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BMC Primary Care
Published in: BMC Primary Care 1/2010

Open Access 01-12-2010 | Research article

Medically unexplained pain complaints are associated with underlying unrecognized mood disorders in primary care

Authors: Luis Agüera, Inmaculada Failde, Jorge A Cervilla, Paula Díaz-Fernández, Juan Antonio Mico

Published in: BMC Primary Care | Issue 1/2010

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Abstract

Background

Patients with chronic pain frequently display comorbid depression, but the impact of this concurrence is often underestimated and mistreated. The aim of this study was to determine the prevalence of unrecognized major depression and other mood disorders and comorbid unexplained chronic pain in primary care settings and to explore the associated factors.
Also, to compare the use of health services by patients with unexplained chronic pain, both with and without mood disorder comorbidity.

Methods

A cross-sectional study was carried out in a sample of primary care centers. 3189 patients consulting for "unexplained chronic pain" were assessed by the Visual Analogue Scales (VAS) and the Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire.

Results

We report: a) a high prevalence of unrecognized mood disorders in patients suffering from unexplained chronic pain complaints (80.4%: CI 95%: 79.0%; 81.8%); b) a greater susceptibility of women to mood disorders (OR adjusted = 1.48; CI 95%:1.22; 1.81); c) a direct relationship between the prevalence of mood disorders and the duration of pain (OR adjusted = 1.01; CI 95%: 1.01; 1.02) d) a higher comorbidity with depression if the pain etiology was unknown (OR adjusted = 1.74; CI 95%: 1.45; 2.10) and, e) an increased use of health care services in patients with such a comorbidity (p < 0.0001).

Conclusions

The prevalence of undiagnosed mood disorders in patients with unexplained chronic pain in primary care is very high, leading to dissatisfaction with treatment processes and poorer outcomes. Consequently, it seems necessary to explore this condition more regularly in general practice in order to reach accurate diagnoses and to select the appropriate treatment.
Literature
1.
Means-Christensen AJ, Roy-Byrne PP, Sherbourne CD, Craske MG, Stein M: Relationships among pain, anxiety and depression in primary care. Depression and Anxiety. 2008, 25: 593-600. 10.1002/da.20342.CrossRefPubMed
2.
García-Campayo J, Ayuso-Mateos JL, Caballero L, Romera I, Aragonés E, Rodríguez-Artalejo F, Quail D, Gilaberte I: Relationship of somatic symptoms with depression severity, quality of life, and health resources utilization in patients with major depressive disorder seeking primary health care in Spain. Prim Care Companion J Clin Psychiatry. 2008, 10: 355-362. 10.4088/PCC.v10n0502.CrossRefPubMedPubMedCentral
3.
Campbell LC, Clauw DJ, Keefe FJ: Persistent pain and depression: A biopsychosocial perspective. Biol Psychiatry. 2003, 54: 399-409. 10.1016/S0006-3223(03)00545-6.CrossRefPubMed
4.
Bair MJ, Robinson RL, Katon W, Kroenke K: Depression and pain comorbidity. Arch Intern Med. 2003, 163: 2433-2445. 10.1001/archinte.163.20.2433.CrossRefPubMed
5.
Kroenke K, Shen J, Oxman TE, Williams JW, Dietrich AJ: Impact of pain on the outcomes of depression treatment: Results from the RESPECT trial. Pain. 2008, 134: 209-215. 10.1016/j.pain.2007.09.021.CrossRefPubMed
6.
Ohayon MM, Schatzberg AF: Using chronic pain to predict depressive morbidity in the general population. Arch Gen Psychiatry. 2003, 60: 39-47. 10.1001/archpsyc.60.1.39.CrossRefPubMed
7.
Löwe B, Spitzer RL, Williams JB, Mussell M, Schellberg D, Kroenke K: Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment. Gen Hos Psychiatry. 2008, 30: 191-199. 10.1016/j.genhosppsych.2008.01.001.CrossRef
8.
Ciaramella A, Grosso S, Poli P, Gioia A, Inghirami S, Massimetti G, Conti L: When pain is not fully explained by organic lesion: a psychiatric perspective on chronic pain patients. Eur J Pain. 2004, 8: 13-22. 10.1016/S1090-3801(03)00062-4.CrossRefPubMed
9.
Levinson D, Karger CJ, Haklai Z: Chronic physical conditions and use of health services among persons with mental disorders: results from the Israel National Health Survey. Gen Hos Psychiatry. 2008, 30: 226-232. 10.1016/j.genhosppsych.2008.02.007.CrossRef
10.
Bair MJ, Kroenke K, Sutherland JM, McCoy KD, Harris H, McHorney CA: Effects of depression and pain severity on satisfaction in medical outpatients: analysis of the Medical Outcomes Study. J Rehabil Res Dev. 2007, 44: 143-52. 10.1682/JRRD.2006.06.0061.CrossRefPubMed
11.
Kirmayer LJ, Robbins JM, Dworkind M, Yaffe MJ: Somatization and the recognition of depression and anxiety in primary care. Am J Psychiatry. 1993, 150: 734-41.CrossRefPubMed
12.
Marazatti M, Menchetti M, Murri MB, Bertakis K, Bortolotti B, Berardi D: Recognition and treatment of depression in primary care: effect of patients' presentation and frequency of consultation. J Psychosom Res. 2009, 66: 335-41. 10.1016/j.jpsychores.2008.10.008.CrossRef
13.
Arnow BA: Depression and physical symptoms: The mind-body connection. J Clin Psychiatry. 2004, 65: 869-870.
14.
Brecht S, Courtecuisse C, Debieuvre C, Croenlein J, Desaiah D, Raskin J, Petit C, Demyttenaere K: Efficacy and safety of duloxetine 60 mg once daily in the treatment of pain in patients with major depressive disorder and at least moderate pain of unknown etiology: a randomized controlled trial. J Clin Psychiatry. 2007, 68: 1707-16. 10.4088/JCP.v68n1110.CrossRefPubMed
15.
Mico JA, Ardid D, Berrocoso E, Eschalier A: Antidepressants and pain. Trends Pharmacol Sci. 2006, 27: 348-354. 10.1016/j.tips.2006.05.004.CrossRefPubMed
16.
Perrot S, Javier RM, Marty M, Jeunne Le C, Laroche F, CEDR(Cercle d' Etude de la Douleur en Rheumatologie France), Frech Rheumatological Society, Pain Study Section: Is there any evidence to support the use of anti-depressants in painful rheumatological condition? Systematic review of pharmacological and clinical studies. Rheumatology. 2008, 47: 1117-1123. 10.1093/rheumatology/ken110.CrossRefPubMed
17.
Giesecke T, Gracely RH, Williams DA, Geisser ME, Petzke FW, Clauw DJ: The relationship between depression, clinical pain, and experimental pain in a chronic pain cohort. Arthritis Rheum. 2005, 52: 1577-84. 10.1002/art.21008.CrossRefPubMed
18.
Strigo IA, Simmons AN, Scott MC, Craig AD, Paulus MP: Association of major depressive disorder with altered functional brain response during anticipation and processing of heat pain. Arch Gen Psychiatry. 2008, 65: 1275-1284. 10.1001/archpsyc.65.11.1275.CrossRefPubMedPubMedCentral
19.
Peveler R, Katona C, Wessely S, Dowrick C: Painful symptoms in depression: under-recognised and under-treated?. Br J Psychiatry. 2006, 188: 202-203. 10.1192/bjp.bp.105.012963.CrossRefPubMed
20.
Onder G, Landi F, Gambassi G, Liperoti R, Soldato M, Catananti C, Finne-Soveri H, Katona C, Carpenter I, Bernabei R: Association between pain and depressionamong older adults in Europe: results from the Aged in Home Care (AdHOC) project:a cross-sectional study. J Clin Psychiatry. 2005, 66: 982-988. 10.4088/JCP.v66n0804.CrossRefPubMed
21.
Collins SL, Moore RA, McQuay HJ: The visual analogue pain intensity scale: what is moderate pain in millimeters?. Pain. 1997, 72: 95-97. 10.1016/S0304-3959(97)00005-5.CrossRefPubMed
22.
Spitzer RL, Williams JB, Kroenke K, Linzer M, deGruy FV, Hahn SR, Brody D, Johnson JG: Utility of a new procedure for diagnosing mental disorders in primary care: The PRIME-MD 1000 study. JAMA. 1994, 272: 1749-1756. 10.1001/jama.272.22.1749.CrossRefPubMed
23.
Baca E, Saiz J, Agüera L, Caballero L, Fernández-Liria A, Ramos J, Gil A, Madrigal M, Porras A: Validation of the Spanish versión of PRIME-MD: a procedure for diagnosing mental disorders in primary care. Actas Esp Psiquiatr. 1999, 27: 375-383.PubMed
24.
Kroenke K, Spitzer RL, Williams JB, Linzer M, Hahn SR, deGruy FV, Brody D: Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. Arch Fam Med. 1994, 3: 774-9. 10.1001/archfami.3.9.774.CrossRefPubMed
25.
Tang NK, Salkovskis PM, Hodges A, Wright KJ, Hanna M, Hester J: Effects of mood on pain responses and pain tolerance: An experimental study in chronic back pain patients. Pain. 2008, 138: 392-401. 10.1016/j.pain.2008.01.018.CrossRefPubMed
26.
Lin EH, Katon WJ, VonKorff M, Russo JE, Simon GE, Bush TM, Rutter CM, Walker EA, Ludman E: Relapse of depression in primary care. Rate and clinical predictors. Arch Fam Med. 1998, 7: 443-449. 10.1001/archfami.7.5.443.CrossRefPubMed
27.
van Rijswijk E, van Hout H, Lisdonk van de E, Zitman F, van Weel C: Barriers in recognising, diagnosing and managing depressive and anxiety disorders as experienced by Family Physicians; a focus group study. BMC Fam Pract. 2009, 10: 52-10.1186/1471-2296-10-52.CrossRefPubMedPubMedCentral
28.
Keogh E, Lance M, McCracken L, Eccleston Ch: Gender moderates the association between depression and disability in chronic pain patients. Eur J Pain. 2006, 10: 413-422. 10.1016/j.ejpain.2005.05.007.CrossRefPubMed
29.
Arnow BA, Hunkeler EM, Blasey CM, Lee J, Constantino MJ, Fireman B, Kraemer HC, Dea R, Robinson R, Hayward C: Comorbid depression, chronic pain and disability in primary care. Psychosom Med. 2006, 68: 262-268. 10.1097/01.psy.0000204851.15499.fc.CrossRefPubMed
30.
Wiesenfeld-Hallin Z: Sex differences in pain perception. Gend Med. 2005, 2: 137-45. 10.1016/S1550-8579(05)80042-7.CrossRefPubMed
31.
Gureje O, Simon GE, Von Korff M: A cross-national study of the course of persistent pain in primary care. Pain. 2001, 92: 195-200. 10.1016/S0304-3959(00)00483-8.CrossRefPubMed
32.
Gureje O, Von Korff M, Kola L, Demyttenaere K, He Y, Posada-Villa J, Lepine JP, Angermeyer MC, Levinson D, de Girolamo G, Iwata N, Karam A, Guimaraes Borges GL, de Graaf R, Browne MO, Stein DJ, Haro JM, Bromet EJ, Kessler RC, Alonso J: The relation between multiple pains and mental disorders: Results from the World Mental Health Surveys. Pain. 2008, 135: 82-91. 10.1016/j.pain.2007.05.005.CrossRefPubMed
33.
Marazziti D, Mungai F, Vivarelli L, Presta S, Dell'Osso B: Pain and psychiatry: a critical analysis and pharmacological review. Clin Pract Epidem Mental Health. 2006, 2: 31-10.1186/1745-0179-2-31.CrossRef
34.
Bao Y, Strurm R, Croghan TW: A nacional study of the effect of chronic pain on the use of health care by depressed persons. Psychiatr Serv. 2003, 54: 683-697. 10.1176/appi.ps.54.5.693.CrossRef
35.
Upshur CC, Luckmann RS, Savageau JA: Primary care provider concerns about management of chronic pain in community clinic populations. J Gen Intern Med. 2006, 21: 652-5. 10.1111/j.1525-1497.2006.00412.x.CrossRefPubMedPubMedCentral
36.
Pinto-Meza A, Serrano-Blanco A, Codony M, Reneses B, von Korff M, Haro JM, Alonso J: Prevalencia y comorbilidad física y mental del dolor dorsal y cervical crónico en España. Resultados del estudio ESEMed. Med Clin (Barc). 2006, 127: 325-330. 10.1157/13092313.CrossRef
37.
Scott KM, Bruffaerts R, Tsang A, Ormel J, Alonso J, Angermeyer MC, Benjet C, Bromet E, de Girolamo G, de Graaf R, Gasquet I, Gureje O, Haro JM, He Y, Kessler RC, Levinson D, Mneimneh ZN, Oakley Browne MA, Posada-Villa J, Stein DJ, Takeshima T, Von Korff M: Depression-anxiety relationships with chronic physical conditions: results from the World Mental Health Surveys. J Affect Disord. 2007, 103: 113-20. 10.1016/j.jad.2007.01.015.CrossRefPubMed
38.
Breslau N, Davis GC: Migraine, physical health and psychiatric disorder: a prospective epidemiologic study in young adults. J Psychiatr Res. 1993, 27: 21-10.1016/0022-3956(93)90009-Q.CrossRef
Metadata
Title
Medically unexplained pain complaints are associated with underlying unrecognized mood disorders in primary care
Authors
Luis Agüera
Inmaculada Failde
Jorge A Cervilla
Paula Díaz-Fernández
Juan Antonio Mico
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2010
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-11-17

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