Chronic spinal pain and physical-mental comorbidity in the United States: results from the national comorbidity survey replication.
This paper investigates comorbidity between chronic back and neck pain and other physical and mental disorders in the US population, and assesses the contributions of chronic spinal pain and comorbid conditions to role disability. A probability sample of US adults (n=5692) was interviewed. Chronic spinal pain, other chronic pain conditions and selected chronic physical conditions were ascertained by self-report. Mood, anxiety and substance use disorders were ascertained with the Composite International Diagnostic Interview (CIDI). Role disability was assessed with questions about days out of role and with impaired role functioning. The 1 year prevalence of chronic spinal pain was 19.0%. The vast majority (87.1%) of people with chronic spinal pain reported at least one other comorbid condition, including other chronic pain conditions (68.6%), chronic physical conditions (55.3%), and mental disorders (35.0%). Anxiety disorders showed as strong an association with chronic spinal pain as did mood disorders. Common conditions not significantly comorbid with chronic spinal pain were diabetes, heart disease, cancer, and drug abuse. Chronic spinal pain was significantly associated with role disability after controlling for demographic variables and for comorbidities. However, comorbid conditions explained about one-third of the gross association of chronic spinal pain with role disability. We conclude that chronic spinal pain is highly comorbid with other pain conditions, chronic diseases, and mental disorders, and that comorbidity plays a significant role in role disability associated with chronic spinal pain. The societal burdens of chronic spinal pain need to be understood and managed within the context of comorbid conditions.
Von Korff
Michael
M
Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue Suite 1600, Seattle, WA 98101, USA Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA Department of Health Care Policy, Harvard University, Boston, MA, USA Galt Associates Inc., and Adjunct, University of NC at Chapel Hill School of Public Health, Chapel Hill, NC, USA Pfizer Inc., New York, NY, USA.
Crane
Paul
P
Lane
Michael
M
Miglioretti
Diana L
DL
Simon
Greg
G
Saunders
Kathleen
K
Stang
Paul
P
Brandenburg
Nancy
N
Kessler
Ronald
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002908:Chronic Disease; D015897:Comorbidity; D003710:Demography; D004066:Digestive System Diseases / Q000453:epidemiology; D004185:Disability Evaluation; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D010146:Pain / Q000453:epidemiology* / Q000523:psychology*; D015995:Prevalence; D011602:Psychophysiologic Disorders; D012044:Regression Analysis; D012140:Respiratory Tract Diseases; D013997:Time Factors; D014481:United States / Q000453:epidemiology