Comorbid chronic pain and depression: who is at risk?

Abstract

The purpose of this study was to investigate the prevalence and demographic risk factors of chronic pain and its comorbidity with depression. Computer-assisted telephone interviewing was utilized to obtain a representative community sample in the state of Michigan (N = 1,179). The prevalence of chronic pain due to any cause was 21.9%.Approximately 35% of participants with chronic pain also had comorbid depression (7.7% of the entire sample). Depression was not associated with pain types or sites. A multinomial regression analysis revealed several demographic correlates of chronic pain and depression.Participants with chronic pain or comorbid pain and depression were more likely to be older, female, employed less than full-time, and have less education than persons without either condition. Logistic regression analyses showed that younger participants were more likely to have comorbid pain and depression than chronic pain only. A similar but marginally significant effect was found for African-American participants. Compared to the depression only group, those in the comorbid group were more likely to be women and middle-aged. These findings provide additional evidence on the prevalence of comorbid pain and depression in the community and suggest that certain demographic groups with chronic pain may especially benefit from depression screenings.Perspective. This article reports on the prevalence of chronic pain and co-occurring depression in a representative community sample. The high prevalence rates of pain and comorbid depression point to the clinical importance of assessing depression in chronic pain samples.

Defining Racial and Ethnic Disparities in Pain Management

“…African Americans have higher levels of comorbid depression and/or anxiety, fear, and helplessness than whites [13,41,67,78] African Americans are more likely to attribute pain to personal inadequacies than whites [58] Overt behavioral expression of pain; verbal expressions; pain reporting; pain coping strategies; healthcare seeking; activity/role interference and restrictions African Americans are more likely than whites to underreport pain unpleasantness, especially in the presence of physicians perceived as ''higher social status'' [52] African Americans and Hispanics are more likely than whites to believe health professionals did not believe them when they reported being in pain [74] African Americans experience greater activity interference at comparable pain level than whites or Hispanics [6,48,50,51,61] African Americans are more likely to use passive pain coping strategies (prayer, pain catastrophizing) [41,92] African Americans and Hispanics are more afraid than whites of opioid addiction risk [3,23] Volume 469, Number 7, July 2011 Racial/Ethnic Disparities in Pain Management 1863 recognized knowledge regarding pain conditions and pain management principles and strategies, especially the pharmacology and prescribing guides for pain medications, are not well covered in medical undergraduate and specialty education. Physicians' lack of such knowledge and the resultant discomfort in pain management skill level have been advanced as important contributors to the observed racial/ethnic disparities [2,13,100].…”

Recovery From Depressive Symptoms Over the Course of Physical Therapy: A Prospective Cohort Study of Individuals With Work-Related Orthopaedic Injuries and Symptoms of Depression

“…33 Previous research has suggested that depression and chronic pain are common comorbid conditions and that 1 out of every 3 individuals suffering from chronic pain is estimated to also suffer from depression. 37 Individuals suffering from both conditions are likely to experience greater levels of disease-related burden. 37 For instance, people with orthopaedic pain conditions who are also depressed are at a greater risk of having elevated levels of pain intensity and prolonged work disability compared to those who are not depressed.…”

“…37 Individuals suffering from both conditions are likely to experience greater levels of disease-related burden. 37 For instance, people with orthopaedic pain conditions who are also depressed are at a greater risk of having elevated levels of pain intensity and prolonged work disability compared to those who are not depressed. 5,37 Increasingly compelling research suggests that elevated levels of depression among individuals with musculoskeletal pain are associated with increased risk for poor response to physical therapy.…”

“…37 For instance, people with orthopaedic pain conditions who are also depressed are at a greater risk of having elevated levels of pain intensity and prolonged work disability compared to those who are not depressed. 5,37 Increasingly compelling research suggests that elevated levels of depression among individuals with musculoskeletal pain are associated with increased risk for poor response to physical therapy. 22 Elevated levels of depressive symptoms among physical therapy patients have been linked both cross-sectionally and prospectively to measures of pain intensity, disability, and physical performance.…”

The Use of Ketamine in Neuropathic Pain

“…The effect on clinical depression has been noted before the effect on the pain. We find that ketamine infusions in NP treatment are particularly effective given the clustering of chronic pain with depression occurs at such a high prevalence, ranging from 30 to 60 % [109][110][111].…”