title: Neck and upper limb pain: more pain is associated with psychological distress and consultation rate in primary care.
abstract: OBJECTIVE
  To investigate the association between the extent of pain and the severity of psychological distress in neck and upper limb pain, and to establish whether extent of pain is associated with consultation frequency in primary care.
  
  
  METHODS
  The study population was selected from responders to a general health survey conducted in a general practice in North Staffordshire, UK. Responders indicating pain in the neck or upper limb area were included. The survey included the Hospital Anxiety and Depression Scale (HADS). Consultation data were retrieved for a period of 12 months following the survey.
  
  
  RESULTS
  A total of 867 responders had experienced neck-upper limb pain in the month preceding the survey (33% of all responders). Responders with more generalized pain within the neck-upper limb area had significantly higher HADS scores compared to responders with pain in one area only, particularly for depression (median scores 5 vs 3 points). Annual consultation frequency was also higher among responders with generalized pain [adjusted OR for high consultation frequency (> or = 7 visits vs 0-2 visits) 1.6, 95% CI 1.1 to 2.4]. When the analysis was restricted to consultations specifically related to neck-upper limb pain, the association between extent of pain and consultation frequency was weak and not statistically significant.
  
  
  CONCLUSIONS
  Our survey revealed a significant association between extent of pain in the neck-upper limb area and psychological distress, although scores for anxiety and depression were generally low, with only a small proportion of responders reporting moderate or severe symptoms. Responders with both generalized pain and depressive symptoms were more likely to consult their family doctor, but not specifically for musculoskeletal pain. These results confirm the hypothesis that general psychological well being rather than specific somatic symptoms predict consultation frequency.
authors.affiliation: Institute for Research in Extramural Medicine Department of General Practice, VU University Medical Center, Amsterdam, The Netherlands. dawm.van_der_windt.emgo@med.vu.nl
authors.forename: Danielle
authors.initials: D
authors.lastname: van der Windt
authors.forename: Peter
authors.initials: P
authors.lastname: Croft
authors.forename: Brenda
authors.initials: B
authors.lastname: Penninx
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000150:complications*; D001132:Arm; D003863:Depression / Q000150:complications; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009140:Musculoskeletal Diseases / Q000523:psychology / Q000628:therapy; D019547:Neck Pain / Q000523:psychology* / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012782:Shoulder; D011795:Surveys and Questionnaires