Prevalence, onset, and risk of psychiatric disorders in men with chronic low back pain: a controlled study

Abstract

This study used structured diagnostic interviews and DSM-III criteria to assess lifetime prevalence and pre-morbid risk of psychiatric disorder in a sample of men with long-standing chronic back pain (CLPB) attending a primary care clinic. A control group of age and demographically matched men without history of back pain was also studied. Compared to controls, men with CLBP had significantly higher lifetime rates of major depression (32% vs. 16%), alcohol use disorder (64.9% vs. 38.8%), and a major anxiety disorder (30.9% vs. 14.3%). Almost all CLBP men ever experiencing a mood disorder reported recurrent, not single, episodes. The 6 month point prevalence of major depression, but not other disorders, was also significantly elevated for men with CLBP. In CLBP, the first episode of major depression generally (58.1%) followed pain onset. While the initial major depressive episode usually commenced within the first 2 years of established pain, late onset mood disorder was also common. By comparison in most cases (81%) onset of alcohol use disorders considerably preceded pain. When an age-matching procedure was used to gauge relative vulnerability to psychiatric illness in patients and controls, CLBP patients had significantly higher pre-pain rates of alcohol use disorder but not depression. After age of pain onset, CLBP subjects had over 9 times the risk of developing major depression, but had similar rates of developing alcoholism. We conclude that (1) alcohol use disorders rather than depression may increase risk of developing CLBP, and (2) risk of new onset and recurrent major depression remains high for men throughout their pain career. This suggests that psychological adaptation to long-standing pain may be less successful than previously thought, especially with regard to recurrent mood disorder.

Genotype-dependent responsivity to inflammatory pain: A role for TRPV1 in the periaqueductal grey

“…Under normal circumstances, there is a physiological balance between inhibition and facilitation of pain to facilitate conscious perception of pain when needed. Hyperalgesia is a heightened pain response to normally painful stimuli and can be exacerbated by negative affective state, including anxiety and depression (Asmundson and Katz, 2009;Atkinson et al, 1991). As demonstrated in the previous chapters 2, 3 and 4, the WKY rat model of negative affective state also displays a hyperalgesic phenotype and represents a useful model with which to study the role of TRPV1 in the PAG in hyperalgesia associated with negative affect.…”

“…Chronic stress, by contrast, generally tends to exacerbate pain in humans and rodents in the phenomenon of stress-induced hyperalgesia (SIH) . Chronic stress is also a well-recognised predisposing factor in anxiety disorders and clinical studies have provided evidence that there is high comorbidity between pain and anxiety (Asmundson and Katz, 2009;Atkinson et al, 1991). Furthermore, a persistent anxiety state can exacerbate pain leading to anxietyinduced hyperalgesia (al Absi and Rokke, 1991;Dougher, 1979;Rhudy and Meagher, 2000).…”

The relation between multiple pains and mental disorders: Results from the World Mental Health Surveys

“…It is therefore unclear whether the suggestion that chronic pain may be a variant of depression or masked depression (Magni and De Bertolini, 1983;Turk and Salovey, 1984;Ohayon and Schatzberg, 2003) is real or instead reflects a paucity of data in regard to the association of chronic pain with other psychiatric conditions. For example, only a few studies have examined the relationship of pain with anxiety disorders and the results have been inconsistent (Atkinson and Slater, 1991;McWilliams and Cox, 2003;McWilliams and Goodwin, 2004).…”

Assessment and Treatment of Psychosocial Comorbidities in Patients With Neuropathic Pain

“…Estimates suggest that at least 1 current psychiatric diagnosis is present in 59% of patients with chronic back pain treated at pain facilities and at least 1 lifetime psychiatric diagnosis is present in 77% of these patients. 10 In contrast, community estimates are 15% for at least 1 current psychiatric diagnosis and 29% to 38% Chronic neuropathic pain is a prevalent problem that eludes cure and adequate treatment. The persistence of intense and aversive symptoms, inadequacy of available treatments, and impact of such pain on all aspects of functioning underscore the important role of several psychosocial factors in causing, maintaining, and amplifying the perception of pain severity, coping adequacy, adaptation, impaired physical function, and emotional distress responses.…”