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Depression and pain: an overview

  • Lana J. Williams (a1), Felice N. Jacka (a1), Julie A. Pasco (a1), Seetal Dodd (a1) and Michael Berk (a1)...

Abstract

Background:

Depression and pain are both burdensome ailments that affect a major proportion of the population. It is evident that depression and pain frequently coexist, with treatment and outcome implications.

Objective:

To review the literature on the nature, prevalence and co-morbidity of depression and pain, the biological and psychological mechanisms involved and treatment options, thus presenting a broad overview of the current information available.

Methods:

Relevant sources were identified from PubMed and Medline databases using a combination of keywords including depression, pain, prevalence, co-morbidity, biological and psychological mechanisms, serotonin (5-HT), norepinephrine (NE), hypothalamic-pituitary-adrenal (HPA) axis, amygdala, functional magnetic resonance imaging (fMRI), antidepressant and psychological therapy.

Results:

It is evident from the research that depression and pain are common co-morbidities. Pain as a physical symptom of depression affects approximately 65% of patients, leading to less favourable outcomes and greater health care utilization. Moreover, depression is a common feature in chronic pain patients and can affect pain threshold and tolerance. Evidence from biological and psychological studies has revealed mechanisms that link chronic pain to depression. Several classes of anti-depressants and psychological interventions have been used successfully in the treatment of somatic symptoms of depression and for a variety of pain syndromes.

Conclusions:

Pain and depression are linked by overlapping phenomenology, neurobiology and therapy. They are mutually interacting, and the interaction has significant treatment and outcome implications.

Copyright

Corresponding author

Lana J. Williams, Bpsych, Grad Dip App Psych, Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, PO Box 281, Geelong 3220, Australia, Tel: +61 35260 3085 Fax: +61 35246 5165; E-mail: lanaw@barwonhealth.org.au

References

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1.Murray, CJ, Lopez, AD. Global mortality, disability, and the contribution of risk factors: global burden disease study. Lancet 1997;349: 14361442.
2.Cassano, P, Fava, M. Depression and public health: an overview. J Psychosom Res 2002;53: 849857.
3.McConnell, S, Jacka, FN, Williams, LJ, Dodd, S, Berk, M. The relationship between depression and cardiovascular disease. Int J Psychiatry Clin Pract 2005;9: 157167.
4.Musselman, DL, Betan, E, Larsen, H, Phillips, LS. Relationship of depression to diabetes types 1 and 2: epidemiology, biology, treatment. Biol Psychiatry 2003;54: 317329.
5.Michelson, D, Stratakis, C, Hill, Let al. Bone mineral density in women with depression. N Engl J Med 1996;335: 11761181.
6.Robin, L, Regier, D, eds. Psychiatric Disorders in America. The Epidemiologic Catchment Area Study. New York: The Free Press, 1991.
7.Kessler, RC, Berglund, P, Demler, Oet al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003;289: 30953105.
8.Jenkins, R, Lewis, G, Bebbington, Pet al. The National Psychiatric Morbidity surveys of Great Britain – initial findings from the household survey. Psychol Med 1997;27: 775789.
9.Andrews, G, Henderson, S, Hall, W. Prevalence, comorbidity, disability and service utilisation. Overview of the Australian Mental Health Survey. Br J Psychiatry 2001;178: 145153.
10.Frischenschlager, O, Pucher, I. Psychological management of pain. Disabil Rehabil 2002;24: 416422.
11.Ruoff, GE. Depression in the patient with chronic pain. J Fam Pract 1996;43: S25S33.
12.Endler, NS, Corace, KM, Summerfeldt, LJ, Johnson, JM, Rothbart, P. Coping with chronic pain. Personal Ind Diff 2003;34: 323346.
13.Elliott, AM, Smith, BH, Hannaford, PC, Smith, WC, Chambers, WA. The course of chronic pain in the community: results of a 4-year follow-up study. Pain 2002; 99: 299307.
14.Van Den Kerkhof, E, Hopman, W, Towheed, T, Anastassiades, T, Goldstein, D. The impact of sampling and measurement on the prevalence of self reported pain in Canada. Pain Res Manage 2003;8: 157163.
15. Australian Bureau of Statistics. National Health Survey: use of Medications. Catalogue No. 4377.0, 1995.
16.Blyth, FM, March, LM, Brnabic, AJ, Jorm, LR, Williamson, M, Cousins, MJ. Chronic pain in Australia: a prevalence study. Pain 2001;89: 127134.
17.Department of Health. The prevalence of back pain in Great Britain in 1998. Great Britain: Department of Health, 1998.
18.Stover, E, Fenton, W, Rosenfeld, A, Insel, TR. Depression and co-morbid medical illness: the National Institute of Mental Health perspective. Biol Psychiatry 2003;54: 184186.
19.Fishbain, DA, Cutler, R, Rosomoff, HL, Rosomoff, RS. Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain 1997;13: 116137.
20.Stahl, SM. Does depression hurt? J Clin Psychiatry 2002;63: 273274.
21.Alonso, J, Angermeyer, MC, Bernert, Set al. Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004;420: 2127.
22.Bair, MJ, Robinson, RL, Katon, W, Kroenke, K. Depression and pain co-morbidity: a literature review. Arch Intern Med 2003;163: 24332445.
23.Corruble, E, Guelfi, JD. Pain complaints in depressed inpatients. Psychopathology 2000;33: 307309.
24.Kroenke, K, Spitzer, RL, Williams, JBet al. Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. Arch Fam Med 1994;3: 774779.
25.Bao, Y, Sturm, R, Croghan, TW. A national study of the effect of chronic pain on the use of health care by depressed persons. Psychiatr Serv 2003;54: 693697.
26.Harma, AM, Kaltiala-Heino, R, Rimpela, M, Rantanen, P. Are adolescents with frequent pain symptoms more depressed? Scand J Prim Health Care 2002;20: 9296.
27.Von Korff, M, Simon, G. The relationship between pain and depression. Br J Psychiatry Suppl 1996;30: 101108.
28.McBeth, J, Macfarlane, GJ, Silman, AJ. Does chronic pain predict future psychological distress? Pain 2002;96: 239245.
29.Sullivan, MD, Turner, JA, Romano, J. Chronic pain in primary care. Identification and management of psychosocial factors. J Fam Pract 1991;32: 193199.
30.Benjamin, S, Morris, S, McBeth, J, Macfarlane, GJ, Silman, AJ. The association between chronic widespread pain and mental disorder: a population-based study. Arthritis Rheum 2000;43: 561567.
31.Ohayon, MM, Schatzberg, AF. Using chronic pain to predict depressive morbidity in the general population. Arch Gen Psychiatry 2003;60: 3947.
32.Ohayon, MM. Specific characteristics of the pain/depression association in the general population. J Clin Psychiatry 2004;65 (Suppl. 12):59.
33.Meana, M, Cho, R, DesMeules, M. Chronic pain: the extra burden on Canadian women. BMC Womens Health 2004;4 (Suppl. 1):S17.
34.Campbell, LC, Clauw, DJ, Keefe, FJ. Persistent pain and depression: a biopsychosocial perspective. Biol Psychiatry 2003;54: 399409.
35.Delgado, PL. Common pathways of depression and pain. J Clin Psychiatry 2004;65 (Suppl. 12):1619.
36.Stahl, S, Briley, M. Understanding pain in depression. Hum Psychopharmacol 2004;19 (Suppl. 1):S9S13.
37.Blackburn-Munro, G. Hypothalamo-pituitary-adrenal axis dysfunction as a contributory factor to chronic pain and depression. Curr Pain Headache Rep 2004;8: 116124.
38.Blackburn-Munro, G, Blackburn-Munro, RE. Chronic pain, chronic stress and depression: coincidence or consequence? J Neuroendocrinol 2001;13: 10091023.
39.Heuser, I. Anna-Monika-Prize paper. The hypothalamic-pituitary-adrenal system in depression. Pharmacopsychiatry 1998;31: 1013.
40.Neugebauer, V, Li, W, Bird, GC, Han, JS. The amygdala and persistent pain. Neuroscientist 2004;10: 221234.
41.Neugebauer, V, Li, W. Differential sensitisation of amygdala neurons to afferent inputs in a model of arthritic pain. J Neurophysiol 2003;89: 716727.
42.Drevets, WC. Neuroimaging abnormalities in the amygdala in mood disorders. Ann N Y Acad Sci 2003;985: 420444.
43.Bowley, MP, Drevets, WC, Ongur, D, Price, JL. Low glial numbers in the amygdala in major depressive disorder. Biol Psychiatry 2002;52: 404412.
44.Drevets, WC. Neuroimaging studies of mood disorders. Biol Psychiatry 2000;48: 813829.
45.Whalen, PJ, Rauch, SL, Etcoff, NL, McInerney, SC, Lee, MB, Jenike, MA. Masked presentations of emotional facial expressions modulate amygdala activity without explicit knowledge. J Neurosci 1998;18: 411418.
46.Roozendaal, B, Koolhaas, JM, Bohus, B. The role of the central amygdala in stress and adaption. Acta Physiol Scand Suppl 1997;640: 5154.
47.Becerra, L, Breiter, HC, Wise, R, Gonzalez, RG, Borsook, D. Reward circuitry activation by noxious thermal stimuli. Neuron 2001;32: 927946.
48.Derbyshire, SW, Jones, AK, Gyulai, F, Clark, S, Townsend, D, Firestone, LL. Pain processing during three levels of noxious stimulation produces differential patterns of central activity. Pain 1997;73: 431445.
49.Petrovic, P, Carlsson, K, Petersson, KM, Hansson, P, Ingvar, M. Context-dependent deactivation of the amygdala during pain. J Cogn Neurosci 2004;16: 12891301.
50.Drevets, WC. Functional neuroimaging studies of depression: the anatomy of melancholia. Annu Rev Med 1998;49: 341361.
51.Krishnan, KR. Brain imaging correlates. J Clin Psychiatry 1999;60 (Suppl. 15):5054.
52.Beyer, JL, Krishnan, KR. Volume tric brain imaging findings in mood disorders. Bipolar Disord 2002;4: 89104.
53.Frodl, T, Meisenzahl, EM, Zetzsche, Tet al. Larger amygdala volumes in first depressive episode as compared to recurrent major depression and healthy control subjects. Biol Psychiatry 2003;53: 338344.
54.Buffington, AL, Hanlon, CA, McKeown, MJ. Acute and persistent pain modulation of attention-related anterior cingulate fMRI activations. Pain 2005;113: 172184.
55.Schneider, F, Habel, U, Holthusen, Het al Subjective ratings of pain correlate with subcortical-limbic blood flow: an fMRI study. Neuropsychobiology 2001;43: 175185.
56.Ploghaus, A, Tracey, I, Gati, JS, Clare, S, Menon, RS, Matthews, PM, Rawlins, JN. Dissociating pain from its anticipation in the human brain. Science 1999;284: 19791981.
57.Fulbright, RK, Troche, CJ, Skudlarski, P, Gore, JC, Wexler, BE. Functional MR imaging of regional brain activation associated with the affective experience of pain. AJR Am J Roentgenol 2001;177: 12051210.
58.Ciechanowski, P, Sullivan, M, Jensen, M, Romano, J, Summers, H. The relationship of attachment style to depression, catastrophising and health care utilization in patients with chronic pain. Pain 2003;104: 627637.
59.Gildenberg, PL. Management of chronic pain. Appl Neurophysiol 1984;47: 157170.
60.Katon, WJ. Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biol Psychiatry 2003;54: 216226.
61.Willoughby, SG, Hailey, BJ, Mulkana, S, Rowe, J. The effect of laboratory-induced depressed mood state on responses to pain. Behav Med 2002;28: 2331.
62.Sullivan, MJ, D'Eon, JL. Relation between catastrophising and depression in chronic pain patients. J Abnorm Psychol 1990;99: 260263.
63.Turner, JA, Jensen, MP, Romano, JM. Do beliefs, coping, and catastrophising independently predict functioning in patients with chronic pain? Pain 2000;85: 115125.
64.McCracken, LM, Vowles, KE, Eccleston, C. Acceptance of chronic pain: component analysis and a revised assessment method. Pain 2004;107: 159166.
65.McCracken, LM, Eccleston, C. Coping or acceptance: what to do about chronic pain? Pain 2003;105: 197204.
66.McCracken, LM. Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain 1998;74: 2127.
67.Rahman, A, Ambler, G, Underwood, MR, Shipley, ME. Important determinants of self-efficacy in patients with chronic musculoskeletal pain. J Rheumatol 2004;31: 11871192.
68.Arnstein, P. The mediation of disability by self efficacy in different samples of chronic pain patients. Disabil Rehabil 2000;22: 794801.
69.Arnstein, P, Caudill, M, Mandle, CL, Norris, A, Beasley, R. Self efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain patients. Pain 1999;80: 483491.
70.Kores, RC, Murphy, WD, Rosenthal, TL, Elias, DB, North, WC. Predicting outcome of chronic pain treatment via a modified self-efficacy scale. Behav Res Ther 1990;28: 165169.
71.Greden, JF. Physical symptoms of depression: unmet needs. J Clin Psychiatry 2003;64: 511.
72.Stewart, DE. Physical symptoms of depression: unmet needs in special populations. J Clin Psychiatry 2003;64 (Suppl. 7):1216.
73.Hendler, N. Depression caused by chronic pain. J Clin Psychiatry 1984;45: 3038.
74.Greco, T, Eckert, G, Kroenke, K. The outcome of physical symptoms with treatment of depression. J Gen Intern Med 2004;19: 813818.
75.Jain, R. Single-action versus dual-action antidepressants. J Clin Psychiatry 2004;6: 711.
76.Hickie, IB, Scott, EM, Davenport, TA. Are antidepressants all the same? Surveying the opinions of Australian psychiatrists. Aust N Z J Psychiatry 1999;33: 642649.
77.Iyengar, S, Webster, AA, Hemrick-Luecke, SK, Xu, JY, Simmons, RM. Efficacy of duloxetine, a potent and balanced serotonin-norepinephrine reuptake inhibitor in persistent pain models in rats. J Pharmacol Exp Ther 2004;311: 576584.
78.Detke, MJ, Wiltse, CG, Mallinckrodt, CH, McNamara, RK, Demitrack, MA, Bitter, I. Duloxetine in the acute and long-term treatment of major depressive disorder: a placebo- and paroxetine-controlled trial. Eur Neuropsychopharmacol 2004; 14: 457470.
79.Brannan, SK, Mallinckrodt, CH, Brown, EB, Wohlreich, MM, Watkin, JG, Schatzberg, AF. Duloxetine 60 mg once-daily in the treatment of painful physical symptoms in patients with major depressive disorder. J Psychiatr Res 2005;39: 4353.
80.Nelson, JC, Wohlreich, MM, Mallinckrodt, CH, Detke, MJ, Watkin, JG, Kennedy, JS. Duloxetine for the treatment of major depressive disorder in older patients. Am J Geriatr Psychiatry 2005;13: 227235.
81.Goldstein, DJ, Lu, Y, Detke, MJ, Wiltse, C, Mallinckrodt, C, Demitrack, MA. Duloxetine in the treatment of depression: a double-blind placebo-controlled comparison with paroxetine. J Clin Psychopharmacol 2004;24: 389399.
82.Bradley, RH, Barkin, RL, Jerome, J, Deyoung, K, Dodge, CW. Efficacy of venlafaxine for the long term treatment of chronic pain with associated major depressive disorder. Am J Ther 2003;10: 318323.
83.Lynch, ME. Antidepressants as analgesics: a review of randomised controlled trials. J Psychiatry Neurosci 2001;26: 3036.
84.Ashburn, MA, Staats, PS. Management of chronic pain. Lancet 1999;353: 18651869.
85.Arnold, LM, Lu, Y, Crofford, LJet al. A double-blind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder. Arthritis Rheum 2004;50: 29742984.
86.Kamata, M, Takahashi, H, Naito, S, Higuchi, H. Effectiveness of milnacipran for the treatment of chronic pain: a case series. Clin Neuropharmacol 2004;27: 208210.
87.Briley, M. Clinical experience with dual action antidepressants in different chronic pain syndromes. Hum Psychopharmacol 2004;19 (Suppl. 1):S21S25.
88.Fishbain, DA, Cutler, R, Rosomoff, HL, Rosomoff, RS. Evidence-based data from animal and human experimental studies on pain relief with antidepressants: a structured review. Pain Med 2000;1: 310316.
89.Ellis, P. Australian and New Zealand clinical practice guidelines for the treatment of depression. Aust N Z J Psychiatry 2004;38: 389407.
90.Embling, S. The effectiveness of cognitive behavioural therapy in depression. Nurs Stand 2002;17: 3341.
91.Hollon, SD, Jarrett, RB, Nierenberg, AA, Thase, ME, Trivedi, M, Rush, AJ. Psychotherapy and medication in the treatment of adult and geriatric depression: which monotherapy or combined treatment? J Clin Psychiatry 2005;66: 455468.
92.Sharpe, L, Sensky, T, Timberlake, N, Ryan, B, Allard, S. Long-term efficacy of a cognitive behavioural treatment from a randomised controlled trial for patients recently diagnosed with rheumatoid arthritis. Rheumatology (Oxford) 2003;42: 435441.
93.Evers, AW, Kraaimaat, FW, Van Riel, PL, De Jong, AJ. Tailored cognitive-behavioural therapy in early rheumatoid arthritis for patients at risk: a randomised controlled trial. Pain 2002;100: 141153.
94.Reid, MC, Otis, J, Barry, LC, Kerns, RD. Cognitive-behavioural therapy for chronic low back pain in older persons: a preliminary study. Pain Med 2003;4: 223230.
95.Nash, JM, Park, ER, Walker, BB, Gordon, N, Nicholson, RA. Cognitive-behavioural group treatment for disabling headache. Pain Med 2004;5: 178186.
96.Williams, DA, Cary, MA, Groner, KHet al. Improving physical functional status in patients with fibromyalgia: a brief cognitive behavioural intervention. J Rheumatol 2002;29: 12801286.
97.White, KP, Nielson, WR. Cognitive behavioural treatment of fibromyalgia syndrome: a follow-up assessment. J Rheumatol 1995;22: 717721.
98.Wells-Federman, C, Arnstein, P, Caudill, M. Nurse-led pain management program: effect on self-efficacy, pain intensity, pain-related disability, and depressive symptoms in chronic pain patients. Pain Manag Nurs 2002;3: 131140.
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