Skip to main content

Advertisement

SpringerLink
Log in

Comorbidity between psychiatric disorders and chronic pain

  • Published:
Current Review of Pain Aims and scope Submit manuscript

Abstract

The term comorbidity refers to the coexistence of an index disease with another clinical entity. Comorbidity between chronic pain and psychiatric pathology as delineated on Axis I and II of the Diagnostic and Statistical Manual of Mental Disorders is reviewed here.The literature indicates that this type of comorbidity is common in chronic pain patients (CPPs).The most common groups of comorbid psychiatric disorders found within CPPs are affective disorders, substance-related disorders, and personality disorders. A number of other psychiatric disorder comorbidities should also be present within CPPs, but these have not yet been researched. Finally, the importance of psychiatric comorbidities to chronic pain treatment is discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Feinstein A: The pre-therapeutic classification of comorbidity in chronic disease. ronic Dis 1970, 23:455.

    Google Scholar 

  2. Merikangas KR, Gelernter CS: Comorbidity for alcoholism and depression. Psychiatric Clin North Am 1990, 13(6):613–631.

    CAS  Google Scholar 

  3. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 3 (revised). Washington, DC: American Psychiatric Association Press; 1987.

    Google Scholar 

  4. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 3 (revised). Washington, DC: American Psychiatric Association; 1980.

    Google Scholar 

  5. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association; 1994.

    Google Scholar 

  6. Kessler RC, McGonagle KA, Zhao S, et al.: Lifetime and 12- month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry 1994, 51:8–19.

    Article  CAS  PubMed  Google Scholar 

  7. McCullough JP: The importance of diagnosing comorbid personality disorder in patients who are chronically depressed. J Depressive Disord 1987, 1(3sn3):3–17.

    Google Scholar 

  8. Rosenthal RN: Comorbidity of psychiatric and substance use disorders. Primary Psychiatry 1995, Jul/Aug:42–45.3

  9. Rodin G, Voshart K: Depression in the medically ill: an overview. Am J Psychiatry 1986, 143(6):696–705.

    Article  CAS  PubMed  Google Scholar 

  10. Wells KB, Golding JM, Burnam RA: Psychiatric disorders in a sample of general populations with and without chronic medical conditions. Am J Psychiatry 1988, 145:976–981.

    Article  CAS  PubMed  Google Scholar 

  11. Fishbain DA, Rosomoff HL: What is chronic pain. Clin J Pain 1990, 6(2):164–166.

    Article  Google Scholar 

  12. Turk DC, Rudy TE, Stieg RL: Chronic pain and depression. Pain Manage 1987, 1:17–25.

    Google Scholar 

  13. Roy R, Thomas M, Matas M: Chronic pain and depression: a review. Comp Psychiatry 1984, 25:96–105.

    Article  CAS  Google Scholar 

  14. Romano JM, Turner JA: Chronic pain and depression: does the evidence support a relationship? Psychol Bull 1985, 97:18–34.

    Article  CAS  PubMed  Google Scholar 

  15. Pilowsky I: Affective disorders and pain. In Proceedings of the Vth World Congress on Pain. Edited by Dubner R, Gebhart GF, Bond MR. Seattle: IASP Press; 1988:263–274.

    Google Scholar 

  16. Magni G: Review article on the relationship between chronic pain and depression when there is no organic lesion. Pain 1987, 31:1–21.

    Article  CAS  PubMed  Google Scholar 

  17. Fishbain DA, Goldberg M, Meagher BR, et al.: Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain 1986, 26:181–197.

    Article  CAS  PubMed  Google Scholar 

  18. Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS: Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain 1997, 13(2):116–137. Review that deals with the etiologic relationship between chronic pain and affective disorder.

    Article  CAS  PubMed  Google Scholar 

  19. Magni G, Caldieron C, Regatti-Luchini S: Chronic musculoskeletal pain and depressive symptoms in the general population: an analysis of the First National Health and Nutrition Examination Survey data. Pain 1990, 43:299–307.

    Article  CAS  PubMed  Google Scholar 

  20. Romano JM, Turner JA: Chronic pain and depression: does the evidence support a relationship. Psychol Bull 1985, 97:18–34.

    Article  CAS  PubMed  Google Scholar 

  21. Banks SM, Kerns RD: Explaining high rates of depression in chronic pain: a diathesis-stress framework. Psychol Bull 1996, 119:95–110.

    Article  Google Scholar 

  22. Dworkin RH, Gitlin NU: Clinical aspects of depression in chronic pain patient. Clin J Pain 1991, 7:79–94.

    Article  CAS  PubMed  Google Scholar 

  23. Marshall M, Helmes E, Deathe AB: A comparison of psychosocial functioning and personality in amputee and chronic pain populations. Clin J Pain 1992, 8:351–357.

    Article  CAS  PubMed  Google Scholar 

  24. Fogel BS: Major depression versus organic mood disorder: a questionable distinction. J Clin Psychiatry 1990, 51(2):53–56.

    CAS  PubMed  Google Scholar 

  25. Rapp SR, Virana S: Substituting nonsomatic for somatic symptoms in the diagnoses of depression in elderly male medical patients. Am J Psychiatry 1989, 146(9):1197–1200.

    Article  CAS  PubMed  Google Scholar 

  26. Popkin K, Callier AL, Calon EA: A framework for the study of medical depression. Psychosomatics 1987, 28(l):27–33.

    Article  CAS  PubMed  Google Scholar 

  27. Bacon SF, Klapow JC, Slater MA: Characterizing subsyndromal depression in chronic low back pain. In American Pain Society 10th Annual Meeting, New Orleans, LA; 1991:A91251,61.

  28. Magni-Guido, Schifano-Fabrizio, de-Leo-Diego: Pain as a symptom in elderly depressed patients: relationship to diagnostic subgroups. Eur Arch Psychiatry Neurol 1985, 235(3):143–145.

    Article  Google Scholar 

  29. Reich J, Rosenblatt RM, Tupen J: DSM-III: a new nomenclature for classifying patients with chronic pain. Pain 1983, 16:201–206.

    Article  CAS  PubMed  Google Scholar 

  30. Katon W, Egan K, Millder D: Chronic pain: lifetime psychiatric diagnoses and family history. Am J Psychiatry 1985, 142:1156–1160.

    Article  CAS  PubMed  Google Scholar 

  31. Polatin PB, Kinney RK, Gatchel RJ, et al.: Psychiatric illness and chronic low-back pain. Spine 1993, 18(l):66–71.

    Article  CAS  PubMed  Google Scholar 

  32. Portenoy RK, Foley K: Chronic use of opioid analgesics in non-malignant pain: report of 38 cases. Pain 1986, 25:171–186.

    Article  CAS  PubMed  Google Scholar 

  33. Steele-Rosomoff R, Fishbain DA, Goldberg M, Rosomoff HL: Chronic pain patients who lie in this psychiatric examination about current drug/alcohol use. Pain 1990, 5(suppl):S299.

    Article  Google Scholar 

  34. Rafii A, Haller DL, Poklis A: Incidence of recreational drug use among chronic pain clinic patients. In American Pain Society Ninth Annual Meeting; 1990:A33.

  35. Evans PJD: Narcotic addiction in patients with chronic pain. Anaesthesia 1981, 36:597–602.

    Article  CAS  PubMed  Google Scholar 

  36. Medina JL, Diamond S: Drug dependency in patients with chronic headache. Headache 1997, 17:12–14.

    Article  Google Scholar 

  37. Hoffmann NG, Olofsson O, Salen B, Wickstrom L: Prevalence of abuse and dependency in chronic pain patients. Int J Addict 1995, 30(8):919–927.

    CAS  PubMed  Google Scholar 

  38. Chabal C, Erjavec MK, Jacobson L, et al.: Prescription opiate abuse in chronic pain patients: clinical criteria, incidence, and predictors. Clin J Pain 1997, 13:150–155.

    Article  CAS  PubMed  Google Scholar 

  39. Large RG: DSM-III diagnoses in chronic pain: confusion or clarity? J Nerv Ment Dis 1986, 174(5):295–302.

    Article  CAS  PubMed  Google Scholar 

  40. Muse M: Stress-related, post-traumatic chronic pain syndrome: criteria for diagnosis, and preliminary report on prevalence. Pain 1985, 24:295–300.

    Article  Google Scholar 

  41. Fishbain DA, Goldberg M, Steele-Rosomoff R, Rosomoff HL: More Munchausen with chronic pain. Clin J Pain 1991, 7:237–244.

    Article  CAS  PubMed  Google Scholar 

  42. Carrocini D, Figueiro JAB, Lin TY, et al.: Psychiatric aspects in a population of 53 reflex sympathetic dystrophy (complex regional pain syndrome) patients. In International Association for the Study of Pain, 8th World Congress on Pain, Vancouver, Canada; 1996:abstract 254, 403.

  43. King SA: The clinical application of DSM-IV for patients with pain. In International Association for the Study of Pain, 8th World Congress on Pain, Vancouver, Canada; 1996:abstract 288, 304.

  44. Benedikt RA, Kolb LC: Preliminary findings on chronic pain and posttraumatic stress disorder. Am J Psychiatry 1986, 143:908–910.

    Article  CAS  PubMed  Google Scholar 

  45. Remick RA, Blasberg B, Campos PE, Miles JE. Psychiatric disorder associated with atypical facial pain. Can J Psychiatry 1983, 28:178–181.

    CAS  PubMed  Google Scholar 

  46. Turnbull JM: Anxiety and physical illness in the elderly. J Clin Psych 1989, 50(suppl):40–45.

    Google Scholar 

  47. Wise MG, Taylor SE: Anxiety and mood disorders in medically ill patients. J Clin Psychiatry 1990, 51(l):27–32.

    PubMed  Google Scholar 

  48. Ranga Rama Krishnan K, France RD, Pelton SZ: Chronic pain and depression, II. Symptoms of anxiety in chronic low back pain patients and their relationship to subtypes of depression. Pain 1985, 22:289–294.

    Article  Google Scholar 

  49. Katon W: Panic disorder and somatization: review of 55 cases. Am J Med 1984, 77:101–106.

    Article  CAS  PubMed  Google Scholar 

  50. Polatin PB, Kinney RK, Gatchel RJ: Premorbid psychopathology in somatoform pain syndrome. In American Psychiatric Association 144th Annual Meeting, New Orleans, LA; 1991:NR 553, 181.

  51. Gilcrist IC: Psychiatric and social factors related to low-back pain in general practice. Rheumatol Rehabil 1976, 18(2):101–107.

    Article  Google Scholar 

  52. Asmudson GJ, Norton GR, Jacobson SJ: Social, blood/injury, and agoraphobic fears in patients with physically unexplained chronic pain: are they clinically significant? Anxiety 1996, 2(l):28–33.

    Article  Google Scholar 

  53. Dworkin RH, Catigor E: Psychiatric diagnosis and chronic pain: DSM-III-R and beyond. J Pain Symptom Manage 1988, 3(2):87–95.

    Article  CAS  PubMed  Google Scholar 

  54. Merskey H: Psychiatry and chronic pain. Can J Psychiatry 1989, 34:329–335.

    CAS  PubMed  Google Scholar 

  55. Fishbain DA: DSM-IV: implications and issues for the pain clinician. APS Bull 1995, 6–18.

  56. Fishbain DA, Goldberg M: The misdiagnosis of conversion disorder in a psychiatric emergency service. Gen Hosp Psychiatry 1991, 13:177–181.

    Article  CAS  PubMed  Google Scholar 

  57. Fishbain DA, Steele-Rosomoff R, Rosomoff HL: Drug abuse, dependence, and addiction in chronic pain patients. Clin J Pain 1992, 8:77–85.

    Article  CAS  PubMed  Google Scholar 

  58. Weisberg JN, Gallagher RM, Gorin A: Personality disorders in chronic pain: a longitudinal approach to validation of diagnosis. In American Pain Society 15th Annual Meeting, Washington, DC; 1996:abstract 738, A–83

  59. Weisberg JN, Keefe FJ: Personality disorders in the chronic pain population: basic concepts, empirical findings, and clinical implications. Pain Forum 1997, 6(l):1–9. Review dealing with comorbidity between chronic pain and personality disorders.

    Article  Google Scholar 

  60. Fishbain DA: Can personality disorders in chronic pain patients be accurately measured? Pain Forum 1997, 6(l):16–19. Review outlining the difficulties of measuring personality disorders in chronic pain.

    Article  Google Scholar 

  61. Fishbain DA, Cutler RB, Rosomoff HL, Steele-Rosomoff R: Comorbid psychiatric disorders in chronic pain patients with psychoactive substance use disorders. Pain Clinics, accepted for publication.

  62. Fishbain DA, Cutler RB, Rosomoff HL, Steele-Rosomoff R: False information on chronic pain patient illicit drug use as determined by urine toxicology. Clin J Pain, accepted for publication.

  63. Kremer E, Atkinson JH, Fagnelzi RN: Measurement of pain: patient preference does not confound pain measurement. Pain 1981, 51:281–287.

    Google Scholar 

  64. Cornwal A, Doncleri DC: The effect of experimentally induced anxiety on the experience of pressure pain. Pain 1988, 35:105–113.

    Article  Google Scholar 

  65. Weisberg JN, Gorin A, Drozd K, Gallagher RM: The relationship between depression and psychophysiological reactivity in chronic pain patients. In International Association for the Study of Pain, 8th World Congress on Pain, Vancouver, Canada; 1996:abstract 233, 71.

  66. Krass S, Gallagher RM, Myers P, Friedman R: The effect of chronic pain and depression on pain perception in chronic pain patients. American Pain Society 15th Annual Meeting, Washington, DC; 1996:abstract 684, A–71.

  67. Magee WJ, Eaton WW, Wittchen HU, et al.: Agoraphobia, simple phobia, and social phobia in the national comorbidity survey. Arch Gen Psychiatry 1996, 53:159–168.

    Article  CAS  PubMed  Google Scholar 

  68. Mauskopf JA, Simeon GP, Miles MA, et al.: Functional status in depressed patients: the relationship to disease severity and disease resolution. J Clin Psychiatry 1996, 77(12):588. Study that points to the relationship between Axis I disorders and functional status.

    Article  Google Scholar 

  69. Judd LL, Paulus MP, Wells KB, Rapaport MH: Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population. Am J Psychiatry 1996, 153(11):1411–1416.

    Article  CAS  PubMed  Google Scholar 

  70. Katon WJ: Depression in patients with inflammatory bowel disease. J Clin Psychiatry 1997, 58(suppl 1):20–23. Study that points to the negative effect of depression on medical disorders.

    PubMed  Google Scholar 

  71. Angst J: Depression and anxiety: implications for nosology, course, and treatment. J Clin Psychiatry 1997, 58(suppl 8):3–5.

    PubMed  Google Scholar 

  72. Beautrais AL, Joyce PR, Mulder RT, et al.: Attempts: a case-control study. Am J Psychiatry 1996, 153(8):1009–1014.

    Article  CAS  PubMed  Google Scholar 

  73. Fava M, Alpert JE, Borus JS, et al.: Patterns of personality disorder comorbidity in early-onset versus late-onset major depression. Am J Psychiatry 1996, 153(10):1308–1312. Study that points to the importance of comorbidities between Axis I and Axis II disorders.

    Article  CAS  PubMed  Google Scholar 

  74. Cheng ATA, Mann AH, Chan KA: Personality disorder and suicide. Br J Psychiatry 1997, 170:441–446.

    Article  CAS  PubMed  Google Scholar 

  75. Kushner MG, Mackenzie TB, Fiszdon J, et al.: The effects of alcohol consumption on laboratory-induced panic and state anxiety. Arch Gen Psychiatry 1996, 53:264–270.

    Article  CAS  PubMed  Google Scholar 

  76. Chutuape MA, Brooner RK, Stitzer M: Sedative use disorders in opiate-dependent patients: association with psychiatric and other substance use disorders. J Nerv Ment Dis 1997, 185(5):289–297..

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Psychiatry, Neurological Surgery, and Anesthesiology, University of Miami School of Medicine, University of Miami Comprehensive Pain & Rehabilitation Center at South Shore Hospital, 600 Alton Road, 33139, South Miami Beach, FL, USA

    David A. Fishbain MD & Brian R. Cutler PhD

  2. Departments of Psychiatry, Neurological Surgery, and Anesthesiology, University of Miami Comprehensive Pain & Rehabilitation Center at South Shore Hospital, 600 Alton Road, 33139, South Miami Beach, FL, USA

    David A. Fishbain MD, Brian R. Cutler PhD, Hubert L. Rosomoff MD, DMedSc & Renneè Steele Rosomoff RN

  3. Departments of Neurological Surgery, and Anesthesiology, University of Miami School of Medicine, University of Miami Comprehensive Pain & Rehabilitation Center at South Shore Hospital, 600 Alton Road, 33139, South Miami Beach, FL, USA

    David A. Fishbain MD, Brian R. Cutler PhD, Hubert L. Rosomoff MD, DMedSc & Renneè Steele Rosomoff RN

  4. Departments of Neurological Surgery, and Anesthesiology, University of Miami School of Medicine, University of Miami Comprehensive Pain & Rehabilitation Center at South Shore Hospital, 600 Alton Road, 33139, South Miami Beach, FL, USA

    David A. Fishbain MD, Hubert L. Rosomoff MD, DMedSc & Renneè Steele Rosomoff RN

Authors
  1. David A. Fishbain MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brian R. Cutler PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hubert L. Rosomoff MD, DMedSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Renneè Steele Rosomoff RN
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fishbain, D.A., Cutler, B.R., Rosomoff, H.L. et al. Comorbidity between psychiatric disorders and chronic pain. Current Review of Pain 2, 1–10 (1998). https://doi.org/10.1007/s11916-998-0057-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-998-0057-7

Keywords

Search

Navigation