Effect of Pruritus Similar to Chronic Pain in Reducing QoL

Laurie Barclay, MD

June 22, 2011

June 22, 2011 — Individuals with chronic pruritus have a similar reduction in quality of life (QoL) as do individuals with chronic pain, according to the results of a cross-sectional study reported Online First June 16 in the Archives of Dermatology.

"Despite the reported widespread and debilitating effect of chronic pruritus, research relating to this symptom has not been as well established as in other chronic conditions such as pain," write Seema P. Kini, MD, MSCR, from Emory University School of Medicine in Atlanta, Georgia, and colleagues. "Chronic pain and pruritus share many similarities: both are complex, subjective symptoms that have been demonstrated to have a compelling effect on health-related QoL, including the development of symptoms of depression and the impairment of activities of daily living. However, unlike chronic pruritus, pain syndromes have been well studied in health services and outcomes research, resulting in a better understanding of this complex condition and the development of novel treatments."

The goal of the study was to use directly elicited health utility scores to compare the effects of chronic pruritus and chronic pain on QoL in a convenience sample of patients seen at the Emory Dermatology Clinic, Emory Spine Center, and Emory Center for Pain Management. Participants included 73 patients with chronic pruritus and 138 patients with chronic pain, all of whom were at least 18 years old and had a duration of chronic pain or pruritus of at least 6 weeks.

To determine the effect of the symptom type (pain or pruritus) on the primary outcome variable (mean utility score measuring the effect on QoL), a regression analysis was conducted. The utility scores ranged from 0 (death) to 1 (perfect health) and measured how much of their life expectancy participants would be willing to forgo in order to live without pain or pruritus.

For patients with pruritus, mean utility score was 0.87 ± 0.27 vs 0.77 ± 0.31 for patients with pain (P < .01). Significant predictors of the mean symptom utility score were symptom severity (0.03; P < .05) and single marital status (−0.12; = .02), but not symptom type (P = .43), after controlling for symptom severity, duration, and demographic variables.

"Chronic pruritus has a substantial impact on QoL, one that may be comparable to that of pain," the study authors write. "The severity of symptoms and the use of support networks are the main factors that determine the degree to which patients are affected by their symptoms. Addressing support networks in addition to developing new therapies may improve the QoL of itchy patients."

Limitations of this study include possible response, recall, and selection biases; limited generalizability to nonacademic settings; and inability to determine the potential contribution of other comorbidities such as mood states.

"Overall, our data support previously published results indicating that patients with chronic pruritus carry a significant burden of disease," the study authors conclude. "This study provides preliminary data that future studies may build on by incorporating larger and more general populations of patients and by assessing the contribution of mood states (eg, depression, anxiety) to the impact of pruritus on QoL. Such other studies are needed to corroborate our findings."

The study authors have disclosed no relevant financial relationships.

Arch Dermatol. Published online June 16, 2011. Abstract

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