Abstract
BackgroundPatients 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.MethodsA 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.ResultsWe 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).ConclusionsThe 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.
Highlights
Patients with chronic pain frequently display comorbid depression, but the impact of this concurrence is often underestimated and mistreated
By means of a structured interview, this study investigated the prevalence of unrecognized mood disorders, Major Depressive Disorder (MDD), in patients with medically unexplained chronic pain complaints in primary care settings, and studied possible factors associated with the comorbid mood disorder
Population Characteristics 3588 patients were initially included in the study, of whom 399 were excluded (75 had a current diagnosis of depression, 41 had suffered pain for less than 6 weeks, 50 had a limitation when responding to the PRIME-MD questionnaire, 171 refused to participate and 199 had correctly filled in less than 80% of the information)
Summary
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. To compare the use of health services by patients with unexplained chronic pain, both with and without mood disorder comorbidity. Chronic pain and depression are amongst the most common health problems reported by patients attending primary care [1]. Both conditions produce increased use of health resources and impaired health-related quality of life [2,3]. Chronic pain and depression are frequently comorbid processes, with some studies showing a prevalence ranging from 15% to 100% [4]. Some studies suggest that patients with depression and chronic pain are more likely to be dissatisfied with their healthcare[10]
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