2010 March Mayo Proceedings Psychosocial and NeP.pdf

Psychosocial comorbidities Mayo Clin Proc. ? March 2010;85(3)(suppl):S42-S50 ? doi:10.4065/mcp.2009.0648 ? S42 For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings. of efficacy or adverse events often exceed 30%,1 and more than 40% of patients enrolled in long-term, open-label extensions of clinical trials for opioids terminate partici- pation.2 Furthermore, opioids may be less effective in the setting of neuropathic pain and have risk of misuse and abuse that may exceed 40%.3-5 In some studies, investiga- tors reported that more than 40% of patients with implant- ed devices for pain control experience adverse events6; up to 67.7% of patients treated with lumbar surgery for back pain reported that their pain was worse after surgery,7 and at least moderate adverse effects have been reported to oc- cur in 30% to 61% of all patients who undergo spinal ma- nipulations.8 These findings do not argue against the use of such treatments but serve as reminders of limitations and possible harmful effects. The mean duration of pain in patients who seek treat- ment at chronic pain treatment facilities is approximately 7 years.9 Consequently, all domains of their lives may have been compromised for a substantial amount of time. It is hardly surprising that levels of emotional distress for pa- tients with persistent pain are high. Estimates suggest that at least 1 current psychiatric diagnosis is present in 59% of patients with chronic back pain treated at pain facilities and at least 1 lifetime psychiatric diagnosis is present in 77% of these patients.10 In contrast, community estimates are 15% for at least 1 current psychiatric diagnosis and 29% to 38% Assessment and Treatment of Psychosocial Comorbidities in Patients With Neuropathic Pain suPPlement ar icle Dennis C. Turk, PhD; Joseph Audette, MD; Robert M. Levy, MD, PhD; Sean C. Mackey, MD, PhD; and Steven Stanos, DO Chronic neuropathic pain is a prevalen