Журнал депрессии и тревоги
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The Association between Affectivity, Perceived Stress and Pain in Patients with Bipolar Disorder

Pontus Karling, Maripuu M, Wikgren M, Adolfsson R, Norrback KF

Objective: Patients with bipolar disorder commonly experience recurrent/chronic pain, usually associated with worsening of the psychic state. The primary aim of the study was to evaluate the association to state anxiety, depression, perceived stress and concurrent pain. A secondary aim was to determine the locations and characteristics of pain.

Method: A cross-sectional study was conducted on 87 bipolar type 1 and 50 bipolar type 2 patients (mean age 50.4 years; 63% women). HADS-A and HADS-D was used to determine the levels of anxiety and depression, the Perceived Stress Questionnaire (PSQ) was used to measure the perception of stress, and experience of pain was determined using a validated pain questionnaire including the duration, characteristics and location of pain.

Results: Eighty-six patients (63%) reported pain, and all but 5 of these had chronic pain (≥ 3 months). Patients with pain scored significantly higher on anxiety, depression and perceived stress, and significantly lower on well being than patients with no pain. In a logistic regression using different pain locations as the dependent variables and age, gender, HADS-D, HADS-A and PSQ index score as covariates, female gender was found to be significantly associated with abdominal pain (adjusted OR 4.59; CI: 1.09-19.2), thoracic spine pain (adjusted OR 4.32; CI: 1.37-14.3), shoulder pain (adjusted OR 3.39; CI: 1.17-4.39) and ≥3 pain locations (adjusted OR 2.55; CI: 1.06-6.13. In both males and females the experience of stress was significantly associated with the presence of any pain (adjusted OR 5.56; CI: 1.61-19.2), hip pain (adjusted OR 5.52; CI 1.41-21.7) and neck pain (adjusted OR 3.37; CI: 1.10-10.3). Finally, depressive mood is significantly associated with abdominal pain (adjusted OR 12.1; CI: 2.18-67.9) and knee pain (adjusted OR 5.90; CI:1.47-23.6).

Conclusions: In patients with bipolar disorder the experience of stress and depressive mood, but not level of anxiety, is strongly related to pain.