Comorbid major psychopathology in chronic pain: a neglected clinical condition? Results from the P3 study

Objectives. Prevalence of major psychopathology in patients with chronic pain varies widely across studies and is overrated using screening instruments. The main goals of this investigation were: (1) to calculate the prevalence of major psychopathology in adults with chronic pain at the moment of their first contact with an Italian specialist pain clinic, and (2) to explore its relationship with the presence of current psychiatric comorbidity clinically diagnosed by mental healthcare specialists.

Methods. 172 patients were recruited within the “Pain Therapy” service” at the Parma University Hospital. They were assessed at entry using the Millon Clinical Multiaxial Inventory-III edition (MCMI-III). MCMI-III cut-off score of ≥ 75 in at least one of the clinical scales indicated the presence of a current major psychiatric syndrome. Clinical and sociodemographic data were also collected. Frequencies and prevalence rates of comorbid psychopathology were reported and discussed.

Results. 98 (57.6%) of participants with chronic pain showed MCMI-III scores indicative of a current, clinically relevant psychiatric syndrome, especially anxiety (n=41; 23.8%) and somatoform (n=25; 14.5%) disorders. However, only 31 participants (18%; 31.6% of the subsample scoring above 75 in at least one of the MCMI-III clinical scales) had a current, clinically diagnosed psychiatric comorbidity and declared a past specialist mental health contact or a retention in care within psychiatric services.

Conclusions. Although mental disorders are more common in subjects with chronic pain, a large portion of them remain undiagnosed and under-treated. Mental healthcare professionals stably involved in multidisciplinary teams for chronic pain management are thus recommended.