Early Identification of Co-Occurring Pain, Depression and Anxiety

Published in:Journal of general internal medicine , v. 24, no. 5, May 2009, p. 620-625

Posted on RAND.org on December 31, 2008

by Cathy D. Sherbourne, Steven M. Asch, Lisa R. Shugarman, Joy R Goebel, Andrew B. Lanto, Lisa V. Rubenstein, Li Wen, Lisa Zubkoff, Karl Lorenz

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BACKGROUND: Depression and anxiety frequently co-occur with pain and may affect treatment outcomes. Early identification of these co-occurring psychiatric conditions during routine pain screening may be critical for optimal treatment. OBJECTIVE: To determine aspects of pain related to psychological distress, and, among distressed patients, to determine whether pain factors are related to provider identification of distress. DESIGN: Cross-sectional interview of primary care patients and their providers participating in a Veteran's Administration HELP-Vets study. SUBJECTS: A total of 528 predominately male Veterans. MEASUREMENTS AND MAIN RESULTS: The authors measured self-reported pain, including a 0-10 numeric rating scale and interference items from the Brief Pain Inventory. To evaluate distress, brief indicators of depression, anxiety and PTSD were combined. A substantial number of patients had psychological distress (41%), which was even higher (62%) among patients with moderate-severe current pain. Only 29% of those with distress reported talking to their provider about emotional problems during their visit. In multivariate analyses, other pain factors related to distress included interference with enjoyment of life and relationships with others, pain in multiple locations and joint pains. Prior diagnoses of depression and anxiety were also related to current distress. Only prior diagnosis and patient reported headaches and sleep interference because of pain were related to provider identification of distress. CONCLUSIONS: VA patients with moderate-severe pain are at high risk for psychological distress, which often goes unrecognized. Providers need to be more vigilant to mental health problems in patients experiencing high pain levels. Targeted screening for co-occurring conditions is warranted.

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