Medically unexplained pain complaints are associated with underlying unrecognized mood disorders in primary care.
BACKGROUND
Patients with chronic pain frequently display comorbid depression, but the impact of this concurrence is often underestimated and mistreated. The aim of this study was to determine the prevalence of unrecognized major depression and other mood disorders and comorbid unexplained chronic pain in primary care settings and to explore the associated factors.Also, to compare the use of health services by patients with unexplained chronic pain, both with and without mood disorder comorbidity.


METHODS
A cross-sectional study was carried out in a sample of primary care centers. 3189 patients consulting for "unexplained chronic pain" were assessed by the Visual Analogue Scales (VAS) and the Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire.


RESULTS
We report: a) a high prevalence of unrecognized mood disorders in patients suffering from unexplained chronic pain complaints (80.4%: CI 95%: 79.0%; 81.8%); b) a greater susceptibility of women to mood disorders (OR adjusted = 1.48; CI 95%:1.22; 1.81); c) a direct relationship between the prevalence of mood disorders and the duration of pain (OR adjusted = 1.01; CI 95%: 1.01; 1.02) d) a higher comorbidity with depression if the pain etiology was unknown (OR adjusted = 1.74; CI 95%: 1.45; 2.10) and, e) an increased use of health care services in patients with such a comorbidity (p < 0.0001).


CONCLUSIONS
The prevalence of undiagnosed mood disorders in patients with unexplained chronic pain in primary care is very high, leading to dissatisfaction with treatment processes and poorer outcomes. Consequently, it seems necessary to explore this condition more regularly in general practice in order to reach accurate diagnoses and to select the appropriate treatment.
Agüera
Luis
L
Preventive Medicine and Public Health Department, University of Cádiz, Spain.
Failde
Inmaculada
I
Cervilla
Jorge A
JA
Díaz-Fernández
Paula
P
Mico
Juan Antonio
JA
D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D019964:Mood Disorders / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D010146:Pain / Q000523:psychology*; D010147:Pain Measurement; D015995:Prevalence; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales