New evidence reveals the association between physical pain and risk of developing a mental disorder.
By Dr. Minal Mistry, Psychiatrist
Pain and mental health
“Those who develop pain or depression are at risk of developing the other … when pain is refractory to treatment, it is associated with more depressive symptoms and worse depression outcomes, and vice versa.” (F. Dunne, 2011)
Above is a quote from an article written by one expert in the area of physical pain and mental disorders, in which the common biological pathways between pain and depression were explored, including reference to those “mood” neurotransmitters you often hear about: “serotonin” and “noradrenaline.” This is not surprising as we intuitively know that the physical pain one experiences has a close relationship to how we feel.
In my psychiatric clinic I frequently encounter people with mental disorders who are also experiencing physical health difficulties. In part of my practice, where I care for veterans who are ex-military personnel, injuries and physical pain often arises during the course of their past duties. Their pain and mental disorders (e.g. depression, anxiety, post-traumatic stress disorder) appear to merge and impact on each other. This poses an enormous challenge in getting better.
We now have new evidence about pain and mental disorders, with another European study that helps us to understand this relationship better. This time the research comes from the Netherlands. I have visited the Netherlands once and it is a great place with their culture, coffee shops, and people. So, I was pleased to read the interesting “population-based” study based on the Dutch general population. This study, by Eric de Heer and colleagues, had many strengths in that it involved PAIN:
Details of the study
The researchers described this study as a “Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2). Impressive, eh? The subjects in the study were aged 18-64, and from the general Dutch population. The researchers looked at 3 groups; subjects without any 12-month baseline mood disorder, anxiety disorder, and substance use disorder were the respective groups.
As well as assessing for the presence of a mental disorder, using the “Composite International Diagnostic Interview (CIDI)”, the researchers used the “SF-36-item Short Form Health Survey” to measure:
Results of the study
Using some easy to understand but impressive statistical methods, they found that the prevalence of:
“These subjects had a more than two-fold increased risk of developing a first-incident or recurrent mood and anxiety disorder 3 years later.”
This means that moderate to severe pain that interferes with normal activities (e.g. work, domestic work) at least doubles the chances of the person developing depression and anxiety. A similar relationship was not found with the risk of developing a substance use disorder.
The painful ending
I find the results of this study in the Dutch population very interesting, not only because it is another example of high quality research from the Netherlands, but also because it has given me more knowledge and evidence to explain what I see in my clinics. The relationship between pain and mental disorders, such as anxiety and depression, makes sense to me, and I am sure to the people I see every week.
Although the researchers had placed a caveat to their findings, to say they cannot say for certain that severe pain independently causes pain as other factors may have played a role, it is clear from this research that physical pain needs to be better identified and treated. I end with another quote from Dr. Dunne’s paper, “Depression and pain: is there a common pathway?”, with respect to implications for treatment:
“Antidepressants are frequently used in the treatment of depression and generalized anxiety disorders. Their use extends beyond these areas, however, and it is now accepted that antidepressants are efficacious in treating chronic pain syndromes in addition to their effects on psychological features such as low mood, inordinate guilt, or feelings of worthlessness”.
Cite this article as-
Minal Mistry (2018). New evidence reveals the association between physical pain and risk of developing a mental disorder. The Beautiful Space-A Journal of Mind, Art and Poetry. May 2018: TBSB129
Please check author names highlighted with each article.
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