Multiple pains and psychiatric disturbance. An epidemiologic investigation

We assessed multiple pain conditions and their association with affective disturbance, somatization, and psychological distress based on questionnaire data from a probability sample of 1016 enrollees of a large health maintenance organization. Respondents were asked about the presence of five pain conditions and were classified empirically in terms of dysfunctional chronic pain status based on pain severity, pain persistence, and pain-related disability days. Logistic regression analyses revealed a highly significant association between number of pain conditions reported and elevated levels of somatization as measured by the Symptom Checklist 90-Revised. Individuals with two or more pain conditions were at elevated risk of an algorithm diagnosis of major depression, while persons with a single pain condition did not differ from persons with no current pain conditions. Number of pain conditions reported was a better predictor of major depression than were important measures of pain experience, including pain severity and pain persistence.