Arthralgias, bodily aches and pains and somatic complaints in midlife women: etiology, pathophysiology and differential diagnosis.
Somatic symptoms characterized by arthralgias, bodily aches and pains, musculoskeletal pain and joint pain have been investigated in a number of menopause and depression studies. Although depression is one of the most common causes of bodily aches and pains, and arthralgias, these same symptoms are also commonly associated with a natural menopause, surgical menopause and menopause induced by chemotherapy in breast cancer treatment. Somatic symptoms in the absence of definitive medical diagnoses result in these patients receiving various diagnoses and labels--'medically unexplained symptoms', 'worried well', as well as various Diagnostic and Statistical Manual of Mental Disorders (4th edition) somatoform diagnoses. Osteoarthritis and joint pain increase in prevalence from premenopausal- to menopausal-aged women with hormonal change implicated in their etiology. The current research on the relationships among menopause, depression, nociceptive mechanisms, perception and pain in the distressed midlife patient is discussed. The amelioration and management of pain symptoms in the menopausal and postmenopausal woman, with or without comorbid depression, have been elusive and difficult problems for clinicians. Familiarity with the differential diagnosis, pathophysiology and evidence-based treatment for such patients is crucial to their proper care.
Kaiser Permanente Northern California, Psychiatry Women's Health Program, Oakland, CA, USA. Jeanne@afwh.org
Jeanne Leventhal
JL
Alexander
Lorraine
L
Dennerstein
Louise
L
Dennerstein
Nancy Fugate
NF
Woods
Uriel
U
Halbreich
Krista
K
Kotz
Gregg
G
Richardson
Alessandra
A
Graziottin
Jeffrey J
JJ
Sherman
D000367:Age Factors; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008593:Menopause / Q000502:physiology / Q000523:psychology; D001523:Mental Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology; D013001:Somatoform Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000523:psychology