Clinical psychiatry Is there an association between psychiatric disorders and quality of sleep, quality of life, demographic and clinical characteristics in patients with chronic pain?

Objective: Chronic pain (CP) is a common medical condition for which patients seek care from various health-care providers. CP is defined as pain that persists for longer than the expected time frame for healing or pain associated with progressive, nonmalignant disease. Patients with CP commonly experience depression, anxiety, sleep disturbance, fatigue, and decreased overall physical and mental functioning. Psychiatric comorbidity is high among these patients. There are limited data about the effect of Axis I psychiatric disorders in patients with CP despite their frequent existence. There are also an inadequate number of studies based on a structured clinical interview. We aimed to determine Axis-I psychiatric disorders in patients with chronic pain (CP) and compare control subjects determined by a structured clinical interview. Another objective of the study was to examine whether there is an association between psychiatric disorders and quality of sleep, quality of life, demographic and clinical characteristics in patients with CP.

Method: The study sample was comprised of 108 patients with CP and 54 control subjects without pain. Psychiatric interviews were conducted with the Structured Clinical Interview for DSM-IV (SCID-I). Also used were Visual analogue scale (VAS), Hospital Anxiety and Depression Scale, Hamilton Depression Inventory, Short Form (SF-36), and Pittsburgh Sleep Quality Index.

Results: The rate of any Axis I psychiatric disorder stood at 66.7% (any mood disorder, 50%; any anxiety disorder, 33.3%; any somatoform disorder, 20.4%; any substance use disorder, 16.6%), significantly more common in the patients' group compared to the control group. The most common psychiatric disorder was major depression (49.1%) in subjects with CP. Female gender, numbers of localization and, neck and back localizations were significantly higher in the SCID (+) group than the SCID (-) group. A statistically significant difference was observed between the SCID (+) and SCID (-) groups regarding VAS, depression and anxiety scores, mental component summary score (MCS) and global PSQI scores.

Conclusion: The most prevalent disorders were MDD (49.1%), GAD (21.3%), panic disorder (8.3%), somatization disorder (17.6%), and analgesic prescription abuse (16.6%). The prevalence rates are higher than in the general population. Results of this study suggest that psychiatric morbidity in patients with CP is frequently seen and may adversely affect quality of sleep and quality of life of the patients. Therefore, the patients with CP should be examined with respect to their mental status.