The Complex Interplay of Pain, Depression, and Anxiety Symptoms in Patients With Chronic Pain

Penedo, Juan Martín Gómez; Rubel, Julian; Blättler, Larissa Tatjana; Schmidt, Stefanie; Stewart, J.P.; Egloff, Niklaus; Holtforth, Martin Grosse

doi:10.1097/ajp.0000000000000797

Cited by 60 publications

(29 citation statements)

References 65 publications

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“…Network analysis has been previously used to visualize the structure of depressive symptoms in a large European sample of older community-dwellers, in which death wishes, depressed mood, and loss of interest were the most interconnected in the network, whereas somatic symptoms of sleep problems and loss of appetite were less interconnected [ 13 ]. Such framework has also helped uncover how clinical correlates of somatic diseases, such as pain and dyspnea, were linked to several depressive symptoms in individuals with chronic pain and chronic obstructive pulmonary disease, respectively [ 14 , 15 ]. Yet, studies on older adults with multiple co-occurring diseases (i.e., multimorbidity), which detrimentally impact functional status, and increase the vulnerability to depression, are currently lacking [ 16 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

Bridging late-life depression and chronic somatic diseases: a network analysis

et al. 2021

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The clinical presentation of late-life depression is highly heterogeneous and likely influenced by the co-presence of somatic diseases. Using a network approach, this study aims to explore how depressive symptoms are interconnected with each other, as well as with different measures of somatic disease burden in older adults. We examined cross-sectional data on 2860 individuals aged 60+ from the Swedish National Study on Aging and Care in Kungsholmen, Stockholm. The severity of sixteen depressive symptoms was clinically assessed with the Comprehensive Psychopathological Rating Scale. We combined data from individual clinical assessment and health-registers to construct eight system-specific disease clusters (cardiovascular, neurological, gastrointestinal, metabolic, musculoskeletal, respiratory, sensory, and unclassified), along with a measure of overall somatic burden. The interconnection among depressive symptoms, and with disease clusters was explored through networks based on Spearman partial correlations. Bridge centrality index and network loadings were employed to identify depressive symptoms directly connecting disease clusters and depression. Sadness, pessimism, anxiety, and suicidal thoughts were the most interconnected symptoms of the depression network, while somatic symptoms of depression were less interconnected. In the network integrating depressive symptoms with disease clusters, suicidal thoughts, reduced appetite, and cognitive difficulties constituted the most consistent bridge connections. The same bridge symptoms emerged when considering an overall measure of somatic disease burden. Suicidal thoughts, reduced appetite, and cognitive difficulties may play a key role in the interconnection between late-life depression and somatic diseases. If confirmed in longitudinal studies, these bridging symptoms could constitute potential targets in the prevention of late-life depression.

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Section: Introductionmentioning

confidence: 99%

Bridging late-life depression and chronic somatic diseases: a network analysis

et al. 2021

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“…One explanation for this is that the longer forms contain items that assess somatic symptoms often caused by pain and pain medications, whereas the short forms do not. For instance, sleep difficulties are a common symptom of both presentations and emerge as a central component of anxiety, depression, and chronic pain in network models 41 . Sleep difficulties are captured on the GAD‐7 as trouble relaxing (Item 4), as well as on the PHQ‐9 as trouble falling or staying asleep or sleeping too much (Item 3).…”

Section: Discussionmentioning

confidence: 99%

Examining the psychometric properties of brief screening measures of depression and anxiety in chronic pain: The Patient Health Questionnaire 2‐item and Generalized Anxiety Disorder 2‐item

et al. 2022

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Objective Individuals with chronic pain experience anxiety and depressive symptoms at rates higher than the general population. The Patient Health Questionnaire 2‐item (PHQ‐2) and Generalized Anxiety Disorder 2‐item (GAD‐2) are brief screening measures of depression and anxiety, respectively. These brief scales are well‐suited for use in routine care due to their brevity and ease of administration, yet their psychometric properties have not been established in heterogeneous chronic pain samples when administered over the Internet. Materials and Methods Using existing data from randomized controlled trials of an established Internet‐delivered pain management program (n = 1333), we assessed the reliability, validity, diagnostic accuracy, and responsiveness to treatment change in the PHQ‐2 and GAD‐2, as well as the long‐form counterparts. Exploratory analyses were conducted to obtain cutoff scores using those participants with diagnostic data (n = 62). Results The PHQ‐2 and GAD‐2 demonstrated appropriate reliability (eg, Cronbach's α = 0.79–0.84), validity (eg, higher scores in individuals with a diagnosis; p < 0.001), and responsiveness to treatment change (eg, pre‐ to post‐treatment scores, p < 0.001). The psychometric properties of the short forms compared well with the longer forms. Cutoff scores on the short forms were consistent with general population samples, while cutoff scores on the long forms were higher than previously observed using general population samples. All four scales favored specificity over sensitivity. Conclusions The PHQ‐2 and GAD‐2 demonstrated acceptable psychometric properties in the current sample, as did the long forms. Based on our findings, the PHQ‐2 and GAD‐2 can be used as screening tools with chronic pain samples when administered over the Internet.

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“…Social distancing measures and protective face gear (e.g., masks) alter how to engage with others and society. For individuals with chronic pain, who are prone to higher levels of anxiety and depression ( Gómez Penedo et al, 2020 ), there may be added anxieties around how to engage in a novel environment that the CV-19 pandemic imposes. However, it may also provide a means to re-evaluate current circumstances and engage in life in a new and more adaptive manner ( Bland, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Authenticity as a Resilience Factor Against CV-19 Threat Among Those With Chronic Pain and Posttraumatic Stress Disorder

et al. 2021

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ObjectiveThe novel coronavirus (2019; CV-19) is linked to increases in emotional distress and may be particularly problematic for those with pre-existing mental and physical conditions, such as chronic pain and posttraumatic stress disorder (PTSD). However, little empirical research has been published on resilience factors in these individuals. The present study aims to examine authenticity as a resilience factor among those with chronic pain and/or PTSD.MethodsPrior to the national response to the pandemic (January 10-24, 2020), participants were screened for pain-related disability (Oswestry Disability Index; ODI) and PTSD symptoms (Posttraumatic Checklist for DSM-5; PCL-5), and on the basis of those responses were categorized into one of four groups: healthy, chronic pain only, PTSD only, or comorbid chronic pain and PTSD. During the CV-19 pandemic (May 5-May 13, 2020), participants responded again to the ODI and PCL-5, in addition to the Wood Authenticity Scale, Brief Pain Inventory, and items related to the CV-19 pandemic.ResultsA total of 110 participants (54.55% women), aged 42.19 (SD = 13.16), completed the survey during the pandemic. The comorbid group endorsed higher levels of CV-19 Threat and Impact compared to all other groups. Authenticity moderated this relationship relevant to CV-19 Threat among those in the chronic pain only group, and not in any other group.ConclusionThe comorbid group endorsed higher levels of CV-19 Threat and Impact compared to all other groups. Importantly, greater authenticity was associated with less CV-19 Threat in the chronic pain only group, and not in any other group. The present study also highlights the importance of engaging authentically for those with chronic pain during the pandemic.

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The Complex Interplay of Pain, Depression, and Anxiety Symptoms in Patients With Chronic Pain

Cited by 60 publications

References 65 publications

Bridging late-life depression and chronic somatic diseases: a network analysis

Bridging late-life depression and chronic somatic diseases: a network analysis

Examining the psychometric properties of brief screening measures of depression and anxiety in chronic pain: The Patient Health Questionnaire 2‐item and Generalized Anxiety Disorder 2‐item

Authenticity as a Resilience Factor Against CV-19 Threat Among Those With Chronic Pain and Posttraumatic Stress Disorder

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