Psychiatric–Medical Comorbidity Association between anxiety, health-related quality of life and functional impairment in primary care patients with chronic pain ☆ , ☆☆ Kurt Kroenke, M.D. a, b, c, ⁎, Samantha Outcalt, Ph.D. a , Erin Krebs, M.D. d, e , Matthew J. Bair, M.D. a, b, c , Jingwei Wu, M.S. f , Neale Chumbler, Ph.D. a, g , Zhangsheng Yu, Ph.D. f a VA HSR&D Center for Implementing Evidence-Based Practice, Roudebush VA Medical Center, Indianapolis, IN, USA b Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA c Regenstrief Institute, Inc., Indianapolis, IN, USA d VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA e University of Minnesota Medical School, Minneapolis, MN, USA f Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA g Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA abstract article info Article history: Received 24 January 2013 Revised 21 March 2013 Accepted 25 March 2013 Available online xxxx Keywords: Anxiety Pain Quality of life Disability Comorbidity Objective: Anxiety and chronic pain are prevalent and frequently co-occur. Our purpose was to examine the association between anxiety, health-related quality of life (HRQL) and functional impairment in primary care patients with chronic musculoskeletal pain. Methods: Data were drawn from baseline interviews of the 250 primary care patients enrolled in the Stepped Care to Optimize Pain care Effectiveness trial. Validated measures were used to determine the proportion of patients screening positive for five common anxiety disorders: generalized anxiety, panic, social anxiety, posttraumatic stress and obsessive–compulsive disorder. Bivariate analyses examined associations between the type and number of anxiety disorders for which patients screened positive and representative pain, psychological and other HRQL outcomes. Multivariable models controlling for major depression and other covariates examined the association between the number of screen-positive anxiety conditions and functional impairment in psychological [SF-12 mental component summary (MCS) score], pain [Brief Pain Inventory (BPI) interference score] and work (disability days) domains. Results: One hundred fourteen (45%) patients screened positive for at least one anxiety disorder and, compared to the 136 screen-negative patients, had significantly worse scores across multiple pain, psychological and other HRQL domains. Substantial impairment was seen for each of the five screen-positive anxiety conditions and progressively worsened as the number of conditions increased from one (n=54) to two (n=26) to ≥3(n= 34). The number of screen-positive anxiety conditions was strongly associated (Pb .0001) with worse BPI interference and MCS scores and more disability days in models adjusting for age, sex and medical comorbidity. After further adjusting for major depression, associations were attenuated but remained significant for BPI interference (Pb .0001) and MCS (P=.018) and marginally significant for disability days (P= .062). Conclusion: Nearly half of primary care patients with chronic pain screen positive for one or more anxiety disorders, which in turn are adversely associated with impairment across multiple domains of HRQL. Detecting and treating anxiety may be an important component of pain management. © 2013 Published by Elsevier Inc. 1. Introduction Pain is the most common physical symptom-based condition reported in both the general population and in primary care [1], while depression and anxiety are the two most common psychological conditions [2]. Moreover, pain, depression and anxiety are among the leading causes of functional impairment, work-related disability and health care expenditures [3–5]. Additionally, pain, depression and anxiety frequently co-occur and have additive and adverse effects on General Hospital Psychiatry xxx (2013) xxx–xxx ☆ Trial Registration clinicaltrials.gov Identifier: NCT00926588. ☆☆ This work was supported by a Department of Veterans Affairs Health Services Research and Development Merit Review award to Dr. Kroenke (IIR 07–119) and Career Development Award to Dr. Krebs (CDA2 07–215). The sponsor had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report or in the decision to submit the article for publication. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. ⁎ Corresponding author. Regenstrief Institute, Indianapolis, IN 46202, USA. Tel.: +1 317 630 7447; fax: +1 317 630 8776. E-mail address: kkroenke@regenstrief.org (K. Kroenke). 0163-8343/$ – see front matter © 2013 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.genhosppsych.2013.03.020 Contents lists available at SciVerse ScienceDirect General Hospital Psychiatry journal homepage: http://www.ghpjournal.com Please cite this article as: Kroenke K, et al, Association between anxiety, health-related quality of life and functional impairment in primary care patients with chronic pain, Gen Hosp Psychiatry (2013), http://dx.doi.org/10.1016/j.genhosppsych.2013.03.020