Premorbid Anxiety Impedes Progress in Medical Pain Management

Patients with chronic pain who also have a disorder prior to developing chronic pain, such as anxiety, do not do as well in a treatment program for chronic pain compared with patients who do not have premorbid anxiety, according to a study presented at the 2016 Annual Meeting of the Anxiety and Depression Association of America (ADAA).

“We need to intervene [and treat the co-morbidity] before we treat their chronic pain,” said Eric Seamann, PhD, University of Alabama, Huntsville, Alabama. “If patients have a pre-morbid history, they do not achieve the same gains through cognitive behavioural therapy as when they do not have a pre-morbid history. If we identify it [premorbid anxiety], we have to address it at the same time or ideally even before we treat chronic pain.”

Because physical symptoms of pre-morbid conditions like anxiety or depression mimic symptoms of chronic pain, Dr. Seamann said it is important to screen patients who present with chronic pain to determine if they have a condition or multiple co-morbidities and to get a complete history of their mental state.

“We want to make sure that we do not just gather information about symptoms from patients related to their chronic pain,” he said.

For the study, the researchers analysed 104 patients with active chronic pain. Patients completed the Brief Battery for Health Improvement 2 (BBHI-2) at initial assessment and a clinical interview with a licensed psychologist. Treatment records were also examined to arrive at a diagnosis of pre-morbid anxiety.

The researchers observed that anxiety, as measured by the BBHI-2, was significantly decreased through cognitive behavioural therapy for patients with chronic pain who did not have a pre-morbid history of anxiety (P < .001).

The data suggest that patients with chronic pain should not be managed with a one-size-fits-all approach when they present for management, but that an individualised approach that involves screening for pre-morbid conditions would be more appropriate.

[Presentation title: Premorbid Anxiety and Depression Impedes Progress in Medical Pain Management]