Psychiatric disorders as assessed with SCID in chronic pain patients: the anxiety disorders precede the onset of pain.

OBJECTIVE: The aim of the study was to determine the prevalence of psychiatric disorders in patients referred to a tertiary pain clinic. The temporal relationship between the onset of pain and depression and anxiety and the association of psychiatric disorders with pain intensity were also analyzed.

METHOD: One hundred consecutive outpatients underwent a psychiatric assessment using the Structured Clinical Interview and Statistical Manual of Mental Disorders Axis I.

RESULTS: The psychiatric disorders diagnosed for the past 12 months included major depressive (37%), anxiety (25%) and substance use disorder (12%). The prevalence of any lifetime psychiatric disorder was 75%. Most anxiety disorders (77%) had been present before pain onset, whereas 63% of the depressive disorders appeared after the onset of pain. Psychiatric morbidity was associated with increased pain intensity.

CONCLUSIONS: Chronic pain patients have a remarkable psychiatric morbidity. A structured diagnostic interview, covering a large range of psychiatric diagnoses, allows a more comprehensive approach to the assessment of the patient. This should improve the management of chronic pain. However, prospective studies are needed to show this.