Chronic multisite pain in major depression and bipolar disorder: cross-sectional study of 149,611 participants in UK Biobank

Abstract

BackgroundChronic pain has a strong association with major depressive disorder (MDD), but there is a relative paucity of studies on the association between chronic multisite pain and bipolar disorder (BD). Such studies are required to help elucidate the complex biological and psychological overlap between pain and mood disorders. The aim of this study is to investigate the relationship between chronic multisite pain and mood disorder across the unipolar-bipolar spectrum.MethodsWe conducted a cross-sectional study of 149,611 UK Biobank participants. Self-reported depressive and bipolar features were used to categorise participants into MDD and BD groups and a non-mood disordered comparison group. Multinomial logistic regression was used to establish whether there was an association between extent of chronic pain (independent variable) and mood disorder category (dependent variable), using no pain as the referent category, and adjusting for a wide range of potential sociodemographic, lifestyle and comorbidity confounders.ResultsMultisite pain was significantly more prevalent in participants with BD and MDD, for example, 4–7 pain sites: BD 5.8%, MDD 4.5%, and comparison group 1.8% (p < 0.001). A relationship was observed between extent of chronic pain and risk of BD and persisted after adjusting for confounders (relative to individuals with no chronic pain): 2–3 sites RRR of BD 1.84 (95% CI 1.61, 2.11); 4–7 sites RRR of BD 2.39 (95% CI 1.88, 3.03) and widespread pain RRR of BD 2.37 (95% CI 1.73, 3.23). A similar relationship was observed between chronic pain and MDD: 2–3 sites RRR of MDD 1.59 (95% CI 1.54, 1.65); 4–7 sites RRR of MDD 2.13 (95% CI 1.98, 2.30); widespread pain RRR of MDD 1.86 (95% CI 1.66, 2.08).ConclusionsIndividuals who report chronic pain and multiple sites of pain are more likely to have MDD and are at higher risk of BD. These findings highlight an important aspect of comorbidity in MDD and BD and may have implications for understanding the shared neurobiology of chronic pain and mood disorders.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0350-4) contains supplementary material, which is available to authorized users.

Prevalence of different pain categories based on pain spreading on the bodies of older adults in Sweden: a descriptive-level and multilevel association with demographics, comorbidities, medications, and certain lifestyle factors (PainS65+)

“…Disorders of the CNS were associated with the greatest pain spread categories (i.e., RP-Heavy and WSP). These results are consistent with data obtained in cross-sectional and review studies that linked those comorbidities with the development and/or maintenance of WSP 11,16,23,24,27,33,40–42,52,53. The observed strong relationship between those comorbidities and the pain categories can be partly explained by the fact that greater levels of spreading of pain trigger a tendency in health-seeking behavior more frequently than the more limited spreading of pain 24.…”

“…Spatial categories of pain used clinically are local pain (LP), regional pain (RP), and WSP 31,32. A recent epidemiological study found that the vast majority of patients with pain had a regional pain condition; the study also suggested that future analyses should split this group into two categories, an approach used by a large study from the United Kingdom 33. Few studies have investigated the prevalence of pain spread categories in the elderly, and even fewer studies have performed in-depth analyses of the associations of pain spread 1,10,15,16,34,35…”

“…Some others, though, suggest that there is no concrete association between pain and age 1,39. Furthermore, several studies indicate that pain, especially WSP, is associated with increased prevalence of psychological comorbidities (e.g., depression and anxiety) as well as somatic conditions (e.g., cardiovascular disorders [CVDs], hypertension, and diabetes) 33,40–42. It is not known if such conditions are comorbidities to pain, including different pain categories, also in the elderly.…”

Pain at Multiple Sites Is Associated With Prevalent and Incident Fractures in Older Adults

“…We previously reported that 59% of people had pain at more than two sites in our population‐based cohort with a mean age of 63 years . Epidemiological studies have shown that multisite pain (MSP) is linked to worse health outcomes as compared with single‐site pain, including poorer physical health, worse health‐related quality of life, more severe depressive symptoms, cognitive impairments, and poorer sleep quality …”

The role of psychological distress in the relationship between the severity of pressure injury and pain intensity in hospitalized adults

“…Psychological distress plays a significant role in the pain experience and is an experiential factor in the population with chronic pain (Finan & Smith, ; Yalcin & Barrot, ). Indeed, pain is associated with depression (Kroenke et al., ; Ligthart et al., ; Zakoscielna & Parmelee, ), is prevalent in depressed people (Failde et al., ; Nicholl et al., ) and, in fact, has a non‐recursive (reciprocal) relationship with depression (Chou, ; Kroenke et al., ; Meyer, Cooper, & Raspe, ). Similarly, pain has been associated with anxiety (Beesdo et al., ; El‐Gabalawy, Mackenzie, Shooshtari, & Sareen, ; Smeijers et al., ) and sleep disturbance (Schrimpf et al., ; Schuh‐Hofer et al., ; Sivertsen et al., ; Smith, Edwards, McCann, & Haythornthwaite, ).…”