Impact of Pain on Depression Treatment Response in Primary Care

Abstract

Pain is present in two thirds of depressed primary care patients begun on antidepressant therapy, and the severity of pain is a strong predictor of poor depression and health-related quality of life outcomes at 3 months. Better recognition, assessment, and treatment of comorbid pain may enhance outcomes of depression therapy.

Pain exacerbates chronic mild stress-induced changes in noradrenergic transmission in rats

“…Depression and chronic pain frequently co-exist, and they can mutually exacerbate one another, worsening the patient 0 s prognosis and treatment response (Bair et al, 2004;Karp et al, 2005). It is unclear whether depression and chronic pain are causally related, or whether diagnosis with one condition implies a predisposition to the other.…”

Enhanced nociceptive responding in two rat models of depression is associated with alterations in monoamine levels in discrete brain regions

“…Epidemiological studies indicate that up to 66% of major depressed patients report co-morbid chronic pain (Bair et al, 2003;Bair et al, 2004;Arnow et al, 2006) and chronic pain patients are up to 4 times more likely to develop major depressive disorder when compared to the general population (Von Korff and Simon, 1996;Arnold, 2006; Twillman, 2007). The coexistence of depression and chronic pain is associated with increased severity and duration of depressive and physical symptoms, poor treatment response, and is a significant risk factor for relapse (Bair et al, 2004; Ohayon, 2004;Arnow et al, 2006).…”

“…The coexistence of depression and chronic pain is associated with increased severity and duration of depressive and physical symptoms, poor treatment response, and is a significant risk factor for relapse (Bair et al, 2004; Ohayon, 2004;Arnow et al, 2006). Although depressed patients report significantly more frequent and intense pain, pain thresholds to pressure and cold stimuli may be increased (Lautenbacher et al, 1999).…”

“…Furthermore, WKY rats exhibited enhanced formalin-evoked nociceptive responding up to 40 minutes post administration, an effect inversely correlated with serotonin and 5-HIAA levels in the hypothalamus. In conclusion, these findings demonstrate that altered pain responding observed in clinically depressed patients can be modelled pre-clinically, providing a means of investigating the neurochemical basis of, and possible treatments for, this phenomenon.Keyword: olfactory bulbectomy, Wistar-Kayto rat, hot plate, formalin test, mechanical allodynia, serotonin 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 4 The clinical connection between pain and depression has long been recognised.Epidemiological studies indicate that up to 66% of major depressed patients report co-morbid chronic pain (Bair et al, 2003;Bair et al, 2004;Arnow et al, 2006) and chronic pain patients are up to 4 times more likely to develop major depressive disorder when compared to the general population (Von Korff and Simon, 1996;Arnold, 2006; Twillman, 2007). The coexistence of depression and chronic pain is associated with increased severity and duration of depressive and physical symptoms, poor treatment response, and is a significant risk factor for relapse (Bair et al, 2004; Ohayon, 2004;Arnow et al, 2006).…”

Relationship of Somatic Symptoms With Depression Severity, Quality of Life, and Health Resources Utilization in Patients With Major Depressive Disorder Seeking Primary Health Care in Spain

“…Approximately two thirds of patients with depression in the primary care setting present with somatic symptoms. 5,6 Patients usually attribute their somatic symptoms to normalizing causes, making depression difficult to recognize in patients who present with chiefly somatic symptoms. 7 Among these, painful somatic symptoms are most frequent, 4,6 being responsible for disability in 41% of patients with depression.…”