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 locationPain intensityDM 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\ 004- #1226 Intensity Pain Scale (Pain 1) > [4,370,249 facts] ICD-9: \i2b2\Diagnoses\ICD9\A \A \A \A \A \ 250 Diabetes mellitus [2,180,435 facts; 75,653 patients] ICD-10: \i2b2\Diagnoses\ICD10\A \A \A \A \ 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 intra- articular 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:

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]” " Osteoarthrosis, localized, primary, shoulder region [1,672 facts; 447 patients]" " Osteoarthrosis, localized, primary, upper arm [83 facts; 33 patients]" " Osteoarthrosis, localized, primary, forearm [371 facts; 103 patients]" " 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]"