Mehmet Emin DEMİRKOL, Hakkı ÜNLÜGENÇ, Soner ÇAKMAK, Sinan PEKTAŞ, Ali TAŞDEMİR, Abdülkadir Geylan IŞIK, Hayri Tevfik ÖZBEK ÖZBEK, Lut TAMAM

Kronik ağrı hastalarında bedensel duyumları algılama düzeyi ve psikiyatrik komorbidite arasındaki ilişki

Amaç: Biz bu çalışmada kronik ağrı hastalarında komorbid psikiyatrik hastalıkları araştırdık ve bu hastalıkların şiddeti üzerinde hastaların bedensel duyumları algılama düzeylerinin ve sosyodemografik özelliklerinin etkilerini inceledik. Gereç ve Yöntem: Bu çalışmada 51 kronik ağrı hastası konsültasyon yoluyla psikiyatri hekimi tarafından değerlendirilmiştir. Katılımcılara DSM-IV için yapılandırılmış klinik görüşme (SCID I) uygulanmış, yaş, cinsiyet, medeni durum, eğitim düzeyi gibi sosyodemografik verileri alınarak, ağrı etiyolojileri belirlenmiş ve ağrı hastaları idiopatik ve organik etiyolojiye sekonder kronik ağrı hastaları olarak sınıflandırılmıştır. Katılımcılara Ruhsal Belirti Tarama Listesi (SCL-90R), Bedensel Duyumları Algılama Ölçeği (SSAS), Hamilton Depresyon Derecelendirme Ölçeği (HAM-D), Hamilton Anksiyete Dercelendirme Ölçeği (HAM-A) uygulanmıştır. Bulgular: Kronik ağrı hastalarında psikiyatrik bozuklukların yaygınlığı %74.5 olarak bulunmuştur. Somatoform bozukluklar %37.3 ile en sık teşhis edilen bozukluk olup, depresif bozukluklar %29.4, anksiyete bozuklukları %23.5 oranında bulunmuştur. Somatoform bozukluk saptanan kronik ağrı hastalarında komorbid anksiyete puanları (p=0.019) ve SSAS puanları (p=0.046) anlamlı olarak yüksek bulunmuştur. Depresyon tanısı alan katılımcılarda HAM-A puanları anlamlı olarak yüksek bulunmuştur (p=0.004). SSAS puanları ile hastalardaki depresyon, anksiyete ve ruhsal belirti şiddeti arasında pozitif bir ilişki olduğu saptanmıştır. Sonuç: Bedensel duyumları algılama düzeylerini belirleme ile ilgili olarak ağrı polikliniklerinde veya psikiyatri polikliniklerinde yapılandırılmış veya yarı yapılandırılmış görüşmelerin uygulanması bu hastalarda kronik ağrının ve komorbid psikiyatrik rahatsızlıkların tedavisi ve prognozunda yarar sağlayacaktır.

The relationship between somatic sense perception levels and comorbid psychiatric diseases in chronic pain patients

Objectives: The purpose of the study was to evaluate any comorbid psychiatric disorders in patients with chronic pain and toexamine the effects of sociodemographic details and the level of somatic sense perception on the severity of these diseases.Methods: In this study, 51 chronic pain patients were evaluated in a consultation with a psychiatrist. Sociodemographic characteristics of the patients, such as age, gender, education level, and marital status were recorded, and Structured ClinicalInterview for DSM-IV results were assessed. The patients’ chronic pains were classified as idiopathic or secondary to organic etiology. In addition, the Symptom Checklist-90, Somatosensory Amplification Scale (SSAS), Hamilton Depression Rating Scale,and the Hamilton Anxiety Scale (HAM-A) were used.Results: The incidence of psychiatric disorders in chronic pain patients was found to be 74.5%. Somatoform disorders werethe most frequently diagnosed, at 37.3%. The rate of depressive and anxiety disorders was, respectively, 29.4% and 23.5%.Comorbid anxiety scores (p=0.019) and SSAS scores (p=0.046) were significantly higher in chronic pain patients with a somatoform disorder. HAM-A scores were found to be significantly higher in patients with depression (p=0.004). A positive andlinear relationship was determined between the SSAS score and depression, anxiety, and the severity of mental symptoms.Conclusion: Structured or semi-structured interviews can be performed in pain polyclinics or psychiatric outpatient clinics todetermine the level of perception of somatic sensations. This could be beneficial in the treatment of chronic pain and comorbid psychiatric disorders.

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1. Poole H, White S, Blake C, Murphy P, Bramwell R. Depression in chronic pain patients: prevalence and measurement. Pain Pract 2009;9(3):173–80.
2. Knaster P, Karlsson H, Estlander AM, Kalso E. Psychiatric disorders as assessed with SCID in chronic pain patients: the anxiety disorders precede the onset of pain. Gen Hosp Psychiatry 2012;34(1):46–52.
3. Burke AL, Mathias JL, Denson LA. Psychological functioning of people living with chronic pain: a meta-analytic review. Br J Clin Psychol 2015;54(3):345–60.
4. Katon W, Egan K, Miller D. Chronic pain: lifetime psychiatric diagnoses and family history. Am J Psychiatry 1985;142(10):1156–60.
5. Merskey H, Lau CL, Russell ES, Brooke RI, James M, Lappano S, et al. Screening for psychiatric morbidity. The pattern of psychological illness and premorbid characteristics in four chronic pain populations. Pain 1987;30:141–57.
6. Woo AK. Depression and anxiety in pain. Reviews in Pain 2010;4(1):8–12.
7. Hung CI, Liu CY, Fu TS. Depression: An important factor associated with disability among patients with chronic low back pain. Int J Psychiatry Med 2015;49(3):187–98.
8. Ross C, Juraskova I, Lee H, Parkitny L, Stanton TR, Moseley GL, et al. Psychological distress mediates the relationship between pain and disability in hand or wrist fractures. J Pain 2015;16(9):836-43.
9. Kenardy J, Heron-Delaney M, Warren J, Brown EA. Effect of mental health on long-term disability after a road traffic crash: results from the UQ SuPPORT study. Arch Phys Med Rehabil 2015;96(3):410–7.
10. Smith D, Wilkie R, Uthman O, Jordan JL, McBeth J. Chronic pain and mortality: a systematic review. PLoS One 2014;9(6):e99048.
11. Hassett AL, Aquino JK, Ilgen MA. The risk of suicide mortality in chronic pain patients. Curr Pain Headache Rep 2014;18(8):436.
12. Ilgen MA, Kleinberg F, Ignacio RV, Bohnert AS, Valenstein M, McCarthy JF, et al. Noncancer pain conditions and risk of suicide. JAMA Psychiatry 2013;70(7):692–7.
13. Réthelyi JM, Berghammer R, Kopp MS. Comorbidity of pain-associated disability and depressive symptoms in connection with sociodemographic variables: results from a cross-sectional epidemiological survey in Hungary. Pain 2001;93(2):115–21.
14. Haley WE, Turner JA, Romano JM. Depression in chronic pain patients: relation to pain, activity, and sex differences. Pain 1985;23(4):337–43.
15. Meana M. The meeting of pain and depression: Comorbidity in women. Can J Psychiatry 1998;43(9):893–9.
16. Wijeratne C, Shome S, Hickie I, Koschera A. An age-based comparison of chronic pain clinic patients. Int J Geriatr Psychiatry 2001;16(5):477–83.
17. Geerlings SW, Twisk JW, Beekman AT, Deeg DJ, van Tilburg W. Longitudinal relationship between pain and depression in older adults: sex, age and physical disability. Soc Psychiatry Psychiatr Epidemiol 2002;37(1):23–30.
18. Granot M, Ferber SG. The roles of pain catastrophizing and anxiety in the prediction of postoperative pain intensity: a prospective study. Clin J Pain 2005;21(5):439–45.
19. Wittchen HU, Kessler RC, Beesdo K, Krause P, Hofler M, Hoyer J. Generalized anxiety and depression in primary care: prevalence, recognition, and management. J Clin Psychiatry 2002;63(Suppl 8):24–34.
20. Beesdo K, Hartford J, Russell J, Spann M, Ball S, Wittchen HU. The short- and long-term effect of duloxetine on painful physical symptoms in patients with generalized anxiety disorder: results from three clinical trials. J Anxiety Disord 2009;23(8):1064–71.
21. Ho PT, Li CF, Ng YK, Tsui SL, Ng KF. Prevalence of and factors associated with psychiatric morbidity in chronic pain patients. J Psychosom Res 2011;70(6):541–7.
22. Polatin PB, Kinney RK, Gatchel RJ, Lillo E, Mayer TG. Psychiatric illness and chronic low-back pain. The mind and the spine--which goes first? Spine (Phila Pa 1976) 1993;18(1):66–71.
23. Dersh J, Gatchel RJ, Polatin P, Mayer T. Prevalence of psychiatric disorders in patients with chronic work-related musculoskeletal pain disability. J Occup Environ Med 2002;44(5):459–68.
24. Gerrits MM, van Marwijk HW, van Oppen P, van der Horst H, Penninx BW. Longitudinal association between pain, and depression and anxiety over four years. J Psychosom Res 2015;78(1):64–70.
25. Gerrits MM, van Oppen P, Leone SS, van Marwijk HW, van der Horst H, Penninx BW. Pain, not chronic disease, is associated with the recurrence of depressive and anxiety disorders. BMC Psychiatry 2014;14:187.
26. Derogatis LR. SCL-90-R, Administration, Scoring & Procedures Manual-I for the Revised Version. Baltimore, MD: John Hopkins Univ, School of Medicine Clinical Psychometrics Unit; 1977.
27. Dağ I. Belirti Tarama Listesi (Scl-90-R)’nin Üniversite Öğrencileri için güvenirliği ve geçerliği. Türk Psikiyatri Dergisi 1991;2:5–12.
28. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.
29. Akdemir A, Türkcapar H, Orsel SD, Demirergi N, Dag I, Ozbay MH. Reliability and validity of the Turkish version of the Hamilton Depression Rating Scale. Compr Psychiatry 2001;42(2):161–5.
30. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959;32(1):50–5.
31. Yazıcı M, Demir B, Tanrıverdi N, Karaagaoğlu E, Yolac P. Hamilton Anxiety Rating Scale: Interrater Reliabilty and Validity Study. Türk Psikiyatri Dergisi 1998;9(2):114–7.
32. Barsky AJ, Wyshak G, Klerman GL. The somatosensory amplification scale and its relationship to hypochondriasis. J Psychiatr Res 1990;24(4):323–34.
33. Gulec H, Sayar K. Reliability and validity of the Turkish form of the Somatosensory Amplification Scale. Psychiatry Clin Neurosci 2007;61(1):25–30.
34. Howe CQ, Robinson JP, Sullivan MD. Psychiatric and Psychological Perspectives on Chronic Pain. Phys Med Rehabil Clin N Am 2015;26(2):283–300.
35. Adams LM, Turk DC. Psychosocial factors and central sensistivity syndromes. Curr Rheumatol Rev 2015;11(2):96– 108.
36. Huang TY, Lee Y, Chong MY. Psychological distress and help-seeking in patients with chronic pain. Chang Gung Med J 2005;28(4):247–53.
37. Banks S, Kerns R. Explaining high rates of depression in chronic pain: A diathesis-stress framework. Psychological Bulletin 1996;119(1):95–110.
38. Hall AM, Kamper SJ, Maher CG, Latimer J, Ferreira ML, Nicholas MK. Symptoms of depression and stress mediate the effect of pain on disability. Pain 2011;152(5):1044–51.
39. C. Williams A. Depression in Chronic Pain: Mistaken Models, Missed Opportunities. Behaviour Therapy 1998;27:61– 80.
40. Wilson KG, Mikail SF, D’Eon JL, Minns JE. Alternative diagnostic criteria for major depressive disorder in patients with chronic pain. Pain 2001;91(3):227–34.
41. Cassem EH. Depression and anxiety secondary to medical illness. Psychiatr Clin North Am 1990;13(4):597–612.
42. Dworkin SF, Von Korff M, LeResche L. Multiple pains and psychiatric disturbance. An epidemiologic investigation. Arch Gen Psychiatry 1990;47(3):239–44.
43. Kato K, Sullivan PF, Evengard B, Pedersen NL. Chronic widespread pain and its comorbidities: a population-based study. Arch Intern Med 2006;166(15):1649–54.
44. Katz J, Pagé MG, Fashler S, Rosenbloom BM, Asmundson GJG. Chronic pain and the anxiety disorders: epidemiology, mechanisms and models of comorbidity, and treatment. In: Marchand S, Saravane D, Gaumond I, editors. Mental health and pain: somatic and psychiatric components of pain in mental health. New York, Ny, US: SpringerVerlag Publishing; 2014. p.119–55.
45. Campbell LC, Clauw DJ, Keefe FJ. Persistent pain and depression: a biopsychosocial perspective. Biol Psychiatry 2003;54(3):399–409.
46. Stroud MW, Thorn BE, Jensen MP, Boothby JL. The relation between pain beliefs, negative thoughts, and psychosocial functioning in chronic pain patients. Pain 2000;84(2- 3):347–52.
47. Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain 1997;13(2):116–37.
48. Beesdo K, Jacobi F, Hoyer J, Low NC, Hofler M, Wittchen HU. Pain associated with specific anxiety and depressive disorders in a nationally representative population sample. Soc Psychiatry Psychiatr Epidemiol 2010;45(1):89–104.
49. Gerrits MMJG, Vogelzangs N, van Oppen P, van Marwijk HW, van der Horst H, Penninx BW. Impact of pain on the course of depressive and anxiety disorders. Pain 2012;153(2):429– 36.
50. Gerrits MM, van Oppen P, van Marwijk HW, Penninx BW, van der Horst HE. Pain and the onset of depressive and anxiety disorders. Pain 2014;155(1):53–9.
51. Benarroch EE. Descending monoaminergic pain modulation: bidirectional control and clinical relevance. Neurology 2008;71(3):217–21.
52. Mason P. Deconstructing endogenous pain modulations. J Neurophysiol 2005;94(3):1659–63.
53. Zubieta JK, Heitzeg MM, Smith YR, Bueller JA, Xu K, Xu Y, et al. COMT val158met genotype affects mu-opioid neurotransmitter responses to a pain stressor. Science 2003;299(5610):1240–3.
54. Caspi A, Sugden K, Moffitt TE, Taylor A, Craig IW, Harrington H, et al. Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science 2003;301(5631):386–9.
55. Strigo IA, Simmons AN, Matthews SC, Craig AD, Paulus MP. Association of major depressive disorder with altered functional brain response during anticipation and processing of heat pain. Arch Gen Psychiatry 2008;65(11):1275–84.
56. Nekovarova T, Yamamotova A, Vales K, Stuchlik A, Fricova J, Rokyta R. Common mechanisms of pain and depression: are antidepressants also analgesics? Frontiers in Behavioral Neuroscience 2014;8:99.
57. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurology 2015;14(2):162–73.