Skip to main content

Advertisement

SpringerLink
Log in

Early Identification of Co-Occurring Pain, Depression and Anxiety

  • Original Article
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

ABSTRACT

BACKGROUND

Depression and anxiety frequently co-occur with pain and may affect treatment outcomes. Early identification of these co-occurring psychiatric conditions during routine pain screening may be critical for optimal treatment.

OBJECTIVE

To determine aspects of pain related to psychological distress, and, among distressed patients, to determine whether pain factors are related to provider identification of distress.

DESIGN

Cross-sectional interview of primary care patients and their providers participating in a Veteran’s Administration HELP-Vets study.

SUBJECTS

A total of 528 predominately male Veterans

MEASUREMENTS AND MAIN RESULTS

We measured self-reported pain, including a 0-10 numeric rating scale and interference items from the Brief Pain Inventory. To evaluate distress, brief indicators of depression, anxiety and PTSD were combined. A substantial number of patients had psychological distress (41%), which was even higher (62%) among patients with moderate-severe current pain. Only 29% of those with distress reported talking to their provider about emotional problems during their visit. In multivariate analyses, other pain factors related to distress included interference with enjoyment of life and relationships with others, pain in multiple locations and joint pains. Prior diagnoses of depression and anxiety were also related to current distress. Only prior diagnosis and patient reported headaches and sleep interference because of pain were related to provider identification of distress.

CONCLUSIONS

VA patients with moderate-severe pain are at high risk for psychological distress, which often goes unrecognized. Providers need to be more vigilant to mental health problems in patients experiencing high pain levels. Targeted screening for co-occurring conditions is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Komaroff Al. Minor illness symptoms: the magnitude of their burden and of our ignorance. Arch Intern Med. 1990;150:1586–87.

    Article  PubMed  CAS  Google Scholar 

  2. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity. Arch Intern Med. 2003;163(10):2433–45.

    Article  PubMed  Google Scholar 

  3. Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain. 1997;13:116–37.

    Article  PubMed  CAS  Google Scholar 

  4. McWilliams LA, Goodwin RD, Cox BJ. Depression and anxiety associated with three pain conditions: results from a nationally representative sample. Pain. 2004;111:77–83.

    Article  PubMed  Google Scholar 

  5. Carroll LJ, Cassidy JD, Cote P. The Saskatchewan Health and Back Pain Survey: the prevalence and factors associated with depressive symptomatology in Saskatchewan adults. Can J Public Health. 2000;91:459–64.

    PubMed  CAS  Google Scholar 

  6. Moldin SO, Scheftner WA, Rice JP, Nelson E, Kneserich MA, Akiskal H. Association between major depressive disorder and physical illness. Psychol Med. 1993;23:755–61.

    Article  PubMed  CAS  Google Scholar 

  7. Magni G, Marchetti M, Moreschi C, Merskey H, Luchini SR. Chronic musculoskeletal pain and depressive symptoms in the National Health and Nutrition Examination, I: epidemiologic follow-up study. Pain. 1993;53:163–8.

    Article  PubMed  CAS  Google Scholar 

  8. Dworkin SF, Von Korff M, LeResche L. Multiple pains and psychiatric disturbance: an epidemiologic investigation. Arch Gen Psychiatry. 1990;47:239–44.

    PubMed  CAS  Google Scholar 

  9. Von Korff M, Dworkin SF, LeResche L, Kruger A. An epidemiologic comparison of pain complaints. Pain. 1988;32:173–83.

    Article  Google Scholar 

  10. Von Korff M, Ormel J, Keefe F, Dworkin SF, Keefe F, et al. Grading the severity of chronic pain. Pain. 1992;50:133–49.

    Article  Google Scholar 

  11. Von Korff M, Simon G. The relationship between pain and depression. British J of Psychiatry. 1996;168(suppl. 30):101–8.

    Google Scholar 

  12. Dworkin RH, Gitlin MJ. Clinical aspects of depression in chronic pain patients. Clin J Pain. 1991;7:79–94.

    Article  PubMed  CAS  Google Scholar 

  13. Keefe FJ, Wilkins RH, Cook WA, Crisson JE, Muhlbaier LH. Depression, pain and pain behavior. J consul Clin Psychol. 1986;54:665–9.

    Article  CAS  Google Scholar 

  14. Painter JR, Seres JL, Newman RI. Assessing benefits of the pain center: why some patients regress. Pain. 1980;8:101–13.

    Article  PubMed  CAS  Google Scholar 

  15. Katon W. Depression: relationship to somatization and chronic medical illness. J Clin Psychiatry. 1984;45:4–12.

    PubMed  CAS  Google Scholar 

  16. Callahan CM, Unverzagt FW, Hui SL, Perkins AJ, Hendrie HC. Six-item screener to identify cognitive impairment among potential subjects for clinical research. Med Care. 2002;40(9):771–81.

    Article  PubMed  Google Scholar 

  17. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284–92.

    Article  PubMed  Google Scholar 

  18. Kroenke K, Spitzer RL, Williams JB Monahan PO, Lowe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317–25.

    PubMed  Google Scholar 

  19. Lang AJ, Stein MB. An abbreviated PTSD checklist for use as a screening instrument in primary care. Beh Res Ther. 2005;43(5):584–94.

    Article  Google Scholar 

  20. Cleeland C. Brief pain inventory, short form. Pain Research Group, University of Wisconsin at Madison. In: McCaffery M, Passer O, eds. Pain: Clinical Manual. St. Louis: CV Mosby, Inc;1994:61.

    Google Scholar 

  21. Pain as the 5th Vital Sign Toolkit. Available at: http://www.vachronicpain.org/Downloads/pain5thvitalsignv2.PDF.

  22. Kroenke K, Spitzer RL, Williams JB. The PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms Psychosomatic Medicine 2002;64:258-66.

  23. Bridges KW, Goldberg DP. Somatic presentation of DSM III psychiatric disorders in primary care. J Psychosom Res. 1985;29(6):563–9.

    Article  PubMed  CAS  Google Scholar 

  24. Rost K, Nutting P, Smith J, Coyne JC, Cooper-Patrick L, Rubenstein L. The role of competing demands on the treatment provided to primary care patients with major depression. Arch Fam Med. 2000;9:150–4.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgement

Funded by the VA HSR&D 11R #03-150

Conflict of Interest

Drs. Lorenz and Asch received grant funding in the last 3 years from Amgen to RAND Health (PI and Co-PI) for Cancer Quality ASSIST Measures. The other authors state no conflict of interest.

Author information

Authors and Affiliations

  1. RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA

    Cathy D. Sherbourne Ph.D., Steven M. Asch M.D., MPH, Lisa R. Shugarman Ph.D., Lisa V. Rubenstein M.D., MPH & Karl A. Lorenz M.D., MSHS

  2. Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA

    Steven M. Asch M.D., MPH, Andy B. Lanto MA, Lisa V. Rubenstein M.D., MPH, Lisa Zubkoff Ph.D. & Karl A. Lorenz M.D., MSHS

  3. Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Steven M. Asch M.D., MPH, Lisa V. Rubenstein M.D., MPH & Karl A. Lorenz M.D., MSHS

  4. Department of Nursing, California State University School of Nursing, Long Beach, CA, USA

    Joy R. Goebel RN, Ph.D.

  5. Veterans Administration Long Beach Healthcare System, Long Beach, CA, USA

    Li Wen M.D.

Authors
  1. Cathy D. Sherbourne Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven M. Asch M.D., MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lisa R. Shugarman Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joy R. Goebel RN, Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andy B. Lanto MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lisa V. Rubenstein M.D., MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Li Wen M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lisa Zubkoff Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Karl A. Lorenz M.D., MSHS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cathy D. Sherbourne Ph.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sherbourne, C.D., Asch, S.M., Shugarman, L.R. et al. Early Identification of Co-Occurring Pain, Depression and Anxiety. J GEN INTERN MED 24, 620–625 (2009). https://doi.org/10.1007/s11606-009-0956-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-009-0956-2

KEY WORDS

Search

Navigation