Pain May Mask Depression Around the Worldby JC, MD | April 26, 2007
In medicine, we often see patients with chronic neck and back pain. I previously posted about patients who present with neuropathic pain and how they can be some of the most difficult patients to treat. Often, the etiology of their pain is unknown and treatment often involves a long trial and error approach.
Health professionals have always been taught that chronic neck and back pain is a phenomenon of industrialized nations. The words “Worker’s Comp” come to mind when thinking of the patient who comes in for a complaint of neck pain or low back pain. “Worker’s Comp” has become a pejorative term in medicine, clearly indicating the stigma associated with patients who have back or neck pain.
New research published last month reveals that those patients who have persistent neck or back pain often have an underlying mental illness that needs treatment. The data from this study was from the World Health Initiative Survey on Mental Health and included over 85,000 patients from 17 different countries, including the Middle East, Africa, Asia, and South Pacific. The report specifically found an increased risk of anxiety, mood, or substance disorders from patients with chronic neck and back pain. This phenomenon held steady for both industrialized and non-industrialized countries.
What is interesting about these findings is that it actually validates the many opinions of primary care providers – that patients with chronic pain often have other underlying neuropsychiatric issues that may be affecting their pain. Whether the illness is a cause or effect of the chronic pain is unclear, but there is some association there.
I hope this data helps providers hone in on mental health in their patient history. Hopefully, we will start detecting mental illness earlier to prevent problems in the future.
Demyttenaere K, et al. Mental disorders among persons with chronic back or neck pain: Results from the world mental health surveys. Pain 2007 Mar 8.
Mental Context – A Delicate Subject
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