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: 4.09). 03/2006; 68(2):262-8. DOI: 10.1097/01.psy.0000204851.15499.fc
Source: PubMed

ABSTRACT 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.

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Available from: Christine M Blasey, Aug 04, 2015
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    • "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. "
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    Neuropharmacology 05/2014; 85. DOI:10.1016/j.neuropharm.2014.04.021 · 4.82 Impact Factor
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    • "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 ."
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    • "This comorbidity leads to serious clinical problems and has a larger negative impact on the quality of life (Arnow et al., 2006; Goldberg and McGee, 2011). Although the mechanisms concerning pain-emotion diseases have not been defined, preclinical studies have demonstrated a relationship between neuropathic pain and mood disorders in animal models (Arnow et al., 2006; Matsuzawa-Yanagida et al., 2008; Yalcin et al., 2011). In fact, previous studies have shown depression-related behavior in rodents subjected to sciatic nerve injury, a well-recognized model for neuropathic pain (Fukuhara et al., 2012; Jesse et al., 2010). "
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