The relationship of chronic pain with and without comorbid psychiatric disorder to sleep disturbance and health care utilization: results from the Israel National Health Survey.
OBJECTIVE
Chronic pain is associated with health problems including sleep difficulties and increased medical utilization. Because chronic pain is frequently comorbid with psychiatric disorders, it is unclear to what degree chronic pain itself is associated with these problems. In a large population sample, we examined the relationship between chronic pain, both alone and comorbid with psychiatric disorders, with sleep disturbance and increased medical utilization.


METHODS
We analyzed data from the Israel National Health Survey (INHS) conducted in 2003-2004 on a representative sample (N=4859) of the adult Israeli population. Data were collected in face-to-face interviews using the Composite International Diagnostic Interview. Statistical analyses were performed using multinomial logistic regression models.


RESULTS
Past year chronic pain was reported by 29.9% of all study participants (n=1453). Psychiatric disorders were more common among participants with chronic pain; adjusted odds ratios were 2.23 (95% CI 1.49-3.36) for depressive disorders and 2.94 (95% CI 2.08-4.17) for anxiety disorders. Associations of chronic pain and psychiatric disorders were stronger in men. Chronic pain was associated with both sleep problems and increased health care utilization even for individuals with no psychiatric comorbidity. Sleep difficulties but not health care utilization rates were more pronounced in the comorbid group compared to the chronic pain only group.


CONCLUSIONS
Chronic pain was associated with sleep problems and increased health care utilization in this sample, independent of psychiatric comorbidity. Sleep problems were significantly greater in the comorbid vs. non-comorbid group. In contrast, associations of pain with health care utilization were largely independent of psychiatric comorbidity.
Unit of Mental Health Epidemiology and Psychosocial Aspects of Illness, The Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel. avivag@gertner.health.gov.il
Aviva
A
Goral
Joshua D
JD
Lipsitz
Raz
R
Gross
D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology; D002908:Chronic Disease; D015897:Comorbidity; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003866:Depressive Disorder / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D007557:Israel / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D016017:Odds Ratio; D010146:Pain / Q000453:epidemiology / Q000523:psychology*; D059408:Pain Management; D012307:Risk Factors; D012494:Sampling Studies; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires