Academic journal article Iranian Journal of Psychiatry

The High Prevalence of Obsessive-Compulsive Disorder in Patients with Chronic Pain

Academic journal article Iranian Journal of Psychiatry

The High Prevalence of Obsessive-Compulsive Disorder in Patients with Chronic Pain

Article excerpt

Chronic pain prevalence of 10 to 42% in the general population makes it a coimnon disorder, which imposes a great deal of disability and despair (1) (2). About 85% of chronic patients still suffer from pain after 12 years, and during this time have had a significantly higher mortality rate (3).

One of the most common definitions of chronic pain is from the International Association for the Study of Pain (IASP): "A pain longer than three months" (4). Many studies have been conducted on the comorbidity of chronic pain with psychiatric disorders, reporting up to 65% prevalence (5).

The most coimnon and most studied disorder is major depressive disorder (MDD) that affects up to 50% of chronic pain patients in pain clinics or rehabilitation programs (5).

Many studies showed the reciprocal connection of psychiatric disorders like depression and anxiety with chronic pain such that the presence of one increases the prevalence of the other (1, 6-8). However, the onset of most anxiety disorders precedes the onset of chronic pain in contrast to MDD (9), and associations between several pain conditions and anxiety disorders were stronger than depression (10).

Among anxiety disorders, there has been greater focus on generalized anxiety disorder (GAD) (11) and post-traumatic stress disorder (PTSD) (12). Among other anxiety disorders, obsessive compulsive disorder (OCD) deserves special attention. OCD is estimated to be the fourth most prevalent life time psychiatric disorder (13); it is even more coimnon in psychiatric climes (up to 10%) (13). By considering the subclinical OCD that lias at least the same prevalence of OCD, this percentage doubles. Both the OCD and subclinical OCD patients had impaired quality of life (14). OCD patients have selective attention to pain related stimulus (15).

In the Iranian general population survey, among 25180 individuals, based on DSM-IV criteria, OCD prevalence was 1.8% (0.7% males and 2.8% females) that is within the range of other countries (16). Within 3515 patients in an outpatient psychiatric clinic in Iran, 4.72% were diagnosed to have OCD, and the most common psychiatric comorbidity was MDD (44.57%) (17).

To the best of our knowledge, data on the prevalence of OCD in chronic pain are available as only a part of survey studies of all psychiatric disorders. The reported prevalence of OCD widely varies from 0.0% (18), 1.1% (19) and 2% (9) in two DSM-IV based studies to 2.2% (20) and 8% (21) in DSM-III-R studies. Moreover, there is no data on the prevalence of chronic pain in OCD. However, there is a case report on the possibility of correlation of OCD with facial chronic pain after plastic surgery (22) or possible union in strength between OCD and low back pain (23).

Therefore, because of the special characteristics of anxiety disorders and lack of data on the prevalence and possible effects of OCD in managing chronic pain, we studied the prevalence of OCD in chronic pain patients. Due to the precedent onset of OCD to the onset of chronic pain (9), OCD may be considered as an etiological factor in chronic pain.

Material and Methods

The attendees of pain clinic in outpatient setting during a three month period who agreed to participate in the study were screened for having chronic pain disorder for more than three months (4). The protocol was approved by the Shahid Beheshti Medical University Ethics Committee, and the research followed the tenets of the Declaration of Helsinki. After providing sufficient information to the participants, written informed consent was obtained from all of them

Ninety three patients met the chronic pain criteria. They were interviewed based on DSM-IV using the Persian translation and cultural adaptation of Structured Clinical Interview for DSM-IV-TR (SCID-I) for lifetime OCD and current MDD criteria. SCID-I is a stmctured interview tool that was first created in 1992 for the diagnosis of axis-I psychiatric disorders, and different studies confirmed its reliability and validity (24, 25). …

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