Mental disorders are positively associated with subsequent self-reported chronic back and/or neck pain, with a clear dose-response relationship between the number of mental disorders and subsequent pain, according to a study to be published in The Journal of Pain. Furthermore, earlier-onset mental disorders carry a higher risk for subsequent pain than later-onset disorders.
Maria Carmen Viana, MD, PhD, of the department of social medicine and the post graduate program in public health, Federal University of Espirito Santo, Vitoria, Brazil, and colleagues explored the associations between mental disorders and subsequent self-reported chronic back/neck pain onset and the variation in the strength of associations by the timing of events over the course of life, as well as by gender.
The investigators used a population-based, cross-national World Mental Health survey conducted in 19 countries that involved 52,095 subjects. They assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders (including anxiety disorders, mood disorders, substance abuse disorders, and impulse control disorders) and the occurrence and age at onset of back/neck pain using the Composite International Diagnostic Interview. Survival analyses estimated the associations between first onset of mental disorders and subsequent back/neck pain onset.
Bivariate analyses yielded a positive association between all mental disorders and back/neck pain, which remained after adjusting for psychiatric comorbidity in most disorders (12/16). Only bipolar disorder, agoraphobia without panic, and alcohol and drug dependence were not associated with subsequent pain (4/16).
The investigators found no differences based on gender. There was, however, a distinct dose-response relationship between mental disorders and pain — the odds ratio (OR) for pain was 1.8 in respondents with one mental disorder, but increased to 3.2 in respondents with 5 or more lifetime mental disorders (P ≤.001).
The investigators recommend that these findings be taken into account to improve early identification and management of mental health disorders and pain symptoms to reduce comorbidity and disability.
Viana MC, Lim CCW, Pereira FG, et al. Prior mental disorders and subsequent onset of chronic back or neck pain: findings from 19 countries [published online October 11, 2017]. J Pain. doi:10.1016/j.pain.2017.08.011