• Maria Carmen Viana, LimCarmen C WCCWDepartment of Psychological Medicine, University of Otago, Dunedin, New Zealand., Garcia PereiraFlaviaFPost Graduate Program in Public Health, Federal University of Espírito Santo, Vitória, Brazil., Sergio Aguilar-Gaxiola, Jordi Alonso, Ronny Bruffaerts, Peter de Jonge, Jose Miguel Caldas-de-Almeida, Siobhan O'Neill, Dan J Stein, Ali Al-Hamzawi, Corina Benjet, Graça Cardoso, Silvia Florescu, Giovanni de Girolamo, Josep Maria Haro, Chiyi Hu, Viviane Kovess-Masfety, Daphna Levinson, Marina Piazza, José Posada-Villa, Daniel Rabczenko, Ronald C Kessler, and Kate M Scott.
• Department of Social Medicine, Federal University of Espírito Santo, Vitória, Brazil; Post Graduate Program in Public Health, Federal University of Espírito Santo, Vitória, Brazil. Electronic address: mcviana@uol.com.br.
• J Pain. 2018 Jan 1; 19 (1): 9911099-110.

UnlabelledAssociations between depression/anxiety and pain are well established, but its directionality is not clear. We examined the associations between temporally previous mental disorders and subsequent self-reported chronic back/neck pain onset, and investigated the variation in the strength of associations according to timing of events during the life course, and according to gender. Data were from population-based household surveys conducted in 19 countries (N = 52,095). Lifetime prevalence and age of onset of 16 mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the occurrence and age of onset of back/neck pain were assessed using the Composite International Diagnostic Interview. Survival analyses estimated the associations between first onset of mental disorders and subsequent back/neck pain onset. All mental disorders were positively associated with back/neck pain in bivariate analyses; most (12 of 16) remained so after adjusting for psychiatric comorbidity, with a clear dose-response relationship between number of mental disorders and subsequent pain. Early-onset disorders were stronger predictors of pain; when adjusting for psychiatric comorbidity, this remained the case for depression/dysthymia. No gender differences were observed. In conclusion, individuals with mental disorder, beyond depression and anxiety, are at higher risk of developing subsequent back/neck pain, stressing the importance of early detection of mental disorders, and highlight the need of assessing back/neck pain in mental health clinical settings.PerspectivePrevious mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition are positively associated with subsequent back/neck pain onset, with a clear dose-response relationship between number of mental disorders and subsequent pain. Earlier-onset mental disorders are stronger predictors of subsequent pain onset, compared with later-onset disorders.Copyright © 2017 The American Pain Society. Published by Elsevier Inc. All rights reserved.

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