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 Table of Contents  
Year : 2016  |  Volume : 30  |  Issue : 2  |  Page : 108-110

A cross-sectional observational study on the levels of anxiety, depression, and somatic symptoms in patients with chronic pain undergoing physiotherapy treatment

1 Department of Physiotherapy, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
2 Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India

Date of Web Publication18-Jul-2016

Correspondence Address:
Avinash De Sousa
Carmel, 18, St. Francis Road, Off S.V. Road, Santacruz (W), Mumbai - 400 054, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-5333.186466

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Introduction: Chronic pain is one of the most common complaints with which patients present to the physiotherapist. Somatic symptoms, anxiety, and depression are common in this group of patients. The present study was carried out to assess the levels of somatic symptoms, anxiety, and depression in patients with chronic pain. Materials and Methods: About 200 patients (113 male and 87 females) with chronic pain were subjects of the study. They were administered the Chronic Pain Grade Questionnaire, Somatic Symptom Severity-8 scale, and the Hospital Anxiety and Depression Scale. The scores were assessed using descriptive statistics and correlation where needed. Results: Grade II or moderate pain was the commonest severity of pain reported (42 males and 34 females). Most patients reported a low prevalence of somatic symptoms (43 males and 39 females). Combined anxiety and depression levels were seen across both genders (56 males and 52 females). A positive correlation between chronic pain grade and levels of anxiety and depression as well as severity of somatic symptoms were noted across both genders (P < 0.0001). Conclusion: Levels of depression, anxiety, and somatic symptoms are common in patients with chronic pain and also are directly related to the level of intensity of pain.

Keywords: Anxiety, chronic pain, depression, pain, somatic symptoms

How to cite this article:
Patil V, Deshmukh A, Naik R, De Sousa A. A cross-sectional observational study on the levels of anxiety, depression, and somatic symptoms in patients with chronic pain undergoing physiotherapy treatment. Indian J Pain 2016;30:108-10

How to cite this URL:
Patil V, Deshmukh A, Naik R, De Sousa A. A cross-sectional observational study on the levels of anxiety, depression, and somatic symptoms in patients with chronic pain undergoing physiotherapy treatment. Indian J Pain [serial online] 2016 [cited 2022 Oct 3];30:108-10. Available from: https://www.indianjpain.org/text.asp?2016/30/2/108/186466

  Introduction Top

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. [1] It is one of the most common complaints with which patients present to physiotherapy clinics. [2] Pain is defined as chronic when persists for more than 1 month after anticipated tissue healing and has been present for at least 3 of the previous 6 months. [3] Common causes of chronic pain include joint arthritis, degenerative disc disease, traumatic injuries, and various types of headache. [4] Chronic pain is also a common accompaniment of conditions such as fibromyalgia [5] and depression. [6] Somatic symptoms are defined as symptoms that are physical in nature but caused due to underlying psychological phenomena or factors. [7] Somatic symptoms are commonly seen in patients with chronic pain and major depression while they may be an integral part of anxiety disorders as well. [8] Chronic pain and depression may share common underlying cognitive and behavioral processes. [9] The aim of the following study was to assess the prevalence of somatic symptoms in patients with chronic pain undergoing physiotherapy treatment.

  Materials and Methods Top

The subjects were patients that presented for the treatment of pain in the physiotherapy out-patient department of a tertiary general hospital. The study was carried out over 3 months between January and March 2015. The study was a cross-sectional observational study. The inclusion criteria was the presence of chronic musculoskeletal pain for a duration of more than 3 months. Patients with malignancies, infections, recent fractures and surgery or major medical and surgical conditions influencing the pain were excluded from the study. Most patients presenting to the physiotherapy out-patient department have musculoskeletal pain. 243 patients were screened and 200 consecutive patients that met our inclusion criteria were subjects of the study. No power analysis was carried out, and the sample size was arbitrary as a small time frame of 3 months was allotted for the study. All patients included were in the age range 18-60 years. All patients were informed about the aims of the study and a written informed valid consent was obtained. The study was approved by the institutional ethics committee of the hospital. The questionnaires used in the study were:

  • The Somatic Symptoms Scale-8 - this is a brief self-report questionnaire that is used to measure the burden of somatic symptoms and it measures commonly occurring somatic symptoms in clinical practice [10]
  • The Chronic Pain Grade Questionnaire - this is a questionnaire for grading pain and it assesses two dimensions of the severity of chronic pain - intensity and disability [11]
  • Hospital Anxiety and Depression Scale (HADS) - this is a scale that is used to detect anxiety and depression in patients that have been admitted or undergoing treatment in a hospital setting. It is a widely used scale to assess anxiety and depression in medical populations. [12]
The parameters studied using the scale were pain intensity and pain related disability, level of anxiety and depression, and severity of somatic symptoms. The data were collected and descriptive statistics with percentages as well as correlation coefficient estimation using Graph Pad statistical online software (Graph Pad Software Inc. USA) was done.

  Results Top

The total number of subjects in the study was 200. 113 were males and 87 were females. The mean age of male subjects was 39.8 ± 8.9 years while that of females was 40.1 ± 8.6 years. In both genders, it was observed that Grade II intensity of pain was the most common. Most patients across both genders reported low to a moderate prevalence of somatic symptoms. When the subjects were assessed on the HADS it was noted that the presence of anxiety and depression together was the most common across both genders. None of the variable like grade of pain, severity of somatic symptoms, and anxiety or depression showed any differences across genders [Table 1]. A positive correlation was obtained when the pain grade score was correlated with both severity of somatic symptoms and levels of anxiety and depression [Table 2].
Table 1: Findings in ratings across gender

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Table 2: Correlation values between the scales and chronic pain grade

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  Discussion Top

Majority of subjects had Grade II pain which indicates a moderate intensity. This is due to the fact that the pain very often though existing was sometimes not explained medically and the overall level of disability was less. The level of pain usually is in this range when noted in studies with patients that come in for physiotherapy treatment. [13] A moderate grade of pain also explains that most subjects in the study reported a low severity of somatic symptoms. This is in keeping with studies where researchers have found that a worsening of pain leads to a greater degree of somatic symptoms. [14] A positive correlation in this regard has been reported in the present study. A combined level of anxiety and depression were noted in subjects. This is in keeping with studies that report both anxiety and depression in patients with chronic pain. [15] Anxiety disorders and depression have been commonly seen in patients with conditions that involve chronic pain. [16] It has also been noted from a neurobiological perspective that chronic pain may lead to a continuous release of inflammatory mediators like cytokines in the brain that could contribute to the development of anxiety and depression in this population. [17] However, our study did not conduct a diagnostic assessment for anxiety and depressive disorders but rather levels of anxiety and depression were studied. Pain intensity has been correlated with the presence of anxiety and depression. [18] Our study also elicited this positive correlation. The limitations of this study were a lack of diagnostic tools and small sample size. The associations ascertained were rather general and some confounding factors may have been missed. However, further studies in this area are indicated to elucidate more relationships between variables such as pain, depression, anxiety, and somatic symptoms.

  Conclusions Top

Anxiety, depression and somatic symptoms are common in patients in with chronic pain. It is prudent that in treatment settings where patients with chronic pain receive physiotherapy one must screen for these disorders as alleviation of these symptoms may in turn provide better response to physiotherapy as well improve overall quality of life of patients with chronic pain.

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Conflicts of interest

There are no conflicts of interest.

  References Top

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Bushnell MC, Ceko M, Low LA. Cognitive and emotional control of pain and its disruption in chronic pain. Nat Rev Neurosci 2013;14:502-11.  Back to cited text no. 4
English B. Neural and psychosocial mechanisms of pain sensitivity in fibromyalgia. Pain Manag Nurs 2014;15:530-8.  Back to cited text no. 5
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Nicholas MK, Asghari A, Corbett M, Smeets RJ, Wood BM, Overton S, et al. Is adherence to pain self-management strategies associated with improved pain, depression and disability in those with disabling chronic pain? Eur J Pain 2012;16:93-104.  Back to cited text no. 9
Gierk B, Kohlmann S, Kroenke K, Spangenberg L, Zenger M, Brähler E, et al. The somatic symptom scale-8 (SSS-8): A brief measure of somatic symptom burden. JAMA Intern Med 2014;174:399-407.  Back to cited text no. 10
Smith BH, Penny KI, Purves AM, Munro C, Wilson B, Grimshaw J, et al. The Chronic Pain Grade questionnaire: Validation and reliability in postal research. Pain 1997;71:141-7.  Back to cited text no. 11
Anthony SZ, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361-70.  Back to cited text no. 12
Häuser W, Wolfe F, Henningsen P, Schmutzer G, Brähler E, Hinz A. Untying chronic pain: Prevalence and societal burden of chronic pain stages in the general population - A cross-sectional survey. BMC Public Health 2014;14:352.  Back to cited text no. 13
Wolfe F, Brähler E, Hinz A, Häuser W. Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: Results from a survey of the general population. Arthritis Care Res (Hoboken) 2013;65:777-85.  Back to cited text no. 14
Thibodeau MA, Welch PG, Katz J, Asmundson GJ. Pain-related anxiety influences pain perception differently in men and women: A quantitative sensory test across thermal pain modalities. Pain 2013;154:419-26.  Back to cited text no. 15
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Jaremka LM, Fagundes CP, Glaser R, Bennett JM, Malarkey WB, Kiecolt-Glaser JK. Loneliness predicts pain, depression, and fatigue: Understanding the role of immune dysregulation. Psychoneuroendocrinology 2013;38:1310-7.  Back to cited text no. 17
Holmes A, Christelis N, Arnold C. Depression and chronic pain. Med J Aust 2013;199 6 Suppl: S17-20.  Back to cited text no. 18


  [Table 1], [Table 2]

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