CHRONIC PAIN AND DEPRESSION – ARBITRARINESS OR CONSECUTION OF THE PATIENT'S DIAGNOSTIC AND TREATMENT ROUTE

Abstract

Unrecognized depression among patients with chronic pain is a common medical problem, highlighting the need for targeted search and identification of depression-related symptoms. Purpose: The aim of the present study is to investigate the trends in the diagnostic and treatment pathway of comorbid patients with depression and chronic pain. Materials and Methods: 110 psychiatrists and 119 neurologists were interviewed through an anonymous, randomized survey in Bulgaria. Results: Referrals of the patients with chronic pain to neurologists and psychiatrists are not routine practice. The general practitioners are the main group, referring the patients with chronic pain to a consultation with a neurologist (89.10%) and a psychiatrist (68.20%). The patients themselves seek help more often from a neurologist (77.20%) than from a psychiatrist (44.50%). The most common reason for neurologists to consult their patients with a psychiatrist issuicidal ideation and intentions (50.42%) and the least common –insomnia (15.96%). According to psychiatrists, chronic pain patients seek help from them for other symptoms like somatic – vegetative ones (97.8%), anxiety (78.20%), insomnia (55.50%) and depressed mood (54.50%). More than 1/4 (29%) of them have had suicidal thoughts and intentions, which suggests a long history of depressive symptoms. Conclusions: The diagnostic and treatment processes of patients with chronic pain and depression are performed randomly rather than following a certain logical sequence. The creation of an algorithm for general practitioners and pain specialists aimed at early detection of symptoms of depression and related predictors of suicidal behavior is needed.

Keywords

• chronic pain
• depression
• comorbidity
• diagnostic and treatment pathway