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2010 March Mayo Proceedings Psychosocial and NeP
Psychosocial comorbidities
Mayo Clin Proc. ? March 2010;85(3)(suppl):S42-S50 ? doi:10.4065/mcp.2009.0648 ? S42
For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.
of efficacy or adverse events often exceed 30%,1 and more
than 40% of patients enrolled in long-term, open-label
extensions of clinical trials for opioids terminate partici-
pation.2 Furthermore, opioids may be less effective in the
setting of neuropathic pain and have risk of misuse and
abuse that may exceed 40%.3-5 In some studies, investiga-
tors reported that more than 40% of patients with implant-
ed devices for pain control experience adverse events6; up
to 67.7% of patients treated with lumbar surgery for back
pain reported that their pain was worse after surgery,7 and
at least moderate adverse effects have been reported to oc-
cur in 30% to 61% of all patients who undergo spinal ma-
nipulations.8 These findings do not argue against the use of
such treatments but serve as reminders of limitations and
possible harmful effects.
The mean duration of pain in patients who seek treat-
ment at chronic pain treatment facilities is approximately
7 years.9 Consequently, all domains of their lives may have
been compromised for a substantial amount of time. It is
hardly surprising that levels of emotional distress for pa-
tients with persistent pain are high. Estimates suggest that
at least 1 current psychiatric diagnosis is present in 59% of
patients with chronic back pain treated at pain facilities and
at least 1 lifetime psychiatric diagnosis is present in 77% of
these patients.10 In contrast, community estimates are 15%
for at least 1 current psychiatric diagnosis and 29% to 38%
Assessment and Treatment of Psychosocial Comorbidities
in Patients With Neuropathic Pain
suPPlement ar icle
Dennis C. Turk, PhD; Joseph Audette, MD; Robert M. Levy, MD, PhD;
Sean C. Mackey, MD, PhD; and Steven Stanos, DO
Chronic neuropathic pain is a prevalen
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