Clinical Drug Investigation

, Volume 27, Issue 2, pp 139–148 | Cite as

Medical Costs of Chronic Musculoskeletal Pain in Italy

  • Livio Garattini
  • Daniela Koleva
  • Nicola Motterlini
  • Dante Cornago
Original Research Article


Background and objectives: Musculoskeletal system problems are responsible for more than two-thirds of painful conditions in primary care. However, only one published study, conducted in Finland, has analysed the costs of managing musculoskeletal pain as a whole in primary care. This study analysed the costs of diagnosing and treating chronic musculoskeletal pain in primary care in Italy. A secondary aim of the study was to assess the impact of different drug treatment patterns on medical costs associated with musculoskeletal pain.

Methods: Chronic pain of musculoskeletal origin was defined as continuous or recurrent pain persisting over 3 months with involvement of the musculoskeletal system, i.e. arising from primary musculoskeletal disorders or from the late consequences of external events (injuries, medical care or surgery). A total of 52 general practitioners (GPs) recruited 581 patients. We focussed on the differences between patients treated (410) and not treated (171) with drugs. Within the treated group, we also analysed subgroups given non-selective NSAID-based therapy (subgroup A, 169 patients) or cyclo-oxygenase-2 (COX-2) inhibitor-based therapy (subgroup B, 52 patients).

Results: The annual average cost of treating a patient with chronic musculoskeletal pain was €212.60. Hospital admissions and GP consultations were the largest cost components, both accounting for around a quarter of the total cost. Not surprisingly, the treated group included older patients, who had more co-morbidities and more severe pain. This was associated with annual costs more than four times those of untreated patients (€274.50 vs €63.90, respectively). Subgroups A and B did not differ with respect to major demographic and clinical variables except in relation to mean age (63 vs 70 years, respectively; p = 0.037). They had similar per-patient costs (€186.20 vs €172.90), although these totals comprised a different mix of components.

Conclusion: The analysis showed that the annual average cost of treatment of chronic musculoskeletal pain in Italy varied considerably depending on whether drug treatment was used. COX-2 inhibitors and traditional NSAIDs had similar per-patient costs, although this similarity stemmed from a different mix of components.


Fibromyalgia Musculoskeletal Pain Resource Consumption Chronic Musculoskeletal Pain Traditional NSAID 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Pharmacia Italia S.p.A. provided financial support for this study. The authors have no conflicts of interest that are directly relevant to the content of this study.

Members of the study group: Aramini Enrico, Augello Giuseppe, Balzan Corrado, Baraldini Laura, Benincasa Francesco, Beretta Enrico, Bertini Luigi, Bonfiglio Salvatore, Bosisio Marina, Camilleri Vincenzo, Caraceni Luciano, Caso Corrado, Cazzaniga Francesco, Collecchia Giampaolo, Colombo Ivo, Colombo Mario, Corasaniti Francesco, Corti Nearco, D’Anna Maria Achilla, Ermacora Tiziano, Fossati Bianca, Gambarelli Lino, Gentile Maurizio, Gerbino Francesco, Giglione Santo, Giordano Egidio, Iacovella Remo, La Vecchia Diego, Lippa Luciano, Longoni Paolo, Malavasi Paolo, Manganella Gerlanda, Marino Rosanna, Milano Maria, Mosconi Giulio, Mosconi Lidia, Nicolosi Mario, Paci Carmelo, Pennino Maria Immacolata, Perlot Mariapia, Pitruzzella Santo, Randi Daniela, Restivo Vetro Antonietta, Riva Maria Grazia, Saieva Stefania, Sancito Giuseppa, Scifo Giovanni, Suzzi Fabio, Talato Fabiola, Tonon Riccardo, Vento Giovanni, Vetro Filippo, Vinti Beniamino.


  1. 1.
    Cavalieri TA. Pain management in the elderly. J Am Osteopath Assoc 2002; 102(9): 481–5PubMedGoogle Scholar
  2. 2.
    Harden RN. Chronic neuropathic pain: mechanisms, diagnosis, and treatment. Neurologist 2005; 11(2): 111–22PubMedCrossRefGoogle Scholar
  3. 3.
    Gatchel RJ. Musculoskeletal disorders: primary and secondary interventions. J Electromyogr Kinesiol 2004; 14: 161–70PubMedCrossRefGoogle Scholar
  4. 4.
    Smith BH, Hopton JL, Chambers WA. Chronic pain in primary care. Fam Pract 1999; 16(5): 475–82PubMedCrossRefGoogle Scholar
  5. 5.
    National Institute for Clinical Excellence. Technology Appraisal 27 Osteoarthritis and rheumatoid arthritis: COX II inhibitors: guidance. London: NICE, 2003Google Scholar
  6. 6.
    FitzGerald GA, Patrono C. The coxib, selective inhibitors of cyclooxygenase-2. N Engl J Med 2001; 345: 433–42PubMedCrossRefGoogle Scholar
  7. 7.
    Hasselström J, Liu-Palmgren J, Rasjö-Wrååk G. Prevalence of pain in general practice. Eur J Pain 2002; 6(5): 375–85PubMedCrossRefGoogle Scholar
  8. 8.
    Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ 2003; 81(9): 646–56PubMedGoogle Scholar
  9. 9.
    Lubeck DP. The costs of musculoskeletal disease: health needs assessment and health economics. Best Pract Res Clin Rheumatol 2003; 17(3): 529–39PubMedCrossRefGoogle Scholar
  10. 10.
    Boonen A, van den Heuvel R, van Tubergen A, et al. Large differences in cost-of-illness and wellbeing between patients with fibromyalgia, chronic low back pain, or ankylosing spondylitis. Ann Rheum Dis 2005; 64: 396–402PubMedCrossRefGoogle Scholar
  11. 11.
    Zabinski RA, Burke TA, Johnson J, et al. An economic model for determining the costs and consequences of using various treatment alternatives for the management of arthritis in Canada. Pharmacoeconomics 2001; 19Suppl. 1: 49–58PubMedCrossRefGoogle Scholar
  12. 12.
    Hemmilä HM. Quality of life and cost of care of back pain patients in Finnish general practice. Spine 2002; 27(6): 647–53PubMedCrossRefGoogle Scholar
  13. 13.
    Borghouts JAJ, Koes BW, Vondeling H, et al. Cost-of-illness of neck pain in The Netherlands in 1996. Pain 1999; 80: 629: 629–36PubMedCrossRefGoogle Scholar
  14. 14.
    Mäntyselkä PT, Kumpusalo EA, Ahonen RS, et al. Direct and indirect costs of managing patients with musculoskeletal pain: challenge for health care. Eur J Pain 2002; 6: 141–8PubMedCrossRefGoogle Scholar
  15. 15.
    Russo P, Attanasio E, Baio G, et al. Una prima valutazione economica dell’impiego di rofecoxib versus FANS convenzionali nell’artrosi. Pharmacoeconomics 2001; 3(2): 81–9Google Scholar
  16. 16.
    Russo P, Capone A, Attanasio E, et al. Pharmacoutilization and costs of osteoarthritis: changes induced by the introduction of a cyclooxygenase-2 inhibitor into clinical practice. Rheumatology 2003; 42: 879–87PubMedCrossRefGoogle Scholar
  17. 17.
    Lucioni C, Chiroli S, Roggeri D, et al. Analisi di costo della terapia con celecoxib versus FANS tradizionali nell’atrosi in Italia. Pharmacoeconomics 2003; 5(1): 23–34Google Scholar
  18. 18.
    Koleva D, Krulichova I, Bertolini G, et al. Pain in Italian primary care. Eur J Public Health 2005; 15(5): 475–9PubMedCrossRefGoogle Scholar
  19. 19.
    Harstall C, Ospina M. How prevalent is chronic pain? Pain: Clinical Updates 2003; 11(2): 1–4Google Scholar
  20. 20.
    Von Kroff M, Jensen MP, Karoly P. Assessing global pain severity by self-report in clinical and health services research. Spine 2000; 25(24): 3140–51CrossRefGoogle Scholar
  21. 21.
    Turk DC. Clinical effectiveness and cost-effectiveness of treatment for patients with chronic pain. Clin J Pain 2002; 18(6): 355–65PubMedCrossRefGoogle Scholar
  22. 22.
    Garattini L, Castelnuovo E, Lanzeni D, et al. Durata e costo delle visite in medicina generale: il progetto DYSCO. Farmacoeconomia e percorsi terapeutici 2003; 4(2): 109–14Google Scholar
  23. 23.
    Barber JA, Thompson SG. Analysis of cost data in randomized trials: an application of the non-parametric bootstrap. Stat Med 2000; 19: 3219–36PubMedCrossRefGoogle Scholar
  24. 24.
    Barber JA, Thompson SG. Multiple regression of cost data: use of generalised linear models. J Health Serv Res Policy 2004; 9(4): 197–204PubMedCrossRefGoogle Scholar
  25. 25.
    Magni G, Marchetti M, Moreschi C, et al. Chronic musculoskeletal pain and depressive symptoms in the National Health and Nutrition Examination I. Epidemiologic Follow-up Study. Pain 1993; 53: 163–8PubMedCrossRefGoogle Scholar
  26. 26.
    Elliott AM, Smith BH, Penny KI, et al. The epidemiology of chronic pain in the community. Lancet 1999; 354: 1248–52PubMedCrossRefGoogle Scholar
  27. 27.
    Bergman S, Herrstrom P, Hogstrom K, et al. Chronic musculoskeletal pain, prevalence rates, and sociodemographic associations in a Swedish Population Study. J Rheumatol 2001; 28: 1369–77PubMedGoogle Scholar
  28. 28.
    Picavet HSJ, Hazes JMW. Prevalence of self reported musculoskeletal diseases is high. Ann Rheum Dis 2003; 62: 644–50PubMedCrossRefGoogle Scholar
  29. 29.
    Garcia FJB, Mejia RH, Lascuevas PM, et al. Epidemiology of musculoskeletal complaints and use of health services in Asturias, Spain. Scand J Rheumatol 1994; 23: 137–41CrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2007

Authors and Affiliations

  • Livio Garattini
    • 1
  • Daniela Koleva
    • 1
  • Nicola Motterlini
    • 1
  • Dante Cornago
    • 1
  1. 1.Centre for Health Economics‘Mario Negri’ Institute for Pharmacological ResearchRanicaItaly

Personalised recommendations