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Depression and pain: an overview

Published online by Cambridge University Press:  24 June 2014

Lana J. Williams ,
Felice N. Jacka ,
Julie A. Pasco ,
Seetal Dodd  and
Michael Berk
Lana J. Williams*
Affiliation:
Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Victoria, Australia
Felice N. Jacka
Affiliation:
Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Victoria, Australia
Julie A. Pasco
Affiliation:
Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Victoria, Australia
Seetal Dodd
Affiliation:
Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Victoria, Australia
Michael Berk
Affiliation:
Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Victoria, Australia
*
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
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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.

Keywords

biological and psychological mechanismsco-morbiditydepressionpainprevalencetreatment
Type
Review Article
Information
Acta Neuropsychiatrica , Volume 18 , Issue 2 , April 2006 , pp. 79 - 87
Copyright
Copyright © 2006 Blackwell Munksgaard

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References

Murray, CJ, Lopez, AD. Global mortality, disability, and the contribution of risk factors: global burden disease study. Lancet 1997;349: 1436–1442. CrossRefGoogle ScholarPubMed
Cassano, P, Fava, M. Depression and public health: an overview. J Psychosom Res 2002;53: 849–857. CrossRefGoogle ScholarPubMed
McConnell, S, Jacka, FN, Williams, LJ, Dodd, S, Berk, M. The relationship between depression and cardiovascular disease. Int J Psychiatry Clin Pract 2005;9: 157–167. CrossRefGoogle ScholarPubMed
Musselman, DL, Betan, E, Larsen, H, Phillips, LS. Relationship of depression to diabetes types 1 and 2: epidemiology, biology, treatment. Biol Psychiatry 2003;54: 317–329. CrossRefGoogle ScholarPubMed
Michelson, D, Stratakis, C, Hill, Let al. Bone mineral density in women with depression. N Engl J Med 1996;335: 1176–1181. CrossRefGoogle ScholarPubMed
Robin, L, Regier, D, eds. Psychiatric Disorders in America. The Epidemiologic Catchment Area Study. New York: The Free Press, 1991. Google Scholar
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: 3095–3105. CrossRefGoogle Scholar
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: 775–789. CrossRefGoogle ScholarPubMed
Andrews, G, Henderson, S, Hall, W. Prevalence, comorbidity, disability and service utilisation. Overview of the Australian Mental Health Survey. Br J Psychiatry 2001;178: 145–153. CrossRefGoogle Scholar
Frischenschlager, O, Pucher, I. Psychological management of pain. Disabil Rehabil 2002;24: 416–422. CrossRefGoogle Scholar
Ruoff, GE. Depression in the patient with chronic pain. J Fam Pract 1996;43: S25–S33. Google ScholarPubMed
Endler, NS, Corace, KM, Summerfeldt, LJ, Johnson, JM, Rothbart, P. Coping with chronic pain. Personal Ind Diff 2003;34: 323–346. CrossRefGoogle Scholar
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: 299–307. CrossRefGoogle ScholarPubMed
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: 157–163. CrossRefGoogle Scholar
Australian Bureau of Statistics. National Health Survey: use of Medications. Catalogue No. 4377.0, 1995.Google Scholar
Blyth, FM, March, LM, Brnabic, AJ, Jorm, LR, Williamson, M, Cousins, MJ. Chronic pain in Australia: a prevalence study. Pain 2001;89: 127–134. CrossRefGoogle ScholarPubMed
Department of Health. The prevalence of back pain in Great Britain in 1998. Great Britain: Department of Health, 1998. Google Scholar
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: 184–186. CrossRefGoogle Scholar
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: 116–137. CrossRefGoogle ScholarPubMed
Stahl, SM. Does depression hurt? J Clin Psychiatry 2002;63: 273–274. CrossRefGoogle ScholarPubMed
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: 21–27. Google Scholar
Bair, MJ, Robinson, RL, Katon, W, Kroenke, K. Depression and pain co-morbidity: a literature review. Arch Intern Med 2003;163: 2433–2445. CrossRefGoogle ScholarPubMed
Corruble, E, Guelfi, JD. Pain complaints in depressed inpatients. Psychopathology 2000;33: 307–309. CrossRefGoogle ScholarPubMed
Kroenke, K, Spitzer, RL, Williams, JBet al. Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. Arch Fam Med 1994;3: 774–779. CrossRefGoogle ScholarPubMed
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: 693–697. CrossRefGoogle Scholar
Harma, AM, Kaltiala-Heino, R, Rimpela, M, Rantanen, P. Are adolescents with frequent pain symptoms more depressed? Scand J Prim Health Care 2002;20: 92–96. CrossRefGoogle ScholarPubMed
Von Korff, M, Simon, G. The relationship between pain and depression. Br J Psychiatry Suppl 1996;30: 101–108. Google Scholar
McBeth, J, Macfarlane, GJ, Silman, AJ. Does chronic pain predict future psychological distress? Pain 2002;96: 239–245. CrossRefGoogle ScholarPubMed
Sullivan, MD, Turner, JA, Romano, J. Chronic pain in primary care. Identification and management of psychosocial factors. J Fam Pract 1991;32: 193–199. Google ScholarPubMed
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: 561–567. 3.0.CO;2-O>CrossRefGoogle ScholarPubMed
Ohayon, MM, Schatzberg, AF. Using chronic pain to predict depressive morbidity in the general population. Arch Gen Psychiatry 2003;60: 39–47. CrossRefGoogle ScholarPubMed
Ohayon, MM. Specific characteristics of the pain/depression association in the general population. J Clin Psychiatry 2004;65 (Suppl. 12):5–9. Google ScholarPubMed
Meana, M, Cho, R, DesMeules, M. Chronic pain: the extra burden on Canadian women. BMC Womens Health 2004;4 (Suppl. 1):S17. CrossRefGoogle ScholarPubMed
Campbell, LC, Clauw, DJ, Keefe, FJ. Persistent pain and depression: a biopsychosocial perspective. Biol Psychiatry 2003;54: 399–409. CrossRefGoogle ScholarPubMed
Delgado, PL. Common pathways of depression and pain. J Clin Psychiatry 2004;65 (Suppl. 12):16–19. Google ScholarPubMed
Stahl, S, Briley, M. Understanding pain in depression. Hum Psychopharmacol 2004;19 (Suppl. 1):S9–S13. CrossRefGoogle ScholarPubMed
Blackburn-Munro, G. Hypothalamo-pituitary-adrenal axis dysfunction as a contributory factor to chronic pain and depression. Curr Pain Headache Rep 2004;8: 116–124. CrossRefGoogle ScholarPubMed
Blackburn-Munro, G, Blackburn-Munro, RE. Chronic pain, chronic stress and depression: coincidence or consequence? J Neuroendocrinol 2001;13: 1009–1023. CrossRefGoogle ScholarPubMed
Heuser, I. Anna-Monika-Prize paper. The hypothalamic-pituitary-adrenal system in depression. Pharmacopsychiatry 1998;31: 10–13. CrossRefGoogle ScholarPubMed
Neugebauer, V, Li, W, Bird, GC, Han, JS. The amygdala and persistent pain. Neuroscientist 2004;10: 221–234. CrossRefGoogle ScholarPubMed
Neugebauer, V, Li, W. Differential sensitisation of amygdala neurons to afferent inputs in a model of arthritic pain. J Neurophysiol 2003;89: 716–727. CrossRefGoogle Scholar
Drevets, WC. Neuroimaging abnormalities in the amygdala in mood disorders. Ann N Y Acad Sci 2003;985: 420–444. CrossRefGoogle ScholarPubMed
Bowley, MP, Drevets, WC, Ongur, D, Price, JL. Low glial numbers in the amygdala in major depressive disorder. Biol Psychiatry 2002;52: 404–412. CrossRefGoogle ScholarPubMed
Drevets, WC. Neuroimaging studies of mood disorders. Biol Psychiatry 2000;48: 813–829. CrossRefGoogle ScholarPubMed
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: 411–418. Google ScholarPubMed
Roozendaal, B, Koolhaas, JM, Bohus, B. The role of the central amygdala in stress and adaption. Acta Physiol Scand Suppl 1997;640: 51–54. Google ScholarPubMed
Becerra, L, Breiter, HC, Wise, R, Gonzalez, RG, Borsook, D. Reward circuitry activation by noxious thermal stimuli. Neuron 2001;32: 927–946. CrossRefGoogle ScholarPubMed
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: 431–445. CrossRefGoogle ScholarPubMed
Petrovic, P, Carlsson, K, Petersson, KM, Hansson, P, Ingvar, M. Context-dependent deactivation of the amygdala during pain. J Cogn Neurosci 2004;16: 1289–1301. CrossRefGoogle ScholarPubMed
Drevets, WC. Functional neuroimaging studies of depression: the anatomy of melancholia. Annu Rev Med 1998;49: 341–361. CrossRefGoogle ScholarPubMed
Krishnan, KR. Brain imaging correlates. J Clin Psychiatry 1999;60 (Suppl. 15):50–54. Google ScholarPubMed
Beyer, JL, Krishnan, KR. Volume tric brain imaging findings in mood disorders. Bipolar Disord 2002;4: 89–104. CrossRefGoogle Scholar
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: 338–344. CrossRefGoogle ScholarPubMed
Buffington, AL, Hanlon, CA, McKeown, MJ. Acute and persistent pain modulation of attention-related anterior cingulate fMRI activations. Pain 2005;113: 172–184. CrossRefGoogle ScholarPubMed
Schneider, F, Habel, U, Holthusen, Het al Subjective ratings of pain correlate with subcortical-limbic blood flow: an fMRI study. Neuropsychobiology 2001;43: 175–185. CrossRefGoogle Scholar
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: 1979–1981. CrossRefGoogle ScholarPubMed
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: 1205–1210. CrossRefGoogle Scholar
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: 627–637. CrossRefGoogle Scholar
Gildenberg, PL. Management of chronic pain. Appl Neurophysiol 1984;47: 157–170. Google ScholarPubMed
Katon, WJ. Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biol Psychiatry 2003;54: 216–226. CrossRefGoogle ScholarPubMed
Willoughby, SG, Hailey, BJ, Mulkana, S, Rowe, J. The effect of laboratory-induced depressed mood state on responses to pain. Behav Med 2002;28: 23–31. CrossRefGoogle Scholar
Sullivan, MJ, D'Eon, JL. Relation between catastrophising and depression in chronic pain patients. J Abnorm Psychol 1990;99: 260–263. CrossRefGoogle Scholar
Turner, JA, Jensen, MP, Romano, JM. Do beliefs, coping, and catastrophising independently predict functioning in patients with chronic pain? Pain 2000;85: 115–125. CrossRefGoogle Scholar
McCracken, LM, Vowles, KE, Eccleston, C. Acceptance of chronic pain: component analysis and a revised assessment method. Pain 2004;107: 159–166. CrossRefGoogle Scholar
McCracken, LM, Eccleston, C. Coping or acceptance: what to do about chronic pain? Pain 2003;105: 197–204. CrossRefGoogle ScholarPubMed
McCracken, LM. Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain 1998;74: 21–27. CrossRefGoogle ScholarPubMed
Rahman, A, Ambler, G, Underwood, MR, Shipley, ME. Important determinants of self-efficacy in patients with chronic musculoskeletal pain. J Rheumatol 2004;31: 1187–1192. Google ScholarPubMed
Arnstein, P. The mediation of disability by self efficacy in different samples of chronic pain patients. Disabil Rehabil 2000;22: 794–801. CrossRefGoogle ScholarPubMed
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: 483–491. CrossRefGoogle ScholarPubMed
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: 165–169. CrossRefGoogle Scholar
Greden, JF. Physical symptoms of depression: unmet needs. J Clin Psychiatry 2003;64: 5–11. Google ScholarPubMed
Stewart, DE. Physical symptoms of depression: unmet needs in special populations. J Clin Psychiatry 2003;64 (Suppl. 7):12–16. Google ScholarPubMed
Hendler, N. Depression caused by chronic pain. J Clin Psychiatry 1984;45: 30–38. Google ScholarPubMed
Greco, T, Eckert, G, Kroenke, K. The outcome of physical symptoms with treatment of depression. J Gen Intern Med 2004;19: 813–818. CrossRefGoogle ScholarPubMed
Jain, R. Single-action versus dual-action antidepressants. J Clin Psychiatry 2004;6: 7–11. Google ScholarPubMed
Hickie, IB, Scott, EM, Davenport, TA. Are antidepressants all the same? Surveying the opinions of Australian psychiatrists. Aust N Z J Psychiatry 1999;33: 642–649. CrossRefGoogle ScholarPubMed
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: 576–584. CrossRefGoogle ScholarPubMed
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: 457–470. CrossRefGoogle ScholarPubMed
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: 43–53. CrossRefGoogle ScholarPubMed
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: 227–235. CrossRefGoogle ScholarPubMed
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: 389–399. CrossRefGoogle ScholarPubMed
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: 318–323. CrossRefGoogle Scholar
Lynch, ME. Antidepressants as analgesics: a review of randomised controlled trials. J Psychiatry Neurosci 2001;26: 30–36. Google Scholar
Ashburn, MA, Staats, PS. Management of chronic pain. Lancet 1999;353: 1865–1869. CrossRefGoogle ScholarPubMed
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: 2974–2984. CrossRefGoogle ScholarPubMed
Kamata, M, Takahashi, H, Naito, S, Higuchi, H. Effectiveness of milnacipran for the treatment of chronic pain: a case series. Clin Neuropharmacol 2004;27: 208–210. CrossRefGoogle ScholarPubMed
Briley, M. Clinical experience with dual action antidepressants in different chronic pain syndromes. Hum Psychopharmacol 2004;19 (Suppl. 1):S21–S25. CrossRefGoogle ScholarPubMed
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: 310–316. CrossRefGoogle ScholarPubMed
Ellis, P. Australian and New Zealand clinical practice guidelines for the treatment of depression. Aust N Z J Psychiatry 2004;38: 389–407. Google ScholarPubMed
Embling, S. The effectiveness of cognitive behavioural therapy in depression. Nurs Stand 2002;17: 33–41. CrossRefGoogle ScholarPubMed
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: 455–468. CrossRefGoogle ScholarPubMed
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: 435–441. CrossRefGoogle ScholarPubMed
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: 141–153. CrossRefGoogle Scholar
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: 223–230. CrossRefGoogle ScholarPubMed
Nash, JM, Park, ER, Walker, BB, Gordon, N, Nicholson, RA. Cognitive-behavioural group treatment for disabling headache. Pain Med 2004;5: 178–186. CrossRefGoogle Scholar
Williams, DA, Cary, MA, Groner, KHet al. Improving physical functional status in patients with fibromyalgia: a brief cognitive behavioural intervention. J Rheumatol 2002;29: 1280–1286. Google Scholar
White, KP, Nielson, WR. Cognitive behavioural treatment of fibromyalgia syndrome: a follow-up assessment. J Rheumatol 1995;22: 717–721. Google Scholar
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: 131–140. CrossRefGoogle ScholarPubMed