Medically unexplained pain complaints are associated with underlying unrecognized mood disorders in primary care
Medically unexplained pain complaints are associated with underlying unrecognized mood disorders in primary care
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DOI：
10.1186/1471-2296-11-17
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发表时间：
2010-03-03
影响因子：
2.9
通讯作者：
Antonio Mico, Juan
中科院分区：
文献类型：
--
作者：
Aguera, Luis;Failde, Inmaculada;Antonio Mico, Juan
背景：慢性疼痛患者经常表现为共病性抑郁，但这种并发的影响往往被低估和误治。本研究的目的是确定初级保健机构中未被识别的重度抑郁症和其他情绪障碍以及共病不明原因慢性疼痛的患病率，并探讨相关因素。此外，比较不明原因慢性疼痛患者的卫生服务使用情况，无论有无情绪障碍合并症。方法：在初级保健中心样本中进行横断面研究。采用视觉模拟量表（VAS）和精神障碍初级保健评估问卷（PRIME-MD）对3189例因“不明原因慢性疼痛”就诊的患者进行评估。结果：我们报告了：a)在患有不明原因慢性疼痛主诉的患者中，未被识别的情绪障碍的患病率很高（80.4%:CI 95%: 79.0%; 81.8%）；b)女性对情绪障碍的易感性更高（OR调整= 1.48;CI 95%: 1.22; 1.81）；c)情绪障碍的患病率与疼痛持续时间之间存在直接关系（OR调整= 1.01;CI 95%: 1.01; 1.02） d)如果疼痛病因不明，抑郁症的共病发生率较高（OR调整= 1.74;CI 95%: 1.45; 2.10）， e)患有此类共病的患者更多地使用医疗保健服务（p < 0.0001）。结论：初级保健中不明原因慢性疼痛患者中未确诊的情绪障碍患病率非常高，导致患者对治疗过程不满意，预后较差。因此，为了达到准确的诊断和选择适当的治疗，似乎有必要在一般实践中更有规律地探索这种情况。
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.