Depression and Pain Comorbidity

Abstract

Because depression and painful symptoms commonly occur together, we conducted a literature review to determine the prevalence of both conditions and the effects of comorbidity on diagnosis, clinical outcomes, and treatment. The prevalences of pain in depressed cohorts and depression in pain cohorts are higher than when these conditions are individually examined. The presence of pain negatively affects the recognition and treatment of depression. When pain is moderate to severe, impairs function, and/or is refractory to treatment, it is associated with more depressive symptoms and worse depression outcomes (eg, lower quality of life, decreased work function, and increased health care utilization). Similarly, depression in patients with pain is associated with more pain complaints and greater impairment. Depression and pain share biological pathways and neurotransmitters, which has implications for the treatment of both concurrently. A model that incorporates assessment and treatment of depression and pain simultaneously is necessary for improved outcomes.

Symptoms of Depression and Risk of New Episodes of Low Back Pain: A Systematic Review and Meta‐Analysis

“…For instance, a biologic link between depression and pain is plausible, although not completely understood, as these conditions share common biologic pathways and neurotransmitters, such as serotonin and norepinephrine (4). A deficiency of these neurotransmitters is expected to affect both mood and pain thresholds, possibly explaining the relationship between depression and LBP.…”

“…Depression, whether clinically diagnosed by a health practitioner, or as self-reported depressive symptoms, is commonly seen in patients with low back pain (LBP) (4), which is also a highly prevalent, costly, and disabling condition (3). The direct health costs of LBP are higher in patients with depression and usually associated with more complex diagnostic and treatment approaches, commonly involving the engagement of multiprofessional teams and use of tertiary pain specialist clinics, leading to higher costs and rates of health care utilization (5).…”

What Is the Relationship Between Depressive Symptoms and Pain During Functional Tasks in Persons Undergoing TKA? A 6-year Perioperative Cohort Study

“…First, elevated preoperative depressive symptoms have been shown to be prognostic of worse patient postoperative pain and poorer function [5,6,12,17]. High levels of depressive symptoms likely make a challenging postoperative recovery even more difficult for patients and there is a moderate association between depression and pain [1,7]. High preoperative depressive symptom scores also may indicate a high patient risk of worse pain and function after surgery because of poor coping skills and a reduced ability to deal with the challenges of recovery.…”

Predictors of Pain for Patients With Early Inflammatory Polyarthritis

“…It reduces pain tolerance and threshold, increases analgesic requirements, and is associated with poor adherence to therapy (9,10). A crosssectional study of patients with recently diagnosed EIP found that 23% of patients screened positive for depressive symptoms (11).…”