An age-based comparison of chronic pain clinic patients

Objective The aim of this study was to compare demographic, illness and per sonality characteristics, and formal rates of mental disorder between young er ( < 65 years) and older (greater than or equal to 65 years) patients att ending a chronic pain clinic. Method Patients with non-malignant pain of > 6 months' duration attending a specialist outpatient clinic were given a structured medical and psychiatr ic interview, and completed self-report questionnaires assessing disability , personality style and attitudes to illness. Results Fifty patients (26 of whom were older) participated in the study. N one of the older patients had experienced the onset of chronic pain before the age of 50 years. Although current and lifetime major depression were co mmon in both groups, there was no specific association between age and depr ession. The younger group was more likely to have been injured prior to the onset of pain and to be seeking financial compensation, reported more phys ical and social disability, and was more likely to be preoccupied with soma tic discomfort. The younger group was also more likely to be rated as displ aying impulsive personality traits and the older group anxious traits, alth ough there was no difference in neuroticism scores. Conclusion Despite a greater level of multiple medical morbidity and longer duration of pain, older patients with chronic pain were not more likely to suffer from concurrent depression, were less disabled and less somatically preoccupied than younger patients. There were sufficient differences in il lness and psychological characteristics to suggest that the older patients represented an aetiologically distinct sub-group, rather than patients with chronic pain of early onset who have simply grown old. Finally, the utilit y of DSM-IV defined somatofurm disorders, in particular pain disorder, is d iscussed. A model which integrates medical and psychological mechanisms is needed for clinical use. Copyright (C); 2001 John Wiley & Sons, Ltd.