[Somatoform disorders with pain as the predominant symptom: results to distinguish a common group of diseases]

Abstract

According to a population-based prevalence study, medically unexplained pain syndromes are highly prevalent in the German general population. With a 1-year prevalence of 8% for somatoform pain disorders and a lifetime prevalence of 12.7%, they rank among the most prevalent conditions in the community. Until now, few studies have been conducted to characterize and differentiate patients with somatoform pain disorders in more detail. The present study is the first to examine a large patient cohort from a university hospital outpatient unit with somatoform disorders presenting with pain as the predominant complaint (n=282). Patients with a nociceptive or neuropathic pain mechanism were excluded after interdisciplinary diagnostic procedures, and all patients were differentiated in terms of comorbid psychic disorders and their symptom presentation. Psychic disorders were assessed using a standardized structured interview (SCID-I and SCID-II) and a structured biographical case history (MSBI) to assess chronification factors. The extent and distribution of bodily symptoms were collected using the screening for somatoform disorders (SOMS). A total of 69% of the patients examined suffered from anxiety and depressive disorders or other mental disorders, and only 14% had a comorbid personality disorder. More than 90% had further bodily symptoms apart from pain. The presence of mental disorders and the duration of the illness were associated with a higher number of bodily symptoms (e.g., fatigue, dizziness), for which they may also consult a doctor. In addition, the frequency of fibromyalgia syndrome increases with the extent of somatization. Our results ultimately support the idea of classifying this group of patients as an independent diagnostic group. They further suggest a future differentiation regarding the degree of impairment within this group similar to the systems of stages used in depressive disorders.