Psychiatric illness and chronic pain-- chicken and egg

Polatin, P., R. Kinney, et al. (1993). "Psychiatric illness and chronic low-back pain. The mind and the spine--which goes first?" Spine 18(1): 66-71.

As an attempt to understand the relationship between my physical and psychological health, I decided to start looking for literatures on this subject.

The paper I read is titled “Psychiatric illness and chronic low-back pain—Which Goes First” (Polatin, Kinney et al. 1993) stated that people suffering from chronic low-back pain (meaning the pain last for over 6 months) often also have the propensity to have psychiatric co-morbidity such as major depression, anxiety disorder, psychosomatization, and, substance abuse. The assessment was done using the two-part Structural Clinical Interview for DSM-III-R with diagnosis using the DSM-III-R expression.

The most interesting finding I got from this paper was that, among the 200 subjects, 97 percent of the patients have the diagnosis of psychosomatization. What this tells me is that… as long as you experience chronic pain, the psychosomatization diagnosis is readily to be applied to you regardless whether the interview is conducted or not and such label doesn’t really give us much information to work with. And, there might be a problem of over-diagnosis associated with this phenomenon.

Since I did go into major depression and become even more psychotic than I normally am for a while after the injury, let’s take a look at the prevalence of major depression for these patients.

The premorbid depression was observed in 35% of the sample without a gender difference. However, the comorbid prevalence of major depression is 45% of the sample with female patients more prone to develop major depression. In addition, 29% of the patients develop depression after the injury.

What about people with psychotic disorders?

3 percent of the sample report to be psychotic and remained to be psychotic. Since the paper did not address the issue of the qualitative change in the experienced symptoms, I can’t really tell you much about the impact of chronic pain on other psychotic patients.

Reading the last sentence in this paper,

"Psychiatric distress may or may not be reactive to the low-back pain but will certainly contribute to a prolonged disability if left untreated."

Reading the last sentence in this paper, I sighed...

Would there be one day when someone would add this other phrase to the conclusion:

"Chronic pain and temporary disability may or may not be reactive to the psychiatric conditions but will certainly contribute to a prolonged disability if left untreated." 8-O lol