|The following article is part of conference coverage from the PAINWeek 2018 conference in Las Vegas, Nevada. Clinical Pain Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in pain medicine. Check back for the latest news from PAINWeek 2018.|
LAS VEGAS — In a presentation given during the 2018 PAINWeek conference, held September 4-8, David Cosio, PhD, a psychologist in the interdisciplinary pain program at the Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, sought to provide an overview of known relationships between chronic pain and a set of mental health disorders and presented results from a preliminary study examining the prevalence of such conditions in veterans with chronic pain.
It is essential that treatments for mental health disorders be included in chronic pain management therapies, noted Dr Cosio, as this patient population is thought to have a higher prevalence of psychiatric conditions, including anxiety, depression, and substance use disorders, compared with the general population. In addition, such comorbidities may render opioid tapering strategies more challenging, and the presence of pain has been found to worsen psychiatric comorbidities. Other studies indicate that individuals with comorbid pain and mental health disorders may be less susceptible to treat and receive care for their physical conditions and may have impaired recovery, lower quality of life, and be at increased risk for suicide compared with the general population.
Among the mental health disorders known to be associated with chronic pain are anxiety (mainly panic disorder and generalized anxiety disorder), personality disorders (with a prevalence estimated between 30% and 60% in individuals with chronic pain), depression (thought to affect 15%-100% of those with chronic pain, with a higher prevalence in patients seeking treatment in specialty clinics), substance use disorders (3%-48% prevalence in chronic pain), and somatic symptom disorders (prevalence in chronic pain, 0%-53%).
Associations between neurocognitive disorders (eg, dementia) and chronic pain are less understood, although it is thought that 20% to 50% of this population also experience pain. Individuals with bipolar disorder, 24% and 14% of whom are estimated to have chronic pain and migraine, respectively, were found in a study to report approximately 4 different pain complaints at any given time.
Dr Cosio and colleagues recruited veterans with chronic pain (n=272; ages, 18-89; 89% men) to evaluate the prevalence of psychiatric disorders, classified according to a combination of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and “emerging measures,” in this population. Study participants were asked to fill out an initial assessment, which consisted of the 36-item World Health Organization Disability Assessment Schedule questionnaire across 6 domains (including mobility, life activities, and cognition) to evaluate disability in the last 30 days (affecting cognition, life activities, self-care, “getting along,” social participation, and mobility), and the 23-item DSM-5 self-rated level 1 Cross-Cutting Symptom Measure-Adult (CCSM-A) questionnaire to evaluate 12 psychiatric domains (including depression, anxiety, and psychosis) during the previous 2 weeks.
Latino veterans were found to indicate more disability than participants of other races (P <.01 for all). On the basis of these preliminary results, Dr Cosio and colleagues estimate that DSM-5 self-rated level 1 CCSM-A may be useful in assessing patients with chronic pain for mental health disorders. CCSM-A alone was found ineffective in assessing posttraumatic stress disorder and polarizing disorders, but may be more useful as a tool to develop and monitor individualized pain management programs. Interventions that can be used in patient populations with comorbid chronic pain and mental health disorders include cognitive behavioral therapy (eg, for depression, anxiety, and somatic symptom) and acceptance and commitment therapy (eg for obsessive compulsive disorder, and depression).
Cosio D. Unveiling the mask: The relationship of chronic pain and psychopathology. Presented at: PAINWeek 2018, September 4-8, 2018, Las Vegas, Nevada. Presentation BHV-02.
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