about the database is available at http://www.health.state.mn.us/healthreform/allpayer/index.html.
The complete study is available at http://www.health.state.mn.us/healtheconomics.