Is leg pain a significant contributor to health care budget pain?

Peripheral arterial disease (PAD) has major impact on leg function, and the most common symptom of PAD is the exertional leg muscle fatigue, cramping or pain known as ‘claudication’. Lack of leg blood flow, thus, is associated with disability and a poor quality of life. When PAD is not promptly diagnosed and treated and leg blood flow is severely decreased, it may lead to ‘critical limb ischaemia’ and amputation. PAD is also a warning sign that other arteries in the body, including those in the heart and brain, may also be blocked. Thus, it is also associated with a high risk of heart attack, stroke and even death. These are significant health care issues and it has been shown that an insufficient arterial blood flow can impede wound healing, making it almost impossible to heal wounds with any treatment. Two out of three patients are not aware of PAD, a common vascular disease that affects as many as 28 000 000 people in the G7 countries alone, 50% of which are asymptomatic. Patients with chronic diabetes or advanced vascular disease can develop pain in their legs as a consequence of the underlying disease. PAD is a term used to describe diseased blood vessels that are not related to the heart. It results from a build-up of plaque in the walls of blood vessels (arteries). This reduces or blocks the flow of blood to the legs and other organs. PAD is most commonly seen in the legs. If untreated this can lead to major amputations and even when treated around 40% of patients will need an amputation. Amputations are expensive both to the health care system and also society, as these patients become less productive members of society. Treatment costs are not insignificant but are certainly less expensive than the costs associated with ongoing leg pain or amputation. Once diagnosed there are three main approaches to treating PAD: lifestyle changes, medication and in some cases endovascular procedures or surgery. A health care provider will determine the best treatment option in partnership with the patient based on his or her symptoms, life circumstances and medical history. PAD prevalence is increasing globally, fuelled by increasing rates of obesity and diabetes. The condition affects around 28 million individuals in the G7 (Table 1), however, at present the majority of PAD patients remain undiagnosed and untreated. PAD is often under-diagnosed because awareness of the disease is low both within the public and the general medical community. The medical products industry and specialist health care societies in many of the G7 countries are heavily invested in health care education and public awareness programmes, as a way to increase disease awareness and to promote earlier detection. Increasing disease prevalence and higher detection rates represent a potentially significant resource, both personnel and financial, burden to the Canadian health care system. If left to progress, PAD adversely impacts patient's quality of life and independence by limiting mobility through pain or amputation. The consequences of amputation can also reduce patient mortality. This lack of independence has serious implication in terms of indirect costs to society. Early detection and cost-effective treatment will be key to managing and reducing this burden. Under-diagnosis is attributed to a limited degree of referring physician awareness about the diagnosis of PAD, as well as a lack of funding for screening programmes. Patient and public awareness of PAD is also low; many patients attribute PAD symptoms to the ageing process and do not seek treatment. Patient awareness programmes run by health care provider societies can provide the public with knowledge of the common symptoms of the disease and how to seek proper diagnosis and treatment. It is time for the wound care community to highlight this growing issue and to take a lead in heightening the awareness.

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