It may come as no surprise that among the most well-documented effects that come with chronic pain is emotional distress or mood disturbance. In their very useful review paper, Banks and Kerns11 reported that depression is disproportionately prevalent in sufferers of chronic pain compared to other chronic medical conditions, that depression is most likely to be a result and not cause of chronic pain, and that 30.0-54.0 percent of patients seeking treatment for chronic pain suffer with a diagnosable depressive disorder. There is also evidence that patients with chronic pain have high prevalence rates of anxiety disorders, including panic disorder and generalized anxiety disorder, and substance use disorders, although the prevalence figures appear varied across studies.12 Rates of current anxiety disorders may range from 16.5 to 28.8 percent and current substance use disorders from 15 to 28 percent.12 In comparison with the clinical data, a recent nationally representative sample of the USA estimated that for chronic pain sufferers the prevalence of depression was 20.2 percent and for anxiety disorders it was 35.1 percent,13 suggesting a much higher rate of depression in clinical samples, but a similar rate of anxiety disorders.
Naturally, chronic pain can present occasions when patients feel misunderstood or mistreated, feel threatened by poor health, experience interference with normal daily functioning, take medications that can produce side effects, and experience depression and anxiety, as noted above. As a result of these circumstances they also experience anger,14,15 and health anxiety.16 Along with these emotions they experience a host of other distressing problems, such as loss of role functioning and personal identity,17 impaired neuropsychological functioning,18,19 20 21, 22 sexual dysfunction, and sleep disturbance. , In some cases they spend a disproportionate amount of their time seeking health care,23 which will clearly take time away from other important concerns.
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