Chronic spinal pain and physical–mental comorbidity in the United States: results from the national comorbidity survey replication

Abstract

This paper investigates comorbidity between chronic back and neck pain and other physical and mental disorders in the US population, and assesses the contributions of chronic spinal pain and comorbid conditions to role disability. A probability sample of US adults (n=5692) was interviewed. Chronic spinal pain, other chronic pain conditions and selected chronic physical conditions were ascertained by self-report. Mood, anxiety and substance use disorders were ascertained with the Composite International Diagnostic Interview (CIDI). Role disability was assessed with questions about days out of role and with impaired role functioning. The 1 year prevalence of chronic spinal pain was 19.0%. The vast majority (87.1%) of people with chronic spinal pain reported at least one other comorbid condition, including other chronic pain conditions (68.6%), chronic physical conditions (55.3%), and mental disorders (35.0%). Anxiety disorders showed as strong an association with chronic spinal pain as did mood disorders. Common conditions not significantly comorbid with chronic spinal pain were diabetes, heart disease, cancer, and drug abuse. Chronic spinal pain was significantly associated with role disability after controlling for demographic variables and for comorbidities. However, comorbid conditions explained about one-third of the gross association of chronic spinal pain with role disability. We conclude that chronic spinal pain is highly comorbid with other pain conditions, chronic diseases, and mental disorders, and that comorbidity plays a significant role in role disability associated with chronic spinal pain. The societal burdens of chronic spinal pain need to be understood and managed within the context of comorbid conditions.

Mental disorders in patients with obesity in comparison with healthy probands

“…However, the results also highlight an increased prevalence rate of comorbid mental disorders in obese patients from the general population that is comparable with that of other somatic diseases. [1][2][3][4][5][6] The differences in overall prevalence rates between obese individuals and healthy probands are mainly because of significantly higher frequencies of mood, anxiety and somatoform disorders during all three time periods. In accordance with most previous studies, 7-9,11,12 mood disorders are frequent in obese individuals and significantly increased in comparison with healthy probands.…”

“…Again, the increased prevalence rates of mood, anxiety and somatoform disorders in obese individuals are in line with prevalence rates of the corresponding comorbid mental disorders in patients with other physical diseases. [1][2][3][4][5][6] Substance use disorders are more frequent in obese individuals from the general population than in obese rehabilitation inpatients, and are also increased in comparison with healthy probands, albeit not significantly. An explanation for the lower prevalence rates in obese rehabilitation inpatients may be that inpatients tend to dissimulate their substance-related symptoms in a more distinct manner than community dwellers because of the less anonymous setting.…”

“…Several representative, epidemiological surveys have reported increased prevalence rates of mental disorders in patients with somatic diseases like musculoskeletal, [1][2][3][4] cardiovascular, 1,2,4,5 cancer 2,6 and respiratory tract diseases 2,4 in comparison with somatically healthy probands or probands without the examined disease. The findings concerning the association of obesity and mental disorders are more inconsistent.…”

New concept for backache: biopsychosocial pain syndrome

“…Chronic backache should not be regarded as an isolated spinal disease. Two-thirds of subjects with chronic backache have another chronic pain condition and about a third have a diagnosable mental disorder [72]. About one-third of the association between chronic spinal pain and disability can be explained by comorbid conditions.…”

Perceived Injustice and Adverse Recovery Outcomes

“…Similarly, clinical research indicates that anger, especially directed at physicians, and depression are common among patients with chronic pain (Fishbain, Bruns, Disorbio, & Lewis, 2008;Von Korff et al, 2005).…”