Presentation of pain may harbor depression

Better understanding of this association could lead to treatment insights.

By Victoria Stagg Elliott, AMNews staff. April 9, 2007.

When a patient -- whether in Beijing, St. Louis or anywhere else -- presents with a persistent pain in the neck or the back, that patient may also have a mental illness that needs attention.

Experts hope that new evidence supporting this universal connection will lead to a greater recognition of it as well as the identification of the biological factors driving both problems. And these factors could ultimately become novel treatment targets.

For instance, a study published online last month in the journal Pain found the increased risk of an anxiety, mood or substance use disorder conferred by chronic neck and back pain is a worldwide phenomenon not limited to industrialized nations.

"There's the idea that mental health and pain problems are by-products of modern culture. This suggests that the phenomenon is more universal," said Michael Von Korff, ScD, one of the authors and a senior investigator at Group Health Cooperative's Center for Health Studies in Seattle.

This finding is the most recent from the World Health Organization's World Mental Health Survey Initiative. Researchers asked 85,088 adults in 17 countries in Europe, North and South America, the Middle East, Africa, Asia and the South Pacific about their experiences with chronic back and neck pain.

In the survey, mental health was assessed using the Composite International Diagnostic Interview. Pain rates varied from country to country, but the association between the pain and mental health problems was consistent. Chronic pain increased the risk of a mood disorder by 130% and an anxiety problem by 120%. The link with alcohol abuse or dependence was less, with an increased risk of 60%.