Factors associated with chronic pain in patients with bipolar depression: a cross-sectional study

BMC Psychiatry

Juan A Mico⁴  Ana Gonzalez-Pinto³  Jorge A Cervilla⁵  Luis Agüera-Ortíz²  Maria Dueñas¹  Inmaculada Failde¹ 

[1] Department of Preventive Medicine and Public Health, University of Cádiz, Avda Ana de Viya 52, Cádiz 11009, Spain;Centro de Investigación Biomédica en Red de Salud Mental - CIBERSAM, University Hospital 12 de Octubre, Complutense University, Madrid, Spain;Centro de Investigación Biomédica en Red en Salud Mental - CIBERSAM, Hospital Santiago Apóstol, University of the Basque Country, Vitoria, Spain;Centro de Investigación Biomédica en Red de Salud Mental - CIBERSAM, University of Cádiz, Cádiz, Spain;Centro de Investigación Biomédica en Red de Salud Mental - CIBERSAM, Hospital Universitario San Cecilio, Granada, Spain

关键词: Chronic pain;    Bipolar depression;   

Others  :  1124082
DOI  :  10.1186/1471-244X-13-112

 received in 2012-09-17, accepted in 2013-04-09,  发布年份 2013

【 摘 要 】

Background

While pain is frequently associated with unipolar depression, few studies have investigated the link between pain and bipolar depression. In the present study we estimated the prevalence and characteristics of pain among patients with bipolar depression treated by psychiatrists in their regular clinical practice. The study was designed to identify factors associated with the manifestation of pain in these patients.

Methods

Patients diagnosed with bipolar disorder (n=121) were selected to participate in a cross-sectional study in which DSM-IV-TR criteria were employed to identify depressive episodes. The patients were asked to describe any pain experienced during the study, and in the 6 weeks beforehand, by means of a Visual Analogical Scale (VAS).

Results

Over half of the bipolar depressed patients (51.2%, 95% CI: 41.9%–60.6%), and 2/3 of the female experienced concomitant pain. The pain was of moderate to severe intensity and prolonged duration, and it occurred at multiple sites, significantly limiting the patient’s everyday activities. The most important factors associated with the presence of pain were older age, sleep disorders and delayed diagnosis of bipolar disorder.

Conclusions

Chronic pain is common in bipolar depressed patients, and it is related to sleep disorders and delayed diagnosis of their disorder. More attention should be paid to study the presence of pain in bipolar depressed patients, in order to achieve more accurate diagnoses and to provide better treatment options.

【 授权许可】

   
2013 Failde et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Bair MJ, Robinson RL, Katon W, Kroenke K: Depression and pain comorbidity: a literature review. Arch Intern Med 2003, 163(20):2433-2445.
• [2]Ohayon MM, Schatzberg AF: Chronic pain and major depressive disorder in the general population. J Psychiatr Res 2010, 44(7):454-461.
• [3]Kroenke K, Wu J, Bair MJ, Krebs EE, Damush TM, Tu W: Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care. J Pain 2011, 12(9):964-973.
• [4]Delgado PL: Common pathways of depression and pain. J Clin Psychiatry 2004, 65(Suppl 12):16-19.
• [5]Gerrits MM, Vogelzangs N, Van Oppen P, Van Marwijk HW, van der Horst H, Penninx BW: Impact of pain on the course of depressive and anxiety disorders. Pain 2012, 153(2):429-436.
• [6]Kroenke K, Shen J, Oxman TE, Williams JW Jr, Dietrich AJ: Impact of pain on the outcomes of depression treatment: results from the RESPECT trial. Pain 2008, 134(1–2):209-215.
• [7]McIntyre RS, Konarski JZ, Wilkins K, Bouffard B, Soczynska JK, Kennedy SH: The prevalence and impact of migraine headache in bipolar disorder: results from the Canadian Community Health Survey. Headache 2006, 46(6):973-982.
• [8]Oedegaard KJ, Fasmer OB: Is migraine in unipolar depressed patients a bipolar spectrum trait? J Affect Disord 2005, 84(2–3):233-242.
• [9]Brietzke E, Moreira CL, Duarte SV, Nery FG, Kapczinski F, Miranda Scippa A, Lafer B: Impact of comorbid migraine on the clinical course of bipolar disorder. Compr Psychiatry 2012, 53(6):809-812.
• [10]Ehnvall A, Mitchell PB, Hadzi-Pavlovic D, Loo C, Breakspear M, Wright A, Roberts G, Frankland A, Corry J: Pain and rejection sensitivity in bipolar depression. Bipolar Disord 2011, 13(1):59-66.
• [11]Carney CP, Jones LE: Medical comorbidity in women and men with bipolar disorders: a population-based controlled study. Psychosom Med 2006, 68(5):684-691.
• [12]Goldstein BI, Houck PR, Karp JF: Factors associated with pain interference in an epidemiologic sample of adults with bipolar I disorder. J Affect Disord 2009, 117(3):151-156.
• [13]Mico JA, Ardid D, Berrocoso E, Eschalier A: Antidepressants and pain. Trends Pharmacol Sci 2006, 27(7):348-354.
• [14]Pernia A, Mico JA, Calderon E, Torres LM: Venlafaxine for the treatment of neuropathic pain. J Pain Symptom Manage 2000, 19(6):408-410.
• [15]Bond DJ, Noronha MM, Kauer-Sant’Anna M, Lam RW, Yatham LN: Antidepressant-associated mood elevations in bipolar II disorder compared with bipolar I disorder and major depressive disorder: a systematic review and meta-analysis. J Clin Psychiatry 2008, 69(10):1589-1601.
• [16]Goldberg JF: Antidepressant use and risk for suicide attempts in bipolar disorder. J Clin Psychiatry 2011, 72(12):1697.
• [17]Attal N, Cruccu G, Baron R, Haanpaa M, Hansson P, Jensen TS, Nurmikko T: European Federation of Neurological Societies: EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol 2010, 17(9):1113-e88.
• [18]Grunze HC: Anticonvulsants in bipolar disorder. J Ment Health 2010, 19(2):127-141.
• [19]Arana A, Wentworth CE, Ayuso-Mateos JL, Arellano FM: Suicide-related events in patients treated with antiepileptic drugs. N Engl J Med 2010, 363(6):542-551.
• [20]Ragheb M: The clinical significance of lithium-nonsteroidal anti-inflammatory drug interactions. J Clin Psychopharmacol 1990, 10(5):350-354.
• [21]Schaffer CB, Nordahl TE, Schaffer LC, Howe J: Mood-elevating effects of opioid analgesics in patients with bipolar disorder. J Neuropsychiatry Clin Neurosci 2007, 19(4):449-452.
• [22]Moreno Brea MR, Rojas Corrales O, Gibert-Rahola J, Mico JA: Drug interactions of methadone with CNS-active agents. Actas Esp Psiquiatr 1999, 27(2):103-110.
• [23]Gonzalez-Pinto A, Imaz H, De Heredia JL, Gutierrez M, Mico JA: Mania and tramadol-fluoxetine combination. Am J Psychiatry 2001, 158(6):964-965.
• [24]Rojas-Corrales MO, Berrocoso E, Gibert-Rahola J, Mico JA: Antidepressant-like effect of tramadol and its enantiomers in reserpinized mice: comparative study with desipramine, fluvoxamine, venlafaxine and opiates. J Psychopharmacol 2004, 18(3):404-411.
• [25]Ratcliffe GE, Enns MW, Belik SL, Sareen J: Chronic pain conditions and suicidal ideation and suicide attempts: an epidemiologic perspective. Clin J Pain 2008, 24(3):204-210.
• [26]Bellivier F, Yon L, Luquiens A, Azorin JM, Bertsch J, Gerard S, Reed C, Lukasiewicz M: Suicidal attempts in bipolar disorder: results from an observational study (EMBLEM). Bipolar Disord 2011, 13(4):377-386.
• [27]Aguera-Ortiz L, Failde I, Mico JA, Cervilla J, Lopez-Ibor JJ: Pain as a symptom of depression: prevalence and clinical correlates in patients attending psychiatric clinics. J Affect Disord 2011, 130(1–2):106-112.
• [28]Ramos-Brieva JA, Cordero-Villafafila A: A new validation of the Hamilton rating scale for depression. J Psychiatr Res 1988, 22(1):21-28.
• [29]Maier W, Philipp M: Improving the assessment of severity of depressive states: a reduction of the Hamilton depression scale. Pharmacopsychiatry 1985, 18:114-115.
• [30]Collins SL, Moore RA, McQuay HJ: The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain 1997, 72(1–2):95-97.
• [31]Kilbourne AM, Cornelius JR, Han X, Pincus HA, Shad M, Salloum I, Conigliaro J, Haas GL: Burden of general medical conditions among individuals with bipolar disorder. Bipolar Disord 2004, 6(5):368-373.
• [32]Ishak WW, Brown K, Aye SS, Kahloon M, Mobaraki S, Hanna R: Health-related quality of life in bipolar disorder. Bipolar Disord 2012, 14(1):6-18.
• [33]Maina G, Bechon E, Rigardetto S, Salvi V: General medical conditions are associated with delay to treatment in patients with bipolar disorder. Psychosomatics 2013. in press
• [34]Fishbain DA: The association of chronic pain and suicide. Semin Clin Neuropsychiatry 1999, 4(3):221-227.
• [35]Smith MT, Edwards RR, Robinson RC, Dworkin RH: Suicidal ideation, plans, and attempts in chronic pain patients: factors associated with increased risk. Pain 2004, 111(1–2):201-208.
• [36]Elman I, Zubieta JK, Borsook D: The missing p in psychiatric training: why it is important to teach pain to psychiatrists. Arch Gen Psychiatry 2011, 68(1):12-20.
• [37]Smith DJ, Griffiths E, Kelly M, Hood K, Craddock N, Simpson SA: Unrecognised bipolar disorder in primary care patients with depression. Br J Psychiatry 2011, 199(1):49-56.
• [38]Eidelman P, Talbot LS, Gruber J, Hairston I, Harvey AG: Sleep architecture as correlate and predictor of symptoms and impairment in inter-episode bipolar disorder: taking on the challenge of medication effects. J Sleep Res 2010, 19(4):516-524.
• [39]Okifuji A, Hare BD: Do sleep disorders contribute to pain sensitivity? Curr Rheumatol Rep 2011, 13(6):528-534.
• [40]Goral A, Lipsitz JD, Gross R: The relationship of chronic pain with and without comorbid psychiatric disorder to sleep disturbance and health care utilization: results from the Israel National Health Survey. J Psychosom Res 2010, 69(5):449-457.
• [41]Baldwin DS, Allgulander C, Bandelow B, Ferre F, Pallanti S: An international survey of reported prescribing practice in the treatment of patients with generalised anxiety disorder. World J Biol Psychiatry 2012, 13(7):510-516.
• [42]Breslau N, Davis GC: Migraine, physical health and psychiatric disorder: a prospective epidemiologic study in young adults. J Psychiatr Res 1993, 27(2):211-221.
• [43]Gureje O, Von Korff M, Kola L, Demyttenaere K, He Y, Posada-Villa J, Lepine JP, Angermeyer MC, Levinson D, De Girolamo G, Iwata N, Karam A, Guimaraes Borges GL, De Graaf R, Browne MO, Stein DJ, Haro JM, Bromet EJ, Kessler RC, Alonso J: The relation between multiple pains and mental disorders: results from the World Mental Health Surveys. Pain 2008, 135(1–2):82-91.