Ten‐year prevalence of mental disorders in patients presenting with chronic pain in secondary care: A register linkage cohort study

Søndergård, S; Vægter, Henrik Bjarke; Erlangsen, Annette; Stenager, Elsebeth

doi:10.1002/ejp.1124

Cited by 14 publications

(17 citation statements)

References 27 publications

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“…Chronic pain conditions are associated with an elevated risk of suicide, probably due to pain combined with depression and/or substance use disorders (6,8,27). A previous study investigating prevalence of mental disorders in the same population as in this study found in comparison with the general population significantly higher rates of anxiety and depression, and only the males had a higher rate of substance abuse disorders (28). The latter finding might indicate that men tend to cope with somatic symptoms with self-medication through alcohol (29), which may contribute to the increased suicide risk in males.…”

Section: Potential Explanations For Excess Mortality In Patients Withmentioning

confidence: 46%

Cause-specific mortality of patients with severe chronic pain referred to a multidisciplinary pain clinic: a cohort register-linkage study

Vægter

Støten

Silseth

et al. 2018

Scandinavian Journal of Pain

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Abstract Background and aims Almost 20% of the adult population suffers from chronic pain. Chronic pain may be linked to an elevated mortality; however, results from previous studies are inconsistent. Some studies find similar mortality levels in chronic pain patients and pain-free controls while other studies show elevated mortality levels among chronic pain patients, primarily with respect to cancer, diseases of the circulatory and respiratory systems, and suicide. These conflicting results are potentially due to different population samples and different operational definitions of chronic pain. Further research on overall and cause-specific mortality in patients with severe chronic pain is needed to inform clinical practice. The objective of this register-linkage study was to investigate whether patients with severe chronic pain referred to multidisciplinary pain treatment have higher cause-specific mortality rates than the general population. Methods In this register-linkage cohort study, data from 6,142 chronic pain patients (female: n=3,941, male: n=2,201, mean age: 48.2±14.2; range: 16–97 years) attending an interdisciplinary Pain Center in Odense, Denmark from 2005 to 2014 were linked to the Danish Register of Causes of Death. Age and gender standardized mortality ratios (SMRs) with their 95% confidence intervals (CI) were calculated and compared with those of the general population. Data from the general population was extracted from the Danish Register of Causes of Death, and Causes of death were classified according to national Classification of Disease (ICD-10). Results In all, 276 deaths (women: n=152, men: n=124) were observed among the chronic pain patients, and a six-fold higher overall mortality rate was found [SMR: 6.2 (95% CI: 5.5–7.0)] compared with the general population. Elevated cause-specific mortality rates were noted for chronic patients with respect to cancer and neoplasms [4.7 (95% CI: 3.7–5.9)], diseases of the circulatory system [5.7 (95% CI: 4.3–7.3)], diseases of the respiratory system [8.7 (95% CI: 6.2–11.9)], and suicide [7.3 (95% CI: 2.7–15.9)]. Conclusions The overall mortality rate of patients with severe chronic pain in this study was six-fold higher than the rate of the general population in this region. This was reflected in select specific causes of death (cancer and neoplasms, diseases of the circulatory system, diseases of the respiratory system, and suicide). The results are in agreement with previous studies and emphasize the need to understand which factors causally affect this increased mortality allowing for targeted interventions in similar chronic pain populations. Implications Potential reasons for the excess mortality should be adequately addressed by future studies in order to better target this in the management of these patients. The chronic pain population included in this study may have several comorbidities contributing to the increased mortality. To better address these aspects, complete medical profiles are needed in future studies. In addition, implementation of management strategies towards potential risk factors such as poor diet, low levels of physical activity, smoking, and high BMI as well as sleep deprivation and morphine use previously shown associated with having pain may reduce the excess mortality ratio.

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Section: Potential Explanations For Excess Mortality In Patients Withmentioning

confidence: 46%

Cause-specific mortality of patients with severe chronic pain referred to a multidisciplinary pain clinic: a cohort register-linkage study

Vægter

Støten

Silseth

et al. 2018

Scandinavian Journal of Pain

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“…multivariable model 2). The presence of certain comorbidities in the present study to a great extent depended on diagnoses made by physicians, and a recent report indicates that the prevalence of clinically assessed depression and anxiety are, in fact, relatively low compared with reported depressive and anxiety symptoms (74). The time investigated might be of importance as to whether these comorbidities, as well as the other investigator factors, are predictors.…”

Section: Strenghts and Limitationsmentioning

confidence: 57%

Predictors of chronic pain intensity, spread, and sensitivity in the general population: A two-year follow-up study from the SWEPAIN cohort

Larsson¹,

Dragioti²,

Grimby-Ekman³

et al. 2019

J Rehabil Med

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This study shows how characteristics of chronic pain (intensity, spread and sensitivity) can be predicted using demographic and socioeconomic factors and other medical conditions. Information was collected from 34,000 individuals between 18 and 85 years of age in southeastern Sweden. Several socio-demographic factors and other medical conditions were predictors of pain intensity, spread and sensitivity after 2 years. When pain characteristics were taken into consideration in the analysis they were relatively strong predictors of the pain characteristics after 2 years. After modification of the analysis, there were fewer socio-demographic and medical predictors and their importance had decreased. In planning treatment and rehabilitation for chronic pain, pain intensity, spread and sensitivity should specifically be taken into account. Objective: To determine whether the intensity, spread and sensitivity of chronic pain can be predicted using demographic features, socioeconomic conditions and comorbidities. Design: A longitudinal study design was employed. Data was collected at baseline and at 2-year followup. Setting: General population in southeastern Sweden. Subjects: A representative stratified random sample of 34,000 individuals, between 18 and 85 years of age, selected from a sampling frame of 404,661 individuals based on the Swedish Total Population Register. Methods: Eligible individuals were sent postal surveys in 2013 and 2015. The 2 surveys included the same questions about basic demographic data, comorbidities, and chronic pain intensity, spread and sensitivity. Results: Several socio-demographic features and comorbidities at baseline were significant predictors of characteristics of pain (intensity, spread and sensitivity) at the 2-year follow-up. When characteristics of pain at baseline were included in the regression analyses they were relatively strong significant predictors of characteristics of pain after 2 years. After this adjustment there were fewer socio-demographic and comorbidity predictors; the effect estimates for those significant predictors had decreased. Conclusion: Clinical assessment should focus on several characteristics of pain and include a broad medical screening to capture the overall burden of pain in adults from a longitudinal perspective.

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“…Moreover, male gender was overrepresented in the most severe group of depressive symptoms. In a Danish register linkage study of patients attending a pain specialist clinic, men had higher prevalence of depression and anxiety disorders 58. In the SQRP, women were obviously overrepresented at the specialist level, a finding also reported in the Danish study 58.…”

Section: Discussionmentioning

confidence: 68%

“…In a Danish register linkage study of patients attending a pain specialist clinic, men had higher prevalence of depression and anxiety disorders 58. In the SQRP, women were obviously overrepresented at the specialist level, a finding also reported in the Danish study 58. The higher proportion of women could be due to factors such as women, compared with men, had a higher prevalence of chronic pain,59,60 different severity (eg, with respect to spreading of pain), and different societal selection mechanisms for treatment and rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

<p>Who benefits from multimodal rehabilitation – an exploration of pain, psychological distress, and life impacts in over 35,000 chronic pain patients identified in the Swedish Quality Registry for Pain Rehabilitation</p>

Gerdle¹,

Åkerblom²,

Jansen³

et al. 2019

JPR

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BackgroundChronic pain patients frequently suffer from psychological symptoms. There is no consensus concerning the prevalence of severe anxiety and depressive symptoms and the strength of the associations between pain intensity and psychological distress. Although an important aspect of the clinical picture is understanding how the pain condition impacts life, little is known about the relative importance of pain and psychological symptoms for individual’s life impact. The aims of this study were to identify subgroups of pain patients; to analyze if pain, psychological distress, and life impact variables influence subgrouping; and to investigate how patients in the subgroups benefit from treatments.MethodsBackground variables, pain aspects (intensity/severity and spreading), psychological distress (depressive and anxiety symptoms), and two life impact variables (pain interference and perceived life control) were obtained from the Swedish Quality Registry for Pain Rehabilitation for chronic pain patients and analyzed mainly using advanced multivariate methods.ResultsBased on >35,000 patients, 35%–40% had severe anxiety or depressive symptoms. Severe psychological distress was associated with being born outside Europe (21%–24% vs 6%–8% in the category without psychological distress) and low education level (20.7%–20.8% vs 26%–27% in the category without psychological distress). Dose relationships existed between the two psychological distress variables and pain aspects, but the explained variances were generally low. Pain intensity/severity and the two psychological distress variables were significantly associated (R2=0.40–0.48; P>0.001) with the two life impact variables (pain interference and life control). Two subgroups of patients were identified at baseline (subgroup 1: n=15,901–16,119; subgroup 2: n=20,690–20,981) and the subgroup with the worst situation regarding all variables participated less in an MMRP (51% vs 58%, P<0.001) but showed the largest improvements in outcomes.ConclusionThe results emphasize the need to assess both pain and psychological distress and not take for granted that pain involves high psychological stress in the individual case. Not all patients benefit from MMRP. A better matching between common clinical pictures and the content of MMRPs may help improve results. We only partly found support for treatment resistance in patients with psychological distress burden.

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Ten‐year prevalence of mental disorders in patients presenting with chronic pain in secondary care: A register linkage cohort study

Abstract: Prevalence rates of anxiety and depression diagnosed by psychiatrists in patients with chronic pain were found to be lower than previous findings using screening instruments. Adjustment disorders were the most frequent disorders diagnosed, as this study is the first to investigate.

Cited by 14 publications

References 27 publications

Cause-specific mortality of patients with severe chronic pain referred to a multidisciplinary pain clinic: a cohort register-linkage study

Cause-specific mortality of patients with severe chronic pain referred to a multidisciplinary pain clinic: a cohort register-linkage study

Predictors of chronic pain intensity, spread, and sensitivity in the general population: A two-year follow-up study from the SWEPAIN cohort

<p>Who benefits from multimodal rehabilitation – an exploration of pain, psychological distress, and life impacts in over 35,000 chronic pain patients identified in the Swedish Quality Registry for Pain Rehabilitation</p>

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Ten‐year prevalence of mental disorders in patients presenting with chronic pain in secondary care: A register linkage cohort study

Abstract: Prevalence rates of anxiety and depression diagnosed by psychiatrists in patients with chronic pain were found to be lower than previous findings using screening instruments. Adjustment disorders were the most frequent disorders diagnosed, as this study is the first to investigate.

Cited by 14 publications

References 27 publications

Cause-specific mortality of patients with severe chronic pain referred to a multidisciplinary pain clinic: a cohort register-linkage study

Cause-specific mortality of patients with severe chronic pain referred to a multidisciplinary pain clinic: a cohort register-linkage study

Predictors of chronic pain intensity, spread, and sensitivity in the general population: A two-year follow-up study from the SWEPAIN cohort

<p>Who benefits from multimodal rehabilitation &ndash; an exploration of pain, psychological distress, and life impacts in over 35,000 chronic pain patients identified in the Swedish Quality Registry for Pain Rehabilitation</p>

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<p>Who benefits from multimodal rehabilitation – an exploration of pain, psychological distress, and life impacts in over 35,000 chronic pain patients identified in the Swedish Quality Registry for Pain Rehabilitation</p>