First onset of common pain symptoms: a prospective study of depression as a risk factor

Abstract

This report examined first onset rates of 5 common pain symptoms and assessed, on a prospective basis, whether depressive symptoms at baseline were associated with onset risks. Adult Health Maintenance Organization (HMO) enrollees (n = 1016) were interviewed in 1986 about their history of each of 5 pain conditions (back pain, severe headache, chest pain, abdominal pain and temporomandibular disorder (TMD) pain). Three years later, this sample was re-interviewed (n = 803) to measure site-specific first onset rates. The Symptom Checklist 90-Revised (SCL-90-R) Depression scale was administered at baseline and at 3 year follow-up. Over the three year follow-up interval, rates of first onset were: 17.7% for back pain; 4.2% for severe headache; 3.0% for chest pain; 3.1% for abdominal pain; and 6.5% for TMD pain. Onset rates of persistent pain and of chronic pain dysfunction were substantially lower, but over 1% experienced onset of chronic pain dysfunction for back pain and for headache. There were not significant differences in onset rates of back pain, abdominal pain or TMD pain by severity or chronicity of depressive symptoms. Relative to the non-depressed, persons with moderate-to-severe depressive symptoms were more likely to develop headache and chest pain (adjusted odds ratios of 1.7 to 5.0). For headache and chest pain, onset risks were highest among the chronically depressed. After adjusting for age, gender, education and depression severity, persons with a pain condition at baseline were more likely to report first onset of a new pain condition over the follow-up period (adjusted odds ratios of 2.1 for back pain, 4.3 for headache, 1.4 for chest pain, 6.3 for abdominal pain and 3.7 for TMD pain). Thus, presence of a pain condition was a more consistent predictor of subsequent risks of developing a new pain condition than was the severity or chronicity of depressive symptoms. Possible explanations for this relationship are considered.