Skip to main content
Original Article

Mental Disorders in Chronic Pain Patients Seeking Treatment at a Tertiary Pain Hospital

A Cross-Sectional Study

Published Online:https://doi.org/10.1027/2512-8442/a000142

Abstract:Background: The high co-occurrence of chronic pain and mental disorders is well-established. Yet, an up-to-date account of the prevalence of mental disorders according to revised diagnostic criteria is lacking. Aims: The present study investigated the point and lifetime prevalence of a broad range of mental disorders according to DSM-5 in patients with chronic pain and examined associations of current mental health comorbidity with pain catastrophizing and health-related quality of life (HRQoL). Method: In this cross-sectional, observational study, patients with self-reported chronic pain receiving inpatient treatment at a specialized tertiary hospital were recruited for participation. Structured clinical interviews were conducted to assess current and lifetime diagnoses of mental disorders. Pain catastrophizing and HRQoL were assessed via questionnaires. Results: 145 patients (63.5% female; Mage = 54.9 years) participated in the study. 57.2% of the sample met the criteria for any current and 77.9% for any lifetime mental disorder. The most prevalent diagnostic groups of current mental disorders were substance-related and addictive disorders (26.2%), somatic symptom and related disorders (17.9%), depressive disorders (17.2%), and anxiety disorders (15.9%). Current mental health comorbidity was significantly associated with increased levels of pain catastrophizing and poorer HRQoL outcomes. Limitations: Chronic pain was only assessed by self-report, and no data regarding the exact medical diagnoses of the participants were collected. Conclusion: Comorbid mental disorders are highly prevalent in patients with chronic pain. Given the adverse effects of this comorbidity, the findings emphasize the need for addressing comorbid mental disorders in the management of chronic pain.

References

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. APA. First citation in articleGoogle Scholar

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. APA. https://doi.org/10.1176/appi.books.9780890425596 First citation in articleCrossrefGoogle Scholar

  • Annagür, B. B., Uguz, F., Apiliogullari, S., Kara, I., & Gunduz, S. (2014). Psychiatric disorders and association with quality of sleep and quality of life in patients with chronic pain: A SCID-based study. Pain Medicine, 15(5), 772–781. https://doi.org/10.1111/pme.12390 First citation in articleCrossrefGoogle Scholar

  • Bair, M. J., Wu, J., Damush, T. M., Sutherland, J. M., & Kroenke, K. (2008). Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients. Psychosomatic Medicine, 70(8), 890–897. https://doi.org/10.1097/PSY.0b013e318185c510 First citation in articleCrossrefGoogle Scholar

  • Baumeister, H., Knecht, A., & Hutter, N. (2012). Direct and indirect costs in persons with chronic back pain and comorbid mental disorders – A systematic review. Journal of Psychosomatic Research, 73(2), 79–85. https://doi.org/10.1016/j.jpsychores.2012.05.008 First citation in articleCrossrefGoogle Scholar

  • Beesdo-Baum, K., Knappe, S., Asselmann, E., Zimmermann, P., Bruckl, T., Hofler, M., Behrendt, S., Lieb, R., & Wittchen, H. U. (2015). The “Early Developmental Stages of Psychopathology (EDSP) study”: A 20-year review of methods and findings. Social Psychiatry and Psychiatric Epidemiology, 50(6), 851–866. https://doi.org/10.1007/s00127-015-1062-x First citation in articleCrossrefGoogle Scholar

  • Boersma, K., Sodermark, M., Hesser, H., Flink, I. K., Gerdle, B., & Linton, S. J. (2019). Efficacy of a transdiagnostic emotion-focused exposure treatment for chronic pain patients with comorbid anxiety and depression: A randomized controlled trial. Pain, 160(8), 1708–1718. https://doi.org/10.1097/j.pain.0000000000001575 First citation in articleCrossrefGoogle Scholar

  • Borsbo, B., Peolsson, M., & Gerdle, B. (2009). The complex interplay between pain intensity, depression, anxiety and catastrophising with respect to quality of life and disability. Disability and Rehabilitation, 31(19), 1605–1613. https://doi.org/10.1080/09638280903110079 First citation in articleCrossrefGoogle Scholar

  • Breivik, H., Collett, B., Ventafridda, V., Cohen, R., & Gallacher, D. (2006). Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. European Journal of Pain, 10(4), 287–333. https://doi.org/10.1016/j.ejpain.2005.06.009 First citation in articleCrossrefGoogle Scholar

  • Brünahl, C., Dybowski, C., Albrecht, R., Riegel, B., Hoink, J., Fisch, M., & Lowe, B. (2017). Mental disorders in patients with chronic pelvic pain syndrome (CPPS). Journal of Psychosomatic Research, 98, 19–26. https://doi.org/10.1016/j.jpsychores.2017.04.011 First citation in articleCrossrefGoogle Scholar

  • Burke, A. L., Mathias, J. L., & Denson, L. A. (2015). Psychological functioning of people living with chronic pain: A meta-analytic review. British Journal of Clinical Psychology, 54(3), 345–360. https://doi.org/10.1111/bjc.12078 First citation in articleCrossrefGoogle Scholar

  • Cella, D., Choi, S. W., Condon, D. M., Schalet, B., Hays, R. D., Rothrock, N. E., Yount, S., Cook, K. F., Gershon, R. C., Amtmann, D., DeWalt, D. A., Pilkonis, P. A., Stone, A. A., Weinfurt, K., & Reeve, B. B. (2019). PROMIS® adult health profiles: Efficient short-form measures of seven health domains. Value in Health, 22(5), 537–544. https://doi.org/10.1016/j.jval.2019.02.004 First citation in articleCrossrefGoogle Scholar

  • Cella, D., Riley, W., Stone, A., Rothrock, N., Reeve, B., Yount, S., Amtmann, D., Bode, R., Buysse, D., Choi, S., Cook, K., Devellis, R., DeWalt, D., Fries, J. F., Gershon, R., Hahn, E. A., Lai, J. S., Pilkonis, P., Revicki, D., … Group, P. C. (2010). The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. Journal of Clinical Epidemiology, 63(11), 1179–1194. https://doi.org/10.1016/j.jclinepi.2010.04.011 First citation in articleCrossrefGoogle Scholar

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Erlbaum. First citation in articleGoogle Scholar

  • Creed, F., & Gureje, O. (2012). Emerging themes in the revision of the classification of somatoform disorders. International Review of Psychiatry, 24(6), 556–567. https://doi.org/10.3109/09540261.2012.741063 First citation in articleCrossrefGoogle Scholar

  • Crombez, G., Lauwerier, E., Lammertyn, A., Notebaert, L., Van Bockstaele, B., & Van Ryckeghem, D. (2012). Ghent Pain and Disability Study I (GPD-I) : Protocol. http://hdl.handle.net/1854/LU-3050986 First citation in articleGoogle Scholar

  • Csupak, B., Sommer, J. L., Jacobsohn, E., & El-Gabalawy, R. (2018). A population-based examination of the co-occurrence and functional correlates of chronic pain and generalized anxiety disorder. Journal of Anxiety Disorders, 56, 74–80. https://doi.org/10.1016/j.janxdis.2018.04.005 First citation in articleCrossrefGoogle Scholar

  • Edwards, R. R., Dworkin, R. H., Sullivan, M. D., Turk, D. C., & Wasan, A. D. (2016). The role of psychosocial processes in the development and maintenance of chronic pain. Journal of Pain, 17(9 Suppl), T70–92. https://doi.org/10.1016/j.jpain.2016.01.001 First citation in articleCrossrefGoogle Scholar

  • Edwards, R. R., Schreiber, K. L., Dworkin, R. H., Turk, D. C., Baron, R., Freeman, R., Jensen, T. S., Latremoliere, A., Markman, J. D., Rice, A. S. C., Rowbotham, M., Staud, R., Tate, S., Woolf, C. J., Andrews, N. A., Carr, D. B., Colloca, L., Cosma-Roman, D., Cowan, P., … Wesselmann, U. (2023). Optimizing and accelerating the development of precision pain treatments for chronic pain: IMMPACT review and recommendations. Journal of Pain, 24(2), 204–225. https://doi.org/10.1016/j.jpain.2022.08.010 First citation in articleCrossrefGoogle Scholar

  • Ehret, A. M., & Berking, M. (2013). DSM-IV und DSM-5: Was hat sich tatsächlich verändert? [From DSM-IV to DSM-5: What has changed in the new edition?] Verhaltenstherapie, 23(4), 258–266. https://doi.org/10.1159/000356537 First citation in articleCrossrefGoogle Scholar

  • Elashoff, J. D., & Lemeshow, S. (2014). Sample size determination in epidemiological studies. In W. AhrensI. PigeotEds., Handbook of epidemiology (2nd ed., pp. 1023–1056). Springer. https://doi.org/10.1007/978-0-387-09834-0_15 First citation in articleCrossrefGoogle Scholar

  • Falkai, P.Wittchen, H. U. (Eds.). (2018). Diagnostisches und Statistisches Manual Psychischer Störungen DSM-5® (Deutsche Ausgabe) [Diagnostic and statistical manual of mental disorders DSM-5, German edition]. Hogrefe. https://doi.org/10.1026/02803-000 First citation in articleCrossrefGoogle Scholar

  • Frances, A. (2013). The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill. British Medical Journal, 346, Article f1580. https://doi.org/10.1136/bmj.f1580 First citation in articleCrossrefGoogle Scholar

  • Gaskin, D. J., & Richard, P. (2012). The economic costs of pain in the United States. Journal of Pain, 13(8), 715–724. https://doi.org/10.1016/j.jpain.2012.03.009 First citation in articleCrossrefGoogle Scholar

  • Goesling, J., Lin, L. A., & Clauw, D. J. (2018). Psychiatry and pain management: At the intersection of chronic pain and mental health. Current Psychiatry Reports, 20(2), Article 12. https://doi.org/10.1007/s11920-018-0872-4 First citation in articleCrossrefGoogle Scholar

  • Goldberg, D. S., & McGee, S. J. (2011). Pain as a global public health priority. BMC Public Health, 11, Article 770. https://doi.org/10.1186/1471-2458-11-770 First citation in articleCrossrefGoogle Scholar

  • Gureje, O., Von Korff, M., Kola, L., Demyttenaere, K., He, Y., Posada-Villa, J., Lepine, J. P., Angermeyer, M. C., Levinson, D., de Girolamo, G., Iwata, N., Karam, A., Guimaraes Borges, G. L., de Graaf, R., Browne, M. O., Stein, D. J., Haro, J. M., Bromet, E. J., Kessler, R. C., & Alonso, J. (2008). The relation between multiple pains and mental disorders: Results from the World Mental Health Surveys. Pain, 135(1–2), 82–91. https://doi.org/10.1016/j.pain.2007.05.005 First citation in articleCrossrefGoogle Scholar

  • Häuser, W., Bialas, P., Welsch, K., & Wolfe, F. (2015). Construct validity and clinical utility of current research criteria of DSM-5 somatic symptom disorder diagnosis in patients with fibromyalgia syndrome. Journal of Psychosomatic Research, 78(6), 546–552. https://doi.org/10.1016/j.jpsychores.2015.03.151 First citation in articleCrossrefGoogle Scholar

  • Häuser, W., Hausteiner-Wiehle, C., Henningsen, P., Brahler, E., Schmalbach, B., & Wolfe, F. (2020). Prevalence and overlap of somatic symptom disorder, bodily distress syndrome and fibromyalgia syndrome in the German general population: A cross sectional study. Journal of Psychosomatic Research, 133, Article 110111. https://doi.org/10.1016/j.jpsychores.2020.110111 First citation in articleCrossrefGoogle Scholar

  • Hays, R. D., Spritzer, K. L., Schalet, B. D., & Cella, D. (2018). PROMIS®-29 v2.0 profile physical and mental health summary scores. Quality of Life Research, 27(7), 1885–1891. https://doi.org/10.1007/s11136-018-1842-3 First citation in articleCrossrefGoogle Scholar

  • Ho, P. T., Li, C. F., Ng, Y. K., Tsui, S. L., & Ng, K. F. (2011). Prevalence of and factors associated with psychiatric morbidity in chronic pain patients. Journal of Psychosomatic Research, 70(6), 541–547. https://doi.org/10.1016/j.jpsychores.2010.10.006 First citation in articleCrossrefGoogle Scholar

  • Hysing, E. B., Smith, L., Thulin, M., Karlsten, R., Butler, S., & Gordh, T. (2017). Identifying characteristics of the most severely impaired chronic pain patients treated at a specialized inpatient pain clinic. Scandinavian Journal of Pain, 17, 178–185. https://doi.org/10.1016/j.sjpain.2017.09.008 First citation in articleCrossrefGoogle Scholar

  • Kaiser, U., Treede, R. D., & Sabatowski, R. (2017). Multimodal pain therapy in chronic noncancer pain-gold standard or need for further clarification? Pain, 158(10), 1853–1859. https://doi.org/10.1097/j.pain.0000000000000902 First citation in articleCrossrefGoogle Scholar

  • Kang, Y., Trewern, L., Jackman, J., McCartney, D., & Soni, A. (2023). Chronic pain: Definitions and diagnosis. British Medical Journal, 381, Article e076036. https://doi.org/10.1136/bmj-2023-076036 First citation in articleCrossrefGoogle Scholar

  • Katz, N. (2002). The impact of pain management on quality of life. Journal of Pain and Symptom Management, 24(1), S38–S47. https://doi.org/10.1016/s0885-3924(02)00411-6 First citation in articleCrossrefGoogle Scholar

  • Knaster, P., Karlsson, H., Estlander, A. M., & Kalso, E. (2012). Psychiatric disorders as assessed with SCID in chronic pain patients: The anxiety disorders precede the onset of pain. General Hospital Psychiatry, 34(1), 46–52. https://doi.org/10.1016/j.genhosppsych.2011.09.004 First citation in articleCrossrefGoogle Scholar

  • Lame, I. E., Peters, M. L., Vlaeyen, J. W., Kleef, M., & Patijn, J. (2005). Quality of life in chronic pain is more associated with beliefs about pain, than with pain intensity. European Journal of Pain, 9(1), 15–24. https://doi.org/10.1016/j.ejpain.2004.02.006 First citation in articleCrossrefGoogle Scholar

  • Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33(1), 159–174. https://www.ncbi.nlm.nih.gov/pubmed/843571 First citation in articleCrossrefGoogle Scholar

  • Margraf, J., Cwik, J. C., Pflug, V., & Schneider, S. (2017). Strukturierte klinische Interviews zur Erfassung psychischer Störungen über die Lebensspanne [Structured clinical interviews for mental disorders across the life span: psychometric quality and further developments of the DIPS open access interviews]. Zeitschrift für Klinische Psychologie und Psychotherapie, 46(3), 176–186. https://doi.org/10.1026/1616-3443/a000430 First citation in articleLinkGoogle Scholar

  • Margraf, J., Cwik, J. C., Suppiger, A., & Schneider, S. (2017). DIPS Open Access: Diagnostisches Interview bei psychischen Störungen [DIPS Open Access: Diagnostic interview for mental disorders]. Mental Health Research and Treament Center, Ruhr-Universität Bochum. https://doi.org/10.13154/rub.100.89 First citation in articleCrossrefGoogle Scholar

  • Mayou, R., Kirmayer, L. J., Simon, G., Kroenke, K., & Sharpe, M. (2005). Somatoform disorders: Time for a new approach in DSM-V. American Journal of Psychiatry, 162(5), 847–855. https://doi.org/10.1176/appi.ajp.162.5.847 First citation in articleCrossrefGoogle Scholar

  • Meyer, K., Sprott, H., & Mannion, A. F. (2008). Cross-cultural adaptation, reliability, and validity of the German version of the Pain Catastrophizing Scale. Journal of Psychosomatic Research, 64(5), 469–478. https://doi.org/10.1016/j.jpsychores.2007.12.004 First citation in articleCrossrefGoogle Scholar

  • Moffitt, T. E., Caspi, A., Taylor, A., Kokaua, J., Milne, B. J., Polanczyk, G., & Poulton, R. (2010). How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychological Medicine, 40(6), 899–909. https://doi.org/10.1017/S0033291709991036 First citation in articleCrossrefGoogle Scholar

  • Nafziger, A. N., & Barkin, R. L. (2018). Opioid therapy in acute and chronic pain. Journal of Clinical Pharmacology, 58(9), 1111–1122. https://doi.org/10.1002/jcph.1276 First citation in articleCrossrefGoogle Scholar

  • Onwumere, J., Stubbs, B., Stirling, M., Shiers, D., Gaughran, F., Rice, A. S. C., Williams, A. C. D. C., & Scott, W. (2022). Pain management in people with severe mental illness: An agenda for progress. Pain, 163(9), 1653–1660. https://doi.org/10.1097/j.pain.0000000000002633 First citation in articleCrossrefGoogle Scholar

  • Park, S. J., Lee, R., Yoon, D. M., Yoon, K. B., Kim, K., & Kim, S. H. (2016). Factors associated with increased risk for pain catastrophizing in patients with chronic neck pain: A retrospective cross-sectional study. Medicine (Baltimore), 95(37), Article e4698. https://doi.org/10.1097/MD.0000000000004698 First citation in articleCrossrefGoogle Scholar

  • Plana-Ripoll, O., Pedersen, C. B., Holtz, Y., Benros, M. E., Dalsgaard, S., de Jonge, P., Fan, C. C., Degenhardt, L., Ganna, A., Greve, A. N., Gunn, J., Iburg, K. M., Kessing, L. V., Lee, B. K., Lim, C. C. W., Mors, O., Nordentoft, M., Prior, A., Roest, A. M., … McGrath, J. J. (2019). Exploring comorbidity within mental disorders among a Danish national population. JAMA Psychiatry, 76(3), 259–270. https://doi.org/10.1001/jamapsychiatry.2018.3658 First citation in articleCrossrefGoogle Scholar

  • Schaeuffele, C., Schulz, A., Knaevelsrud, C., Renneberg, B., & Boettcher, J. (2020). CBT at the crossroads: The rise of transdiagnostic treatments. International Journal of Cognitive Therapy, 14(1), 86–113. https://doi.org/10.1007/s41811-020-00095-2 First citation in articleCrossrefGoogle Scholar

  • Schrepf, A., Williams, D. A., Gallop, R., Naliboff, B. D., Basu, N., Kaplan, C., Harper, D. E., Richard Landis, J., Quentin Clemens, J., Strachan, E., Griffith, J. W., Afari, N., Hassett, A., Pontari, M. A., Clauw, D. J., & Harte, S. E. (2018). Sensory sensitivity and symptom severity represent unique dimensions of chronic pain: A MAPP Research Network study. Pain, 159(10), 2002–2011. https://doi.org/10.1097/j.pain.0000000000001299 First citation in articleCrossrefGoogle Scholar

  • Sleurs, D., Tebeka, S., Scognamiglio, C., Dubertret, C., & Le Strat, Y. (2020). Comorbidities of self-reported fibromyalgia in United States adults: A cross-sectional study from The National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III). European Journal of Pain, 24(8), 1471–1483. https://doi.org/10.1002/ejp.1585 First citation in articleCrossrefGoogle Scholar

  • Sondergard, S., Vaegter, H. B., Erlangsen, A., & Stenager, E. (2018). Ten-year prevalence of mental disorders in patients presenting with chronic pain in secondary care: A register linkage cohort study. European Journal of Pain, 22(2), 346–354. https://doi.org/10.1002/ejp.1124 First citation in articleCrossrefGoogle Scholar

  • Steel, Z., Marnane, C., Iranpour, C., Chey, T., Jackson, J. W., Patel, V., & Silove, D. (2014). The global prevalence of common mental disorders: A systematic review and meta-analysis 1980–2013. International Journal of Epidemiology, 43(2), 476–493. https://doi.org/10.1093/ije/dyu038 First citation in articleCrossrefGoogle Scholar

  • Taylor, S. J. C., Carnes, D., Homer, K., Pincus, T., Kahan, B. C., Hounsome, N., Eldridge, S., Spencer, A., Diaz-Ordaz, K., Rahman, A., Mars, T. S., Foell, J., Griffiths, C. J., & Underwood, M. R. (2016). Improving the self-management of chronic pain: COping with persistent Pain, Effectiveness Research in Self-management (COPERS). Programme Grants for Applied Research, 4(14), 85–101. https://doi.org/10.3310/pgfar04140 First citation in articleCrossrefGoogle Scholar

  • Treede, R. D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., Cohen, M., Evers, S., Finnerup, N. B., First, M. B., Giamberardino, M. A., Kaasa, S., Korwisi, B., Kosek, E., Lavand’homme, P., Nicholas, M., Perrot, S., Scholz, J., Schug, S., … Wang, S. J. (2019). Chronic pain as a symptom or a disease: The IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain, 160(1), 19–27. https://doi.org/10.1097/j.pain.0000000000001384 First citation in articleCrossrefGoogle Scholar

  • Uher, R., Payne, J. L., Pavlova, B., & Perlis, R. H. (2014). Major depressive disorder in DSM-5: Implications for clinical practice and research of changes from DSM-IV. Depression and Anxiety, 31(6), 459–471. https://doi.org/10.1002/da.22217 First citation in articleCrossrefGoogle Scholar

  • Vartiainen, P., Heiskanen, T., Sintonen, H., Roine, R. P., & Kalso, E. (2016). Health-related quality of life and burden of disease in chronic pain measured with the 15D instrument. Pain, 157(10), 2269–2276. https://doi.org/10.1097/j.pain.0000000000000641 First citation in articleCrossrefGoogle Scholar

  • Yong, R. J., Mullins, P. M., & Bhattacharyya, N. (2022). Prevalence of chronic pain among adults in the United States. pain, 163(2), e328–e332. https://doi.org/10.1097/j.pain.0000000000002291 First citation in articleCrossrefGoogle Scholar