Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
Promenta Research Center, University of Oslo, Oslo, Norway.
Eur J Pain. 2023 Aug;27(7):884-895. doi: 10.1002/ejp.2121. Epub 2023 May 3.
Chronic pain and mental disorders are leading causes of disability worldwide. Individuals with chronic pain are more likely to experience mental disorders compared to individuals without chronic pain, but large-scale estimates are lacking. We aimed to calculate overall prevalence of mental health diagnoses from primary and secondary care among individuals treated for chronic pain in 2019 and to compare prevalence among chronic pain patients receiving opioid versus non-opioid analgesics, according to age and gender.
It is a population-based cohort study. Linked data from nationwide health registers on dispensed drugs and diagnoses from primary (ICPC-2) and secondary (ICD-10) health care. Chronic pain patients were identified as all patients over 18 years of age filling at least one prescription of an analgesic reimbursed for non-malignant chronic pain in both 2018 and 2019 (N = 139,434, 69.3% women).
Prevalence of any mental health diagnosis was 35.6% (95% confidence interval: 35.4%-35.9%) when sleep diagnoses were included and 29.0% (28.8%-29.3%) when excluded. The most prevalent diagnostic categories were sleep disorders (14% [13.8%-14.2%]), depressive and related disorders (10.1% [9.9%-10.2%]) and phobia and other anxiety disorders (5.7% [5.5%-5.8%]). Prevalence of most diagnostic categories was higher in the group using opioids compared to non-opioids. The group with the highest overall prevalence was young women (18-44 years) using opioids (50.1% [47.2%-53.0%]).
Mental health diagnoses are common in chronic pain patients receiving analgesics, particularly among young individuals and opioid users. The combination of opioid use and high psychiatric comorbidity suggests that prescribers should attend to mental health in addition to somatic pain.
This large-scale study with nation-wide registry data supports previous findings of high psychiatric burden in chronic pain patients. Opioid users had significantly higher prevalence of mental health diagnoses, regardless of age and gender compared to users of non-opioid analgesics. Opioid users with chronic pain therefore stand out as a particularly vulnerable group and should be followed up closely by their physician to ensure they receive sufficient care for both their mental and somatic symptoms.
慢性疼痛和精神障碍是全球导致残疾的主要原因。与没有慢性疼痛的人相比，患有慢性疼痛的人更有可能出现精神障碍，但大规模的估计数据仍有所欠缺。我们旨在计算 2019 年接受慢性疼痛治疗的个体在初级和二级保健中精神健康诊断的总体患病率，并根据年龄和性别比较接受阿片类药物与非阿片类药物镇痛治疗的慢性疼痛患者的患病率。
这是一项基于人群的队列研究。利用全国范围内关于药物配给和初级医疗（ICPC-2）和二级医疗（ICD-10）诊断的健康登记数据进行链接。慢性疼痛患者被定义为在 2018 年和 2019 年期间，至少有一次非恶性慢性疼痛镇痛药物处方的 18 岁以上患者（N=139434，69.3%为女性）。
当包含睡眠诊断时，任何精神健康诊断的患病率为 35.6%（95%置信区间：35.4%-35.9%），当排除睡眠诊断时，患病率为 29.0%（28.8%-29.3%）。最常见的诊断类别为睡眠障碍（14%[13.8%-14.2%]）、抑郁和相关障碍（10.1%[9.9%-10.2%]）和恐惧症及其他焦虑障碍（5.7%[5.5%-5.8%]）。与使用非阿片类药物相比，使用阿片类药物的患者中大多数诊断类别的患病率更高。总体患病率最高的是使用阿片类药物的年轻女性（18-44 岁）（50.1%[47.2%-53.0%]）。
接受镇痛药治疗的慢性疼痛患者中，精神健康诊断较为常见，尤其是在年轻个体和阿片类药物使用者中。阿片类药物的使用与高精神共病率相结合表明，临床医生除了关注躯体疼痛外，还应关注精神健康。
这项基于全国范围登记数据的大规模研究支持了之前关于慢性疼痛患者精神负担高的研究结果。与使用非阿片类药物镇痛的患者相比，无论年龄和性别如何，阿片类药物使用者的精神健康诊断患病率均显著更高。因此，患有慢性疼痛且使用阿片类药物的患者是一个特别脆弱的群体，他们的医生应密切跟踪他们，以确保他们同时得到对其精神和躯体症状的充分治疗。
