Goldstein Benjamin I, Houck Patricia R, Karp Jordan F
Advanced Center for Intervention and Services Research for Late Life Mood Disorders, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States.
J Affect Disord. 2009 Oct;117(3):151-6. doi: 10.1016/j.jad.2009.01.011. Epub 2009 Feb 8.
Epidemiologic studies have found that major depressive disorder (MDD) and anxiety disorders are associated with pain. However, little is known regarding the prevalence and correlates of pain in bipolar I disorder (BD).
The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample (N=43,093) of the US adult population, was used to determine if 1) prevalence of moderate-or-greater pain interference is elevated among subjects with 12-month history of BD, and 2) psychiatric and medical comorbidities independently contribute to increased pain interference in BD.
Subjects with BD were significantly more likely to report pain interference of at least moderate severity compared to subjects without BD (24.8% versus 11.9%, p<0.001). Moderate or greater pain interference is also significantly more common among subjects with BD than those with MDD (20.3%) or anxiety disorders (19.3%; p<0.001). Logistic regression analyses adjusting for potential confounding variables indicated that BD is independently associated with increased pain interference (adjusted odds ratio 1.57, 95% confidence interval 1.39-1.78). Factors associated with pain interference in BD included greater age, non-white race, lower income, increased frequency of arthritis and other medical problems, comorbid anxiety disorders, and comorbid substance use disorders.
The prevalence of pain interference is elevated in BD, even compared to MDD or anxiety disorders, and is associated with both medical and psychiatric comorbidities. Interference from pain may be an important variable to consider in the assessment and treatment of BD. Future prospective studies are needed to determine the direction of the observed associations.
流行病学研究发现，重度抑郁症（MDD）和焦虑症与疼痛有关。然而，关于双相I型障碍（BD）中疼痛的患病率及其相关因素知之甚少。
利用2001 - 2002年全国酒精及相关疾病流行病学调查（NESARC），这是一个具有全国代表性的美国成年人口样本（N = 43,093），来确定：1）在有12个月BD病史的受试者中，中度或更严重疼痛干扰的患病率是否升高；2）精神疾病和内科合并症是否独立导致BD患者疼痛干扰增加。
与无BD的受试者相比，有BD的受试者报告至少中度严重程度疼痛干扰的可能性显著更高（24.8%对11.9%，p < 0.001）。中度或更严重的疼痛干扰在BD患者中也比患有MDD（20.3%）或焦虑症（19.3%；p < 0.001）的患者更常见。对潜在混杂变量进行调整的逻辑回归分析表明，BD与疼痛干扰增加独立相关（调整后的优势比为1.57，95%置信区间为1.39 - 1.78）。与BD疼痛干扰相关的因素包括年龄较大、非白人种族、收入较低、关节炎和其他内科问题的频率增加、合并焦虑症以及合并物质使用障碍。
BD中疼痛干扰的患病率升高，甚至与MDD或焦虑症相比也是如此，并且与内科和精神疾病合并症都有关。疼痛干扰可能是BD评估和治疗中需要考虑的一个重要变量。未来需要进行前瞻性研究以确定所观察到的关联的方向。
