Chronic pain and pain-related disability across psychiatric disorders in a clinical adolescent sample

BMC Psychiatry

Marit S Indredavik³  Stian Lydersen²  Ottar Bjerkeset¹  Wenche L Mangerud² 

[1] Department of Research and Development, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway;Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Medicine, Norwegian University of Science and Technology. Medical Technical Research Centre, Postbox 8905, N-7491 Trondheim, Norway;Department of Child and Adolescent Psychiatry, St. Olav’s University Hospital, Trondheim, Norway

关键词: Adolescents;    Psychiatric disorders;    Prevalence;    Disability;    Chronic pain;   

Others  :  1123922
DOI  :  10.1186/1471-244X-13-272

 received in 2013-06-17, accepted in 2013-10-15,  发布年份 2013

【 摘 要 】

Background

People who suffer from psychiatric disorders are burdened with a high prevalence of chronic illnesses and pain, but evidence on pain prevalence among adolescents with psychiatric disorders is scarce. The aim of this study was to investigate the frequency and location of self-reported chronic pain and pain-related disability in adolescent psychiatric patients.

Methods

This study was part of the larger Health Survey administered at the Department of Child and Adolescent Psychiatry (CAP) at St. Olav’s University Hospital, in Trondheim, Norway. All patients aged 13–18 years who visited the CAP clinic at least once between February 15, 2009 and February 15, 2011 were invited to participate. A total of 717 (43.5% of eligible/invited patients) participated; of these, 566 were diagnosed with one or more psychiatric disorders. The adolescents completed a questionnaire, which included questions about pain and pain-related disability. Clinical diagnoses were classified by a clinician according to International Statistical Classification of Diseases and Related Health Problems, 10th revision criteria.

Results

In adolescents with psychiatric disorders, 70.4% reported chronic pain, and 37.3% experienced chronic pain in three or more locations (multisite pain). Chronic musculoskeletal pain was the most prevalent type of pain (57.7%). Pain-related disability was found in 22.2% of the sample. The frequency of chronic pain and multisite pain increased with age, and girls reported a higher frequency of chronic pain, multisite pain and pain-related disability than boys did. There was an increased risk of chronic pain among adolescents with mood or anxiety disorders versus those with hyperkinetic disorders, yet this was not present after adjusting for sex. Comorbidity between hyperkinetic and mood or anxiety disorders involved an increased risk of pain-related disability.

Conclusions

In this study, seven out of 10 adolescents with psychiatric disorders reported chronic pain. These findings indicate the importance of early detection of chronic pain in adolescents with psychiatric disorders, to provide targeted treatment and reduce poor long-term outcomes.

【 授权许可】

   
2013 Mangerud et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Mykletun A, Knudsen AK, Mathiesen KS: Psykiske lidelser i norge: Et folkehelseperspektiv. [Mental disorders in norway: a public health perspective]. Oslo: Norwegian Institute of Public Health; 2009.
• [2]McWilliams LA, Cox BJ, Enns MW: Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample. Pain 2003, 106:127-133.
• [3]Bair MJ, Robinson RL, Katon W, Kroenke K: Depression and pain comorbidity: a literature review. Arch Intern Med 2003, 163:2433-2445.
• [4]Means-Christensen AJ, Roy-Byrne PP, Sherbourne CD, Craske MG, Stein MB: Relationships among pain, anxiety, and depression in primary care. Depress Anxiety 2008, 25:593-600.
• [5]Katona C, Peveler R, Dowrick C, Wessely S, Feinmann C, Gask L, Lloyd H, Williams AC, Wager E: Pain symptoms in depression: definition and clinical significance. Clin Med 2005, 5:390-395.
• [6]Norwegian Institute of Public Health: Facts About Chronic Pain Prevalence. [http://www.fhi.no/eway/default.aspx?pid=240&trg=List_6673&Main_6664=6894:0:25,7583:1:0:0:::0:0&MainContent_6894=6671:0:25,7590:1:0:0:::0:0&List_6673=6674:0:25,7602:1:0:0:::0:0 webcite]
• [7]King S, Chambers CT, Huguet A, MacNevin RC, McGrath PJ, Parker L, MacDonald AJ: The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain 2011, 152:2729-2738.
• [8]Rustoen T, Wahl AK, Hanestad BR, Lerdal A, Paul S, Miaskowski C: Prevalence and characteristics of chronic pain in the general Norwegian population. Eur J Pain 2004, 8:555-565.
• [9]Rustoen T, Wahl AK, Hanestad BR, Lerdal A, Paul S, Miaskowski C: Gender differences in chronic pain–findings from a population-based study of Norwegian adults. Pain Manag Nurs 2004, 5:105-117.
• [10]Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL 3rd: Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain 2009, 10:447-485.
• [11]Nicolson SE, Caplan JP, Williams DE, Stern TA: Comorbid pain, depression, and anxiety: multifaceted pathology allows for multifaceted treatment. Harv Rev Psychiatry 2009, 17:407-420.
• [12]Hoftun GB, Romundstad PR, Zwart JA, Rygg M: Chronic idiopathic pain in adolescence–high prevalence and disability: the young HUNT study 2008. Pain 2011, 152:2259-2266.
• [13]Campo JV, Comer DM, Jansen-Mcwilliams L, Gardner W, Kelleher KJ: Recurrent pain, emotional distress, and health service use in childhood. J Pediatr 2002, 141:76-83.
• [14]DeSocio J, Hootman J: Children’s mental health and school success. J Sch Nurs 2004, 20:189-196.
• [15]WHO: The ICD-10 Classification of Mental and Behavioural Disorders, Clinical Description and Diagnostic Guidelines. Geneva: World Health Organization; 1992.
• [16]Mikkelsson M, Salminen JJ, Kautiainen H: Non-specific musculoskeletal pain in preadolescents. Prevalence and 1-year persistence. Pain 1997, 73:29-35.
• [17]Mikkelsson M, Salminen JJ, Sourander A, Kautiainen H: Contributing factors to the persistence of musculoskeletal pain in preadolescents: a prospective 1-year follow-up study. Pain 1998, 77:67-72.
• [18]Knook LM, Lijmer JG, Konijnenberg AY, Taminiau B, van Engeland H: The course of chronic pain with and without psychiatric disorders: a 6-year follow-up study from childhood to adolescence and young adulthood. J Clin Psychiatry 2012, 73:e134-e139.
• [19]Sharp J, Keefe B: Psychiatry in chronic pain: a review and update. Curr Psychiatry Rep 2005, 7:213-219.
• [20]Lindsay PG, Wyckoff M: The depression-pain syndrome and its response to antidepressants. Psychosomatics 1981, 22:571–573-576–577.
• [21]Goldenberg DL: Pain/depression dyad: a key to a better understanding and treatment of functional somatic syndromes. Am J Med 2010, 123:675-682.
• [22]Gambassi G: Pain and depression: the egg and the chicken story revisited. Arch Gerontol Geriatr 2009, 49(Suppl 1):103-112.
• [23]Asmundson GJ, Katz J: Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art. Depress Anxiety 2009, 26:888-901.
• [24]Sharp TJ, Harvey AG: Chronic pain and posttraumatic stress disorder: mutual maintenance? Clin Psychol Rev 2001, 21:857-877.
• [25]Asmundson GJ, Coons MJ, Taylor S, Katz J: PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models. Can J Psychiatry 2002, 47:930-937.
• [26]Andreescu C, Lenze EJ: Comorbid anxiety and depression: bete noire or quick fix? Br J Psychiatry 2012, 200:179-181.
• [27]Perquin CW, Hazebroek-Kampschreur AA, Hunfeld JA, Bohnen AM, van Suijlekom-Smit LW, Passchier J, van der Wouden JC: Pain in children and adolescents: a common experience. Pain 2000, 87:51-58.
• [28]Fernandez-de-las-Penas C, Hernandez-Barrera V, Alonso-Blanco C, Palacios-Cena D, Carrasco-Garrido P, Jimenez-Sanchez S, Jimenez-Garcia R: Prevalence of neck and low back pain in community-dwelling adults in Spain: a population-based national study. Spine (Phila Pa 1976) 2011, 36:E213-E219.
• [29]Antonaci F, Nappi G, Galli F, Manzoni GC, Calabresi P, Costa A: Migraine and psychiatric comorbidity: a review of clinical findings. J Headache Pain 2011, 12:115-125.
• [30]O’Sullivan P, Beales D, Jensen L, Murray K, Myers T: Characteristics of chronic non-specific musculoskeletal pain in children and adolescents attending a rheumatology outpatients clinic: a cross-sectional study. Pediatr Rheumatol Online J 2011, 9:3. BioMed Central Full Text
• [31]Di Lorenzo C, Colletti RB, Lehmann HP, Boyle JT, Gerson WT, Hyams JS, Squires RH Jr, Walker LS, Kanda PT, Subcommittee AAP, Pain NCoCA: Chronic abdominal pain in children: a technical report of the American academy of pediatrics and the North American society for pediatric gastroenterology, hepatology and nutrition. J Pediatr Gastroenterol Nutr 2005, 40:249-261.
• [32]Maizels M, Aurora S, Heinricher M: Beyond neurovascular: migraine as a dysfunctional neurolimbic pain network. Headache 2012, 52:1553-1565.
• [33]D’Andrea G, Ostuzzi R, Francesconi F, Musco F, Bolner A, D’Onofrio F, Colavito D: Migraine prevalence in eating disorders and pathophysiological correlations. Neurol Sci 2009, 30(1):S55-S59.
• [34]Dorn LD, Campo JC, Thato S, Dahl RE, Lewin D, Chandra R, Di Lorenzo C: Psychological comorbidity and stress reactivity in children and adolescents with recurrent abdominal pain and anxiety disorders. J Am Acad Child Adolesc Psychiatry 2003, 42:66-75.
• [35]Dufton LM, Dunn MJ, Compas BE: Anxiety and somatic complaints in children with recurrent abdominal pain and anxiety disorders. J Pediatr Psychol 2009, 34:176-186.
• [36]Weiselberg EC, Gonzalez M, Fisher M: Eating disorders in the twenty-first century. Minerva Ginecol 2011, 63:531-545.
• [37]Palermo TM: Assessment of chronic pain in children: current status and emerging topics. Pain Res Manag 2009, 14:21-26.
• [38]Huguet A, Miro J: The severity of chronic pediatric pain: an epidemiological study. J Pain 2008, 9:226-236.
• [39]Konijnenberg AY, Uiterwaal CS, Kimpen JL, van der Hoeven J, Buitelaar JK, de Graeff-Meeder ER: Children with unexplained chronic pain: substantial impairment in everyday life. Arch Dis Child 2005, 90:680-686.
• [40]Petersen S, Hagglof BL, Bergstrom EI: Impaired health-related quality of life in children with recurrent pain. Pediatrics 2009, 124:e759-e767.
• [41]Roth-Isigkeit A, Thyen U, Stoven H, Schwarzenberger J, Schmucker P: Pain among children and adolescents: restrictions in daily living and triggering factors. Pediatrics 2005, 115:e152-e162.
• [42]Hall AM, Kamper SJ, Maher CG, Latimer J, Ferreira ML, Nicholas MK: Symptoms of depression and stress mediate the effect of pain on disability. Pain 2011, 152:1044-1051.
• [43]Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC: The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull 2007, 133:581-624.
• [44]Petersen S, Brulin C, Bergstrom E: Recurrent pain symptoms in young schoolchildren are often multiple. Pain 2006, 121:145-150.
• [45]Smedbraten BK, Natvig B, Rutle O, Bruusgaard D: Self-reported bodily pain in schoolchildren. Scand J Rheumatol 1998, 27:273-276.
• [46]Hoftun GB, Romundstad PR, Rygg M: Factors associated with adolescent chronic non-specific pain, chronic multisite pain, and chronic pain with high disability: the Young-HUNT Study 2008. J Pain 2012, 13:874-883.
• [47]Wiesenfeld-Hallin Z: Sex differences in pain perception. Gend Med 2005, 2:137-145.
• [48]Racine M, Tousignant-Laflamme Y, Kloda LA, Dion D, Dupuis G, Choiniere M: A systematic literature review of 10 years of research on sex/gender and pain perception - part 2: do biopsychosocial factors alter pain sensitivity differently in women and men? Pain 2012, 153:619-635.
• [49]Mogil JS, Bailey AL: Sex and gender differences in pain and analgesia. Prog Brain Res 2010, 186:141-157.
• [50]Smitherman TA, Ward TN: Psychosocial factors of relevance to sex and gender studies in headache. Headache 2011, 51:923-931.
• [51]Unruh AM: Gender variations in clinical pain experience. Pain 1996, 65:123-167.
• [52]Dorner TE, Muckenhuber J, Stronegger WJ, Rasky E, Gustorff B, Freidl W: The impact of socio-economic status on pain and the perception of disability due to pain. Eur J Pain 2011, 15:103-109.