Thursday, July 30, 2009

Depression Often Behind Medically Unexplained Pain

Pain symptoms that cannot be attributed to organic disease are more frequently and severely experienced by patients with depression, according to psychologists Dirk Frieser and Stephanie K├Ârber at the Institute of Psychology, Johannes Gutenberg University in Mainz, Germany. They questioned 308 patients with pain attending two practices of family physicians about their pain symptoms, anxieties, social support, level of psychological stress, and other concerns. Subsequently, the pain symptoms reported by the patients were medically evaluated by their physicians.

Results indicated that there is a significantly higher occurrence of so-called “somatoform pain” in patients with depression, or who have suffered depression in the prior 12 months, than in patients without depression. Somatoform symptoms — ie, pain that cannot be accounted for medically [see additional definition] — are an astonishingly widespread phenomenon, Frieser believes, accounting for "up to 80% of the pain symptoms reported in general medical practices.” Indeed, results of the physician evaluations verified that pain was somatoform in 73% of the study subjects, and could be explained medically in only 27% of cases.

This does not mean patients are simply imagining that they have these symptoms or are hypochondriacs. Frieser emphasizes, “somatoform symptoms are very real; they impair quality of life, and can also cause clinically relevant disorders that may require psychological treatment.” Where the pain is attributable to an organic cause, it is irrelevant whether the patient has depression or not: The frequency, duration, and the debilitating effect of the pain are roughly equivalent in both patient groups, he says.

Women are more frequently affected by depression and also by somatoform pain disorders than men, Frieser claims. Besides pain, symptoms may include dizziness, sensations of hypersensitivity in various regions of the body, and even fatigue or exhaustion. What is important, according to Frieser, is that not everyone who has somatoform symptoms is properly diagnosed as having a somatoform pain disorder. The extent to which a patient's quality of life is impaired and the severity of their psychological problems are critical factors, and proper treatment requires attending to the patient’s mental health issues.

Caveats: This research was only briefly reported and, while the concepts presented are important considerations for healthcare providers, the stated prevalence of somatoform pain disorders seems quite large. There also is the danger of falsely attributing the varied symptoms of certain disorders, such as fibromyalgia, solely to somatoform origins when, in fact, there also are underlying organic processes requiring medical attention. — SBL

Source: Family physician survey in Mainz: Patients with depression frequently suffer from medically unexplained pain. Johannes Gutenberg University; Mainz, Germany. July 9, 2009. [Click here for document.]