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Previous Mental Disorders and Subsequent Onset of Chronic Back or Neck Pain: Findings From 19 Countries

Published:October 11, 2017DOI:https://doi.org/10.1016/j.jpain.2017.08.011

      Highlights

      • Chronic back/neck pain is common in the general adult population, affecting 20 to 30%.
      • Most mental disorders are associated with subsequent chronic back/neck pain.
      • The greater the number of mental disorders, the greater the associated risk of pain.
      • Early detection and treatment of mental disorders may help prevent later pain onset.
      • Back/neck pain assessment in psychiatric services may help reduce disability.

      Abstract

      Associations between depression/anxiety and pain are well established, but its directionality is not clear. We examined the associations between temporally previous mental disorders and subsequent self-reported chronic back/neck pain onset, and investigated the variation in the strength of associations according to timing of events during the life course, and according to gender. Data were from population-based household surveys conducted in 19 countries (N = 52,095). Lifetime prevalence and age of onset of 16 mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the occurrence and age of onset of back/neck pain were assessed using the Composite International Diagnostic Interview. Survival analyses estimated the associations between first onset of mental disorders and subsequent back/neck pain onset. All mental disorders were positively associated with back/neck pain in bivariate analyses; most (12 of 16) remained so after adjusting for psychiatric comorbidity, with a clear dose-response relationship between number of mental disorders and subsequent pain. Early-onset disorders were stronger predictors of pain; when adjusting for psychiatric comorbidity, this remained the case for depression/dysthymia. No gender differences were observed. In conclusion, individuals with mental disorder, beyond depression and anxiety, are at higher risk of developing subsequent back/neck pain, stressing the importance of early detection of mental disorders, and highlight the need of assessing back/neck pain in mental health clinical settings.

      Perspective

      Previous mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition are positively associated with subsequent back/neck pain onset, with a clear dose-response relationship between number of mental disorders and subsequent pain. Earlier-onset mental disorders are stronger predictors of subsequent pain onset, compared with later-onset disorders.

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      • Erratum
        The Journal of PainVol. 19Issue 4
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          In the article “Previous Mental Disorders and Subsequent Onset of Chronic Back or Neck Pain: Findings From 19 Countries,” published in the January 2018 issue (The Journal of Pain 2018;19:99–110), Jordi Alonso's affiliations were incomplete. The complete affiliations are Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain, Pompeu Fabra University (UPF), Barcelona, Spain, and CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.
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