Comorbid Depression, Chronic Pain, and Disability in Primary Care

Department of Psychiatry and Behavioral Sciences, University School of Medicine, Stanford, CA, USA.
Psychosomatic Medicine (Impact Factor: 3.47). 03/2006; 68(2):262-8. DOI: 10.1097/01.psy.0000204851.15499.fc
Source: PubMed


The objectives of this study were to provide estimates of the prevalence and strength of association between major depression and chronic pain in a primary care population and to examine the clinical burden associated with the two conditions, singly and together.
A random sample of Kaiser Permanente patients who visited a primary care clinic was mailed a questionnaire assessing major depressive disorder (MDD), chronic pain, pain-related disability, somatic symptom severity, panic disorder, other anxiety, probable alcohol abuse, and health-related quality of life (HRQL). Instruments included the Patient Health Questionnaire, SF-8, and Graded Chronic Pain Questionnaire. A total of 5808 patients responded (54% of those eligible to participate).
Among those with MDD, a significantly higher proportion reported chronic (i.e., nondisabling or disabling) pain than those without MDD (66% versus 43%, respectively). Disabling chronic pain was present in 41% of those with MDD versus 10% of those without MDD. Respondents with comorbid depression and disabling chronic pain had significantly poorer HRQL, greater somatic symptom severity, and higher prevalence of panic disorder than other respondents. The prevalence of probable alcohol abuse/dependence was significantly higher among persons with MDD compared with individuals without MDD regardless of pain or disability level. Compared with participants without MDD, the prevalence of other anxiety among those with MDD was more than sixfold greater regardless of pain or disability level.
Chronic pain is common among those with MDD. Comorbid MDD and disabling chronic pain are associated with greater clinical burden than MDD alone.

Download full-text


Available from: Christine M Blasey,
1 Follower
76 Reads
    • "Consistent with previous research, nearly all participants said their HIV doctor was their most significant health support (Grierson et al., 2009). Many had longestablished relationships with their HIV doctor, which has been identified as an essential component to successful self-management (Arnow et al., 2006), and described their HIV doctor as the only person with whom they discussed their heath. Although trusted doctor–patient relationships are essential to HIV care and management, participants described feeling there was insufficient time in their medical consultations to deal with additional health concerns. "
    [Show abstract] [Hide abstract]
    ABSTRACT: As HIV has transitioned into a chronic disease, reappraisal of clinical management has occurred with chronic disease self-management (CDSM) as one possibility. However, despite extensive work on CDSM across a range of diseases, little attention has focused on psychosocial contexts of the lives of people for whom programs are intended. This article reports semi-structured interviews used to explore health practices and motivations of 33 people with HIV (PWHIV) in Australia. Within participants' accounts, different forms of subjectivity and agency emerged with implications for how they understood and valued health-related behaviors. Four themes arose: health support and disclosure, social support and stigma, employment/structure, and health decisions beyond HIV. The experience of stigma and its intersection with CDSM remains relatively un-chartered. This study found stigma shapes agency and engagement with health. Decisions concerning health behaviors are often driven by perceived social and emotional benefit embedded in concerns of disclosure and stigma. © The Author(s) 2015.
    Qualitative Health Research 08/2015; DOI:10.1177/1049732315600415 · 2.19 Impact Factor
  • Source
    • "In fact, emotional aspect is an intrinsic construct of chronic pain, and co-morbid depression is extensively observed in individuals who suffer from chronic neuropathic pain, with the co-occurrence up to 34% (Gustorff et al., 2008). Reciprocally, pain is one of the most common complaints in patients with depression (Arnow et al., 2006; Demyttenaere et al., 2006) and depressive symptoms may exacerbate or predict chronic pain (Burke et al., 2010; Tunks et al., 2008; Wang et al., 2012). The high prevalence of this co-morbidity intensifies the disamenity of neuropathic patients and deteriorates their overall life qualities (Gustorff et al., 2008), which necessitates improved treatment. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Patients suffering from chronic neuropathic pain are at high risk of co-morbid depression, which burdens healthcare. This work aimed to investigate the effects of resveratrol, a phenolic monomer enriched in red wine and grapes, on pain-related and depressive-like behaviors in mice with mononeuropathy, and explored the mechanism(s). Mice received chronic constriction injury (CCI) of sciatic nerves, and sequentially developed pain-related and depressive-like behaviors, as evidenced by sensory hypersensitivity (thermal hyperalgesia in Hargreaves test and mechanical allodynia in von Frey test) and behavioral despair (prolonged immobility time in forced swim test). Chronic treatment of neuropathic mice with resveratrol (30 mg/kg, p.o., twice per day for three weeks) normalized their thermal hyperalgesia (but not mechanical allodynia) and depressive-like behaviors, and these actions were abolished by chemical depletion of central serotonin (5-HT) but potentiated by co-treatment with 5-HTP, a precursor of 5-HT. The anti-hyperalgesia and anti-depression exerted by resveratrol may be pharmacologically segregated, since intrathecal (i.t.) and intracerebroventricular (i.c.v.) injection of methysergide, a non-selective 5-HT receptor antagonist, separately abrogated the two actions. Furthermore, the antihyperalgesic action of resveratrol was preferentially counteracted by co-administration of the 5-HT7 receptor antagonist SB-258719, while the anti-depression was abrogated by 5-HT1A receptor antagonist WAY-100635. These results confirm that chronic resveratrol administration exerts curative-like effects on thermal hyperalgesia and co-morbid depressive-like behaviors in mice with mononeuropathy. Spinal and supraspinal serotonergic systems (coupled with 5-HT7 and 5-HT1A receptors, respectively) are differentially responsible for the antihyperalgesic and antidepressant-like properties of resveratrol.
    Neuropharmacology 05/2014; 85. DOI:10.1016/j.neuropharm.2014.04.021 · 5.11 Impact Factor
  • Source
    • "al relationships to social support , IL - 6 , depressive symptoms , and pain . All primary analyses adjusted for the following covariates , assessed at T2 : body mass index ( BMI : kg / m 2 ) , age , education level , comorbidities , cancer stage , and time since treatment ( Everson et al . , 2002 ; Salgado et al . , 2003 ; Bozcuk et al . , 2004 ; Arnow et al . , 2006 ; Bjer - keset et al . , 2008 ) . The pain analyses also adjusted for pain medication use . Cancer treatment type is largely dictated by the current National Comprehensive Cancer Network ( NCCN ) guidelines , providing reasonable treatment uniformity within each cancer stage ."
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective Pain and depressive symptoms are commonly experienced by cancer survivors. Lower social support is linked to a variety of negative mental and physical health outcomes among survivors. Immune dysregulation may be one mechanism linking low social support to the development of pain and depressive symptoms over time. Accordingly, the goal of the present study was to examine the relationships among survivors’ social support, pain, depressive symptoms, and inflammation. Methods Breast cancer survivors (N = 164, stages 0-IIIA) completed two study visits, one before any cancer treatment and the other 6 months after the completion of surgery, radiation, or chemotherapy, whichever came last. Women completed self-report questionnaires assessing social support, pain, and depressive symptoms, and provided a blood sample at both visits. Results Survivors with lower social support prior to treatment experienced higher levels of pain and depressive symptoms over time than their more socially supported counterparts. Furthermore, women with lower pretreatment social support had higher levels of IL-6 over time, and these elevations in IL-6 predicted marginally larger increases in depressive symptoms. Conclusions The results of this study suggest that social support at the time of diagnosis predicts the post-treatment development of pain, depressive symptoms, and inflammation. Consequently, early interventions targeting survivors’ social networks could improve quality of life during survivorship.
    Psychoneuroendocrinology 04/2014; 42:38-44. DOI:10.1016/j.psyneuen.2013.12.016 · 4.94 Impact Factor
Show more