Epidemiology of pain and relation to psychiatric disorders

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Highlights

  • Chronic pain prevalence estimates are widely dispersed across studies.

  • Some psychiatric disorders such as anxiety and depression often co-occur with chronic pain.

  • Psychiatric disorders may be associated with an increased risk of chronic pain and its persistence.

Abstract

Chronic pain is a common pain condition. Some psychiatric disorders, such as anxiety and depression, are also common in the general population. Epidemiological studies found that some psychiatric disorders are more commonly found among persons with chronic pain (e.g., headache, back pain) than those without chronic pain. Why those psychiatric disorders co-occur with chronic pain, however, is not well understood. Further, studies demonstrated that some psychiatric disorders, such as depression, increase the risk of chronic pain as well as its persistence. It is also recognized that chronic pain has a negative impact on the persistence of psychiatric disorders. The observations from clinical studies suggest that chronic pain is not a common comorbidity among individuals with other psychiatric disorders, such as dementia and schizophrenia. It is not clear if this is a consequence of any specific biological mechanism, or methodology problems in the studies. This paper provides an overview on the distribution of chronic pain and psychiatric disorders, followed by a review of studies that have demonstrated the association between psychiatric disorders and chronic pain.

Introduction

Chronic pain is a significant health problem. It is common and it affects quality of life, sleep, work, decreases socialization, and increases health care use and costs, as well as mortality (Elliott et al., 1999, Henschke et al., 2015, Smith et al., 2014). Epidemiological studies have also demonstrated that some psychiatric disorders are common in the general population. There is increasing evidence that chronic pain and psychiatric disorders are not only common comorbidities, but psychiatric disorders may modify the risk of chronic pain, as well as pain may contribute to psychiatric disorders (Portenoy et al., 2004, Gureje et al., 1998, de Heer et al., 2014, Bruffaerts et al., 2015). This chapter first provides an overview of the distribution of chronic pain and psychiatric disorders, and then it describes the relationship between psychiatric conditions and chronic pain. This overview is selective, rather than comprehensive. A review of each study assessing the association between a psychiatric disorder and pain would prove infeasible for a single article. Therefore, we have committed this overview to specific psychiatric disorders such as anxiety, depression, substance use disorder, suicide, schizophrenia and dementia.

Section snippets

Overview of epidemiology of chronic pain

The annual incidence rates of chronic pain range from 2% to 8% (Eriksen et al., 2004, Elliott et al., 2002, Reitsma et al., 2012). Table 1 lists a few prevalence estimates of chronic pain around the world, ranging from below 1% to 76%, and some details of the study methods (Andersson, 1994, Arnow et al., 2006, Bhattarai et al., 2007, Blay et al., 2007, Demyttenaere et al., 2007, Elliott et al., 1999, Fayaz et al., 2016, Gureje et al., 1998, Jakobsson, 2010, Moulin et al., 2002, Naidoo et al.,

Overview of psychological disorders associated with chronic pain

Similarly, to chronic pain, some psychiatric disorders, such as anxiety and depression, are also common. A meta-analysis including 174 surveys across 63 countries estimated the 12-month period and lifetime prevalence estimates of a set of common mental disorders (i.e., anxiety, depression and substance use disorders) as 18% and 29%, respectively (Steel et al., 2014).

Chronic pain is frequently accompanied by psychological disorders; anxiety and depression. Gureje et al. found that individuals

Discussion

This overview found many studies showing that some psychiatric disorders are not only more common among persons with chronic pain (e.g., headache, back pain), but they are also possible contributors to a higher incidence of chronic pain. These results are valid, since the methodology used in most of these studies appropriately ascertains that the significant association was not a consequence of bias and confounding.

Although current evidence suggests that psychiatric disorders are associated

Conclusion

The present chapter adds to a growing knowledge of prevalence of chronic pain, and the relation between chronic pain and psychiatric disorders. We have used the best available data to demonstrate that, for some types of chronic pain and psychiatric conditions, they are common comorbidities. Moreover, either condition modifies the risk of the other.

It is therefore essential that health professionals identify psychiatric disorders comorbidities in patients with any kind of chronic pain early on,

Acknowledgements

The authors declare no conflict of interest.

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