title: Pain in patients with panic disorder: relation to symptoms, cognitive characteristics and treatment outcome.
abstract: OBJECTIVE
  Although there has been a link between certain types of pain, notably chest pain, and panic disorder, the relation between pain and panic disorder has not been systematically evaluated. In the present study, the relation between pain symptoms (headache, chest pain, stomach pain, joint pain) and the clinical presentation of patients with panic disorder was evaluated.
  
  
  OBJECTIVE
  Pain was generally hypothesized to be related to increased symptoms of anxiety, panic-relevant cognitive domains and treatment outcome. In terms of specific pain domains, headache and chest pain were expected to be more closely related to anxiety-related symptoms.
  
  
  METHODS
  Patients (n=139) meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition for panic disorder completed a set of standardized clinician-rated and self-reported measures. Moderator analyses were used in a subset of these patients completing a treatment outcome study.
  
  
  RESULTS
  Approximately two-thirds of the participants endorsed at least one current pain symptom. The hypotheses were partially supported, with pain being associated with higher levels of anxiety and depression symptoms, as well as panic frequency. Pain was also related to several cognitive features, including anxiety sensitivity and panic appraisals. Headache and chest pain were more highly associated with anxiety symptoms than was joint pain. Cognitive measures did not mediate the relation between anxiety and pain, and pain did not significantly moderate outcome in response to cognitive-behavioural therapy.
  
  
  CONCLUSIONS
  Co-occurring pain symptoms appear to be more highly related to phenomenology than to treatment response in patients with panic disorder.
authors.affiliation: The Ohio State University, Columbus 43210, USA. schmidt.283@osu.edu
authors.forename: Norman B
authors.initials: NB
authors.lastname: Schmidt
authors.forename: Helen T
authors.initials: HT
authors.lastname: Santiago
authors.forename: John H
authors.initials: JH
authors.lastname: Trakowski
authors.forename: J Michael
authors.initials: JM
authors.lastname: Kendren
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D010147:Pain Measurement; D016584:Panic Disorder / Q000150:complications / Q000523:psychology / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome