Distribution of chronic primary and secondary pain in a patient sample with psychiatric disorders

Chronic pain often coexists with psychiatric disorders, yet less is known about the specific types of chronic pain conditions that may co-occur. This study aimed to classify chronic pain according to ICD-11 categories and provide an overview of the types and frequency of these conditions in a patient sample with psychiatric disorders and coexisting chronic pain.

This descriptive cross-sectional study consecutively recruited 151 patients (78.8 % females, mean age 36 years) from psychiatric outpatient units. Common psychiatric diagnoses included anxiety disorders (27.8 %), stress-related disorders (23.2 %), mood disorders (22.5 %), attention deficit disorders (10.6 %), personality disorders (9.3 %) and other psychiatric disorders (6.6 %). Chronic pain was assessed by structured interviews and comprehensive clinical examinations conducted by physicians and physiotherapists. Examination verified pain conditions were classified into subcategories of chronic primary and secondary pain (ICD-11). We used descriptive statistics to analyze the data.

Chronic primary pain was present in 99 % of the participants; most commonly musculoskeletal pain (94.0 %), e.g. low back pain and neck pain, headache and orofacial pain (80.8 %), e.g. tension-type headache and migraine, and visceral pain (31.8 %), e.g. irritable bowel syndrome. Chronic secondary pain affected 49 % of the participants; most frequently musculoskeletal pain (33.8 %), e.g. osteoarthritis and tendinitis, and neuropathic pain (11.3 %), e.g. sciatica. The distribution of primary and secondary pain conditions was quite similar across the subgroups of psychiatric disorders. Participants had on average 5.7 chronic pain conditions. Females had significantly more pain conditions, chronic widespread pain and primary visceral pain than males.

This study indicates that chronic pain in patients with psychiatric disorders may include complex and multiple chronic primary and secondary pain conditions. Given such complexity, implementing pain assessment and management into routine psychiatric care as well as collaboration across different areas of medical expertise is warranted.