Advertisement

Comorbidity Among Multiple Pain Symptoms and Anxious Depression in a Dutch Population Sample

  • Lannie Ligthart
    Correspondence
    Address reprint requests to Lannie Ligthart, PhD, Department of Biological Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
    Affiliations
    Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands

    EMGO+ Institute for Health and Care, VU University Medical Centre, Amsterdam, The Netherlands
    Search for articles by this author
  • Corine M. Visscher
    Affiliations
    Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
    Search for articles by this author
  • Caroline M.H.H. van Houtem
    Affiliations
    Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
    Search for articles by this author
  • Lot M. Geels
    Affiliations
    Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands

    EMGO+ Institute for Health and Care, VU University Medical Centre, Amsterdam, The Netherlands
    Search for articles by this author
  • Jacqueline M. Vink
    Affiliations
    Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands

    Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
    Search for articles by this author
  • Ad de Jongh
    Affiliations
    Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands

    School of Health Sciences, Salford University, Manchester, United Kingdom
    Search for articles by this author
  • Dorret I. Boomsma
    Affiliations
    Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands

    EMGO+ Institute for Health and Care, VU University Medical Centre, Amsterdam, The Netherlands

    Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
    Search for articles by this author

      Highlights

      • This study describes patterns in prevalence and comorbidity of pain at various anatomical sites.
      • All pain sites were associated with all other pain sites as well as with anxious depression.
      • Relationships with sex and age depended strongly on the pain site.
      • These findings suggest shared as well as specific mechanisms involved in pain at different sites.

      Abstract

      Most studies on pain focus on specific disorders, which makes it difficult to compare characteristics across different types of pain symptoms. In this large population-based study, we examine the prevalence and comorbidity patterns among pain symptoms across a wide range of anatomic sites (back, neck, head, abdomen, joints, chest, face, teeth, and “other”) in relation to anxious depression and a range of demographic, health, and lifestyle variables. Self-report data were collected in 11,787 adult participants of The Netherlands Twin Registry (mean age 44.5 years, 62% female), including twins and relatives of twins. Headache and abdominal pain were strongly associated with female sex, whereas chest pain and toothache were not. Joint pain strongly increased with age, whereas headache and abdominal pain decreased with age. Most other pain sites were only weakly associated with age. A highly consistent pattern of comorbidity was observed: All pain symptoms were correlated with all other pain symptoms, as well as with anxious depression. Frequent and widespread pain (ie, pain at multiple sites) was most strongly associated with anxious depression. These observations reflect important differences between specific pain symptoms, suggesting partly separate etiologies, but also highlight the importance of shared mechanisms underlying pain symptoms in general.

      Perspective

      The association of pain with sex and age strongly depends on pain location. However, all pain sites are consistently associated with other pain sites as well as with anxious depression. This provides important clues with respect to both similarities and differences in the mechanisms underlying different types of pain.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Achenbach T.M.
        • Rescorla L.A.
        Manual for the ASEBA Adult Forms & Profiles.
        Research Center for Children, Youth, & Families, University of Vermont, Burlington, VT2003
        • Andersson G.B.
        Epidemiological features of chronic low-back pain.
        Lancet. 1999; 354: 581-585
        • Asmundson G.J.
        • Katz J.
        Understanding the co-occurrence of anxiety disorders and chronic pain: State-of-the-art.
        Depress Anxiety. 2009; 26: 888-901
        • Auvinen J.P.
        • Paananen M.V.
        • Tammelin T.H.
        • Taimela S.P.
        • Mutanen P.O.
        • Zitting P.J.
        • Karppinen J.I.
        Musculoskeletal pain combinations in adolescents.
        Spine. 2009; 34: 1192-1197
        • Bair M.J.
        • Robinson R.L.
        • Katon W.
        • Kroenke K.
        Depression and pain comorbidity: A literature review.
        Arch Intern Med. 2003; 163: 2433-2445
        • Boomsma D.I.
        • de Geus E.J.
        • Vink J.M.
        • Stubbe J.H.
        • Distel M.A.
        • Hottenga J.J.
        • Posthuma D.
        • van Beijsterveldt T.C.
        • Hudziak J.J.
        • Bartels M.
        • Willemsen G.
        Netherlands Twin Register: From twins to twin families.
        Twin Res Hum Genet. 2006; 9: 849-857
        • Boomsma D.I.
        • Vink J.M.
        • van Beijsterveldt T.C.
        • de Geus E.J.
        • Beem A.L.
        • Mulder E.J.
        • Derks E.M.
        • Riese H.
        • Willemsen G.A.
        • Bartels M.
        • van den Berg M.
        • Kupper N.H.
        • Polderman T.J.
        • Posthuma D.
        • Rietveld M.J.
        • Stubbe J.H.
        • Knol L.I.
        • Stroet T.
        • van Baal G.C.
        Netherlands Twin Register: A focus on longitudinal research.
        Twin Res. 2002; 5: 401-406
        • Branco J.C.
        • Bannwarth B.
        • Failde I.
        • Abello Carbonell J.
        • Blotman F.
        • Spaeth M.
        • Saraiva F.
        • Nacci F.
        • Thomas E.
        • Caubère J.P.
        Prevalence of fibromyalgia: A survey in five European countries.
        Semin Arthritis Rheum. 2010; 39: 448-453
        • Breivik H.
        • Collett B.
        • Ventafridda V.
        • Cohen R.
        • Gallacher D.
        Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment.
        Eur J Pain. 2006; 10: 287-333
        • Breslau N.
        • Rasmussen B.K.
        The impact of migraine: Epidemiology, risk factors, and co-morbidities.
        Neurology. 2001; 56: S4
        • Croft P.
        • Dunn K.M.
        • Von Korff M.
        Chronic pain syndromes: You can't have one without another.
        Pain. 2007; 131: 237-238
        • Fields H.L.
        Pain modulation: Expectation, opioid analgesia and virtual pain.
        Prog Brain Res. 1999; 122: 245-253
        • Fillingim R.B.
        • King C.D.
        • Ribeiro-Dasilva M.C.
        • Rahim-Williams B.
        • Riley III, J.L.
        Sex, gender, and pain: A review of recent clinical and experimental findings.
        J Pain. 2009; 10: 447-485
        • Gore M.
        • Sadosky A.
        • Stacey B.R.
        • Tai K.S.
        • Leslie D.
        The burden of chronic low back pain: Clinical comorbidities, treatment patterns, and health care costs in usual care settings.
        Spine (Phila Pa 1976). 2012; 37: E668-E677
        • Gureje O.
        • Simon G.E.
        • Von Korff M.
        A cross-national study of the course of persistent pain in primary care.
        Pain. 2001; 92: 195-200
        • Hardt J.
        • Jacobsen C.
        • Goldberg J.
        • Nickel R.
        • Buchwald D.
        Prevalence of chronic pain in a representative sample in the United States.
        Pain Med. 2008; 9: 803-812
        • Haug T.T.
        • Mykletun A.
        • Dahl A.A.
        The association between anxiety, depression, and somatic symptoms in a large population: The HUNT-II study.
        Psychosom Med. 2004; 66: 845-851
        • Haukka E.
        • Leino-Arjas P.
        • Solovieva S.
        • Ranta R.
        • Viikari-Juntura E.
        • Riihimäki H.
        Co-occurrence of musculoskeletal pain among female kitchen workers.
        Int Arch Occup Environ Health. 2006; 80: 141-148
        • Karlı N.
        • Baykan B.
        • Ertaş M.
        • Zarifoğlu M.
        • Siva A.
        • Saip S.
        • Özkaya G.
        Impact of sex hormonal changes on tension-type headache and migraine: A cross-sectional population-based survey in 2,600 women.
        J Headache Pain. 2012; 13: 557-565
        • Katon W.
        • Sullivan M.
        • Walker E.
        Medical symptoms without identified pathology: Relationship to psychiatric disorders, childhood and adult trauma, and personality traits.
        Ann intern Med. 2001; 134: 917-925
        • Kendler K.S.
        • Neale M.C.
        • Kessler R.C.
        • Heath A.C.
        • Eaves L.J.
        Major depression and generalized anxiety disorder. Same genes, (partly) different environments?.
        Arch Gen Psychiatry. 1992; 49: 716-722
        • Lautenbacher S.
        Experimental approaches in the study of pain in the elderly.
        Pain Med. 2012; 13: S44-S50
        • Lépine J.P.
        • Briley M.
        The epidemiology of pain in depression.
        Hum Psychopharmacol. 2004; 19: S3-S7
        • Ligthart L.
        • Gerrits M.M.
        • Boomsma D.I.
        • Penninx B.W.
        Anxiety and depression are associated with migraine and pain in general: An investigation of the interrelationships.
        J Pain. 2013; 14: 363-370
        • Magni G.
        • Merskey H.
        A simple examination of the relationships between pain, organic lesions and psychiatric illness.
        Pain. 1987; 29: 295-300
        • McWilliams L.A.
        • Goodwin R.D.
        • Cox B.J.
        Depression and anxiety associated with three pain conditions: Results from a nationally representative sample.
        Pain. 2004; 111: 77-83
      1. Muthén LK, Muthén BO. Mplus User's Guide, 5th ed. Los Angeles, Muthén & Muthén, 2007

        • Racine M.
        • Tousignant-Laflamme Y.
        • Kloda L.A.
        • Dion D.
        • Dupuis G.
        • Choinière M.
        A systematic literature review of 10 years of research on sex/gender and experimental pain perception, Part 1: Are there really differences between women and men?.
        Pain. 2012; 153: 602-618
        • Riedl A.
        • Schmidtmann M.
        • Stengel A.
        • Goebel M.
        • Wisser A.S.
        • Klapp B.F.
        • Mönnikes H.
        Somatic comorbidities of irritable bowel syndrome: A systematic analysis.
        J Psychosom Res. 2008; 64: 573-582
        • Rustøen T.
        • Wahl A.K.
        • Hanestad B.R.
        • Lerdal A.
        • Paul S.
        • Miaskowski C.
        Gender differences in chronic pain—Findings from a population-based study of Norwegian adults.
        Pain Manag Nurs. 2004; 5: 105-117
        • Rustøen T.
        • Wahl A.K.
        • Hanestad B.R.
        • Lerdal A.
        • Paul S.
        • Miaskowski C.
        Prevalence and characteristics of chronic pain in the general Norwegian population.
        Eur J Pain. 2004; 8: 555-565
        • Schwartz B.S.
        • Stewart W.F.
        • Simon D.
        • Lipton R.B.
        Epidemiology of tension-type headache.
        JAMA. 1998; 279: 381-383
        • Stewart W.F.
        • Lipton R.B.
        • Celentano D.D.
        • Reed M.L.
        Prevalence of migraine headache in the United States. Relation to age, income, race, and other sociodemographic factors.
        JAMA. 1992; 267: 64-69
        • Tibblin G.
        • Bengtsson C.
        • Furunes B.
        • Lapidus L.
        Symptoms by age and sex: The population studies of men and women in Gothenburg, Sweden.
        Scand J Prim Health Care. 1990; 8: 9-17
      2. Verhulst FC, van der Ende J, Koot JM: Handleiding voor de Youth Self-Report (YSR): Afdeling Kinder-en Jeugdpsychiatrie, Sophia Kinderziekenhuis/Academisch Ziekenhuis Rotterdam/Erasmus Universiteit Rotterdam, 1997

        • Visscher C.M.
        • Lobbezoo F.
        • De Boer W.
        • Van Der Zaag J.
        • Naeije M.
        Prevalence of cervical spinal pain in craniomandibular pain patients.
        Eur J Oral Sci. 2001; 109: 76-80
        • Von Korff M.
        • Dworkin S.F.
        • Le Resche L.
        • Kruger A.
        An epidemiologic comparison of pain complaints.
        Pain. 1988; 32: 173-183
        • Von Korff M.
        • Ormel J.
        • Keefe F.J.
        • Dworkin S.F.
        Grading the severity of chronic pain.
        Pain. 1992; 50: 133-149
        • Von Korff M.
        • Simon G.
        The relationship between pain and depression.
        Br J Psychiatry. 1996; 168: 101-108
        • Willemsen G.
        • Vink J.M.
        • Abdellaoui A.
        • den Braber A.
        • van Beek J.H.
        • Draisma H.H.
        • van Dongen J.
        • van 't Ent D.
        • Geels L.M.
        • van Lien R.
        • Ligthart L.
        • Kattenberg V.M.
        • Mbarek H.
        • de Moor M.H.
        • Neijts M.
        • Pool R.
        • Stroo N.
        • Kluft K.
        • Suchiman H.E.
        • Slagboom P.E.
        • de Geus E.J.
        • Boomsma D.I.
        The Adult Netherlands Twin Register: 25 years of survey and biological data collection.
        Twin Res Hum Genet. 2013; 16: 271-281