Psychiatric comorbidities are prevalent in patients with chronic pancreatitis (CP) and associated with pain and reduced quality of life (QOL), Anna Evans Phillips, MD, MS, explains. “Prior studies have shown that anxiety and depression have an impact on the pain experience in other chronic pain conditions, such as low back pain, sickle cell disease, and osteoarthritis, but studies have not been conducted exploring their association with CP,” she says. “My colleagues and I aimed to find evidence to support a common assumption that anxiety and depression are highly prevalent in patients with CP.”
For a paper published in The American Journal of Gastroenterology, Dr. Phillips and colleagues used a screening questionnaire (Hospital Anxiety and Depression Scale), which allows patients to self-report common symptoms of anxiety and depression and helps to determine whether they have a higher-than-normal level of symptoms of either anxiety or depression. Patients from three centers (n = 171) completed the questionnaire, in addition to several others, about their pain (modified Brief Pain Inventory) and QOL (European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Form C30) experiences. Scores from each of the questionnaires were evaluated using regression analyses to determine relationships between psychiatric comorbidities, pain, and QOL among participants.
Notable Presence of Anxiety, Depression in Patients With Chronic Pancreatitis
“At baseline, no clear estimation of the prevalence of anxiety and depression had been performed in patients with CP, so this was the necessary first step for our team,” Dr. Phillips says. “We found that symptoms of anxiety were present in 46.8% of patients and symptoms of depression in 38.6%, with an overlap of both in 29%. Patients with anxiety or depression reported higher pain prevalence, pain severity, and pain interference scores than those without either comorbidity. Psychiatric comorbidities were also associated with reduced global health scales and functional subscales and higher symptom burden. In addition, an independent association was noted between global health status and depression.”
“The prevalence of anxiety and depression both increase with increasing frequency of pain in patients with CP,” Dr. Phillips explains (Figure). “There was a statistically significant difference seen between rates of anxiety and depression in patients with pain (intermittent or constant), compared with those who had no pain, suggesting that there is a strong link between pain and symptoms of both anxiety and depression in this disease process. Prior research has shown reduced QOL in patients with constant pain compared with intermittent pain. These data suggest that the likelihood of having a comorbid psychiatric condition increases with increasing pain frequency.”
Anxiety & Depression May Influence Pain
According to Dr. Phillips, anxiety and depression are not only highly comorbid in patients with CP, but they also likely influence the experience of pain in this patient population. “Patients with either psychiatric comorbidity were more likely to report pain (chronic or intermittent), more severe pain, and more pain interference in their daily lives than patients without anxiety or depression,” she notes, adding that it is imperative to screen patients with CP for these conditions at the earliest possible opportunity and treat them appropriately.
“Anxiety and depression are highly prevalent in patients with CP, and approximately one-third of patients experience symptoms of both,” says Dr. Phillips. “Effective treatment for comorbid anxiety or depression in this population may improve the patient’s overall experience of both pain and QOL. The prevalence of anxiety and depression should be confirmed in this population. In CP, where there are few effective treatments for pain and a cure for the underlying disease remains elusive, evaluation of the impact of treatment for comorbid anxiety and depression on pain and QOL will be of great future interest to those who work with this patient population. It is likely that treatment of these comorbid conditions may improve outcomes in CP. This is an area of research that has yet to be explored.”
Rebecca Shover