Psychiatric morbidities, sleep disturbances, suicidality, and quality-of-life in a community population with medically unexplained pain in Korea
Introduction
Chronic pain is a very prevalent and burdensome public health problem (Elliott et al., 1999), and is a common reason for seeking medical treatment and a frequent cause of inability to work (Nickel and Raspe, 2001). The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” (Merskey and Bogduk, 1994). Thus, the subjective experience of pain is not solely caused by tissue damage. In fact, many pain symptoms cannot be fully explained by the presence of a medical condition or injury, or as a direct effect of substance use/abuse. At least one-third of somatic pain symptoms are medically unexplained or incompletely explained (Kroenke, 2003).
There has been extensive debate about the conceptualization and classification of medically unexplained somatic symptoms including pain (Sullivan et al., 1991, Mayou et al., 2005, Kroenke, 2006, Sharpe et al., 2006). While the term "psychogenic" or "psychological" pain is frequently used in medical setting, the Diagnostic and Statistical Manual for Mental Disorders, 4th edition (DSM-IV) (Amerian Psychiatric Association, 1997) and International Classification of Disease, 10th edition (ICD-10) (WHO, 1993) classify pain in which psychological factors are judged to have an important role in the onset, severity, exacerbation, or maintenance of pain as a (somatoform) pain disorder. According to the DSM-IV stipulation, only when the pain symptom was not or not fully explained by medical diagnosis (e.g., doctor's diagnosis of disc herniation for back pain) or injury, or the use of medication, drugs or alcohol, the symptom is rated as “medically unexplained”.
Chronic pain and depression are frequently comorbid processes (Campbell et al., 2003). Previous studies have reported that painful symptoms were associated with more severe depression, poorer quality-of-life, more serious work disability, increased health care utilization, and poor treatment response (Bair et al., 2004, Demyttenaere et al., 2006, Husain et al., 2007). Despite the existence of overwhelming data demonstrating a relationship between chronic pain and depression (Campbell et al., 2003, Bair et al., 2004, Mayou et al., 2005, Demyttenaere et al., 2006), few studies have compared the comorbidity of chronic pain, especially medically unexplained pain symptoms (MUS-pain), and specific DSM-diagnosed conditions other than depression. Only one study examined the relationship between medically unexplained pain and depressive or anxiety disorders. The cited work, which used lifetime data on MUS-pain, reported that such pain increased the likelihood of depressive or anxiety disorders and decreased quality-of-life (Beesdo et al., 2010). However, data on lifetime medically unexplained somatic symptoms can vary over time and may be unreliable because of recall bias (Leiknes et al., 2006). Therefore, there is a need for studies that consider recent pain symptoms, such as pain presence within the prior 12 months, and that canvass possible associations with a wider range of psychiatric disorders.
Several community studies have reported that chronically painful conditions increase psychological distress (Leijon and Mulder, 2009, Leijon et al., 2009) and are associated with suicidality (Braden and Sullivan, 2008, Ilgen et al., 2008, Ratcliffe et al., 2008). However, the cited works did not differentiate MUS-pain from medically explainable pain, or included only pain attributable to a medical condition. To date, no study has investigated the effect of MUS-pain on psychological distress and suicidal ideation in non-clinical, population-based samples.
The subjective experience of pain includes sensory, emotional, behavioral, and cognitive components (Merskey and Bogduk, 1994). Thus, MUS-pain may be as stressful and may have as significant an impact on psychiatric morbidity and quality-of-life as does medically explained physical pain. Only limited epidemiological data on MUS-pain in the general population are available. Thus, in the present study, we examined the prevalence of MUS-pain, clinical correlates of such pain, and correlations between MUS-pain during the previous 12 months and specific DSM-IV disorders, sleep disturbances, suicidality, quality-of-life, and psychological distress, in a nationwide community sample of Korea.
Section snippets
Sample
The Korean Epidemiologic Catchment Area study was conducted in 2001 using the Korean version of the Composite International Diagnostic Interview 2.1 (K-CIDI 2.1) (Cho et al., 2007). In 2006–2007, the Korean Epidemiologic Catchment Area-Replication (KECA-R) study was conducted as a follow-up. KECA-R was designed to determine the epidemiology (prevalence and correlates) of additional psychiatric illnesses such as attention deficity hyperactivity disorder (ADHD), premenstrual dysphoric disorder,
Prevalence and correlates of MUS-pain
The estimated 1-year prevalence of MUS-pain was 2.8% (182/6510). Compared to the control group, MUS-pain was more common in subjects who were female, unemployed, less educated, older than 55 years of age, and had a medical illness. MUS-pain was less prevalent in married and overweight/obese participants (Table 1).
One-year prevalence of psychiatric disorders in subjects with MUS-pain
Comorbidity rates and the frequencies of psychiatric disorders were compared in subjects with MUS-pain and those without by calculating ORs and 95% CIs. Any alcohol use disorder (OR
Discussion
The results of the present study indicate that approximately 2.8% of the Korean general population experienced MUS-pain during the previous year, and that MUS-pain was associated with psychiatric morbidities, sleep disturbances, suicidality, psychological distress, and decreased quality-of-life.
Our findings that MUS-pain is more prevalent in females, participants older than 55 years, the widowed/divorced/separated, the unemployed, and the less educated, are consistent with data of previous
Acknowledgments
This study was funded by the Korean Ministry of Health and Welfare. The authors wish to express gratitude to 12 local investigators and 79 interviewers.
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