An age-based comparison of chronic pain clinic patients

The aim of this study was to compare demographic, illness and personality characteristics, and formal rates of mental disorder between younger (< 65 years) and older (>or= 65 years) patients attending a chronic pain clinic.

Patients with non-malignant pain of > 6 months' duration attending a specialist outpatient clinic were given a structured medical and psychiatric interview, and completed self-report questionnaires assessing disability, personality style and attitudes to illness.

Fifty patients (26 of whom were older) participated in the study. None of the older patients had experienced the onset of chronic pain before the age of 50 years. Although current and lifetime major depression were common in both groups, there was no specific association between age and depression. The younger group was more likely to have been injured prior to the onset of pain and to be seeking financial compensation, reported more physical and social disability, and was more likely to be preoccupied with somatic discomfort. The younger group was also more likely to be rated as displaying impulsive personality traits and the older group anxious traits, although there was no difference in neuroticism scores.

Despite a greater level of multiple medical morbidity and longer duration of pain, older patients with chronic pain were not more likely to suffer from concurrent depression, were less disabled and less somatically preoccupied than younger patients. There were sufficient differences in illness and psychological characteristics to suggest that the older patients represented an aetiologically distinct sub-group, rather than patients with chronic pain of early onset who have simply grown old. Finally, the utility of DSM-IV defined somatoform disorders, in particular pain disorder, is discussed. A model which integrates medical and psychological mechanisms is needed for clinical use.