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The Relationship Between Pain and Depression

Published online by Cambridge University Press:  06 August 2018

Michael Von Korff  and
Gregory Simon
Michael Von Korff*
Affiliation:
Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington, US
Gregory Simon
Affiliation:
Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington, US
*
Michael Von Korff, Center for Health Studies, Group Health Cooperative of Puget Sound, Met Park II, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101-1448, US
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Abstract

Empirical results from epidemiological studies on pain–depression comorbidity in primary care and population samples have shown that: (a) pain is as strongly associated with anxiety as with depressive disorders; (b) characteristics that most strongly predict depression are diffuseness of pain and the extent to which pain interferes with activities; (c) certain psychological symptoms (low energy, disturbed sleep, worry) are prominent among pain patients, while others (guilt, loneliness) are not; (d) depression and pain dysfunction are evident early in the natural history of pain, but dysfunction and distress are often transient; and (e) among initially dysfunctional pain patients whose dysfunction is chronic, depression levels do not improve but neither do they increase over time with chronicity alone. These results seem consistent with these mechanisms of pain–depression comorbidity; (1) a trait of susceptibility to both dysphoric physical symptoms (including pain) and psychological symptoms (including depression), and a state of somatosensory amplification in which psychological distress amplifies dysphoric physical sensations (including pain); (2) psychological illness and behavioural dysfunction being interrelated features of a maladaptive response to pain evident early in the natural history of the condition, and often resolving during an early recovery phase; (3) pain constituting a significant physical and psychological stressor that may induce or exacerbate psychological distress. Thus, pain and psychological illness should be viewed as having reciprocal psychological and behavioural effects involving both processes of illness expression and adaption, as well as pain having specific effects on emotional state and behavioural function.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 168 , Issue S30: Comorbidity of Mood Disorders , June 1996 , pp. 101 - 108
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

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References

Addison, R. (1984) Chronic pain syndrome. American Journal of Medicine, 77, 54–58.CrossRefGoogle ScholarPubMed
Alexander, F. (1950) Psychosomatic Medicine: Its Principles and Applications. New York: W. W. Norton.Google Scholar
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III) Washington, DC: APA.Google Scholar
Barksy, A. (1979) Patients who amplify bodily sensations. Annals of Internal Medicine, 91, 63–70.Google Scholar
Barksy, A. (1992) Amplification, somatization, somatoform disorders. Psychosomatics, 33, 24–34.Google Scholar
Barksy, A. & Wyshak, G. (1990) Hypochondriasis and somatosensory amplification. British Journal of Psychiatry, 157, 404–409.Google Scholar
Black, R. G. (1975) The chronic pain syndrome. Surgical Clinics of North America, 55, 999–1011.CrossRefGoogle ScholarPubMed
Blumer, D. & Heilbronn, M. (1982) Chronic pain as a variant of depressive disease: the pain-prone disorder. Journal of Nervous and Mental Disease, 170, 381–406.CrossRefGoogle ScholarPubMed
Breslau, N. & Davis, G. (1992) Migraine, major depression and panic disorder: a prospective epidemiologic study of young adults. Cephalalgia, 12, 85–90.CrossRefGoogle ScholarPubMed
Buckelew, S., Degood, D., Schwartz, D., et al (1986) Cognitive and somatic item response patterns of pain patients, psychiatric inpatients and hospital employees. Journal of Clinical Psychology, 42, 852–860.3.0.CO;2-R>CrossRefGoogle ScholarPubMed
Cherkin, D., Street, J., Hunt, M., et al (1993) Can an educational session with a primary care nurse improve outcomes for low back pain? Paper presented at the North American Primary Care Research Group; San Diego, CA.Google Scholar
Drossman, D. A. (1982) Patients with psychogenic abdominal pain: six years’ observation in the medical setting. American Journal of Psychiatry, 139, 1549–1557.Google ScholarPubMed
Dworkin, S. F., Von Korff, M. R. & Leresche, L. (1990) Multiple pains and psychiatric disturbance: an epidemiologic investigation. Archives of General Psychiatry, 47, 239–244.Google Scholar
Dworkin, S. F., Von Korff, M. R. & Leresche, L. (1992) Epidemiologic studies of chronic pain: a dynamic ecologic perspective. Annals of Behavior Medicine, 14, 3–11.Google Scholar
Feinmann, C. (1983) Psychogenic facial pain: presentation and treatment. Journal of Psychosomatic Research, 27, 403–410.CrossRefGoogle ScholarPubMed
Feuerstein, M., Carter, R. & Papciak, A. (1987) A prospective analysis of stress and fatigue in recurrent low back pain. Pain, 31, 333–344.CrossRefGoogle ScholarPubMed
Fields, H. (1987) Pain. New York: McGraw Hill.Google Scholar
Fields, H. (1991) Depression and pain: a neurobiological model. Neuropsychiatry, Neuropsychology, Behavior Neurology, 4, 83–92.Google Scholar
Fordyce, W. E. (1976) Behavioural Methods in Chronic Pain and Illness. St Louis, MO: Mosby.Google Scholar
Haber, J., Kuczmierczyk, A. & Adams, H. (1985) Tension headaches: muscle overactivity or psychogenic pain. Headache, 25, 23–29.CrossRefGoogle ScholarPubMed
Haythornthwaite, J. A., Sieber, W. J. & Kerns, R. D. (1991) Depression and the chronic pain experience. Pain, 46, 177–184.Google Scholar
Katon, W. (1987) The epidemiology of depression in medical care. International Journal of Psychiatry in Medicine, 17, 93–111.CrossRefGoogle ScholarPubMed
Kellner, R. (1985) Functional somatic symptoms and hypochondriasis. Archives of General Psychiatry, 42, 821–833.Google Scholar
Kleinman, A. (1988) The Illness Narratives: Suffering, Healing and the Human Condition. New York: Basic Books.Google Scholar
Lesse, S. (1983) The masked depression syndrome – results of a seventeeen year clinical study. American Journal of Psychotherapy, 37, 456–475.CrossRefGoogle ScholarPubMed
Merikangas, K., Angst, J. & Isler, H. (1990) Migraine and psychopathology. Archives of General Psychiatry, 47, 849–853.Google Scholar
Ormel, J., Von Korff, M., Von Den Brink, W., et al (1993) Depression, anxiety and social disability in primary care show synchrony of change. American Journal of Public Health, 83, 385–390.Google Scholar
Osterweis, M., Kleinman, A. & Mechanic, D. (1987) Pain and Disability: Clinical, Behavioural and Public Policy Perspectives. Washington, DC: National Academy Press.Google Scholar
Romano, J. & Turner, J. (1985) Chronic pain and depression: does the evidence support a relationship? Psychological Bulletin, 97, 18–34.CrossRefGoogle ScholarPubMed
Rudy, T., Kerns, R. & Turk, D. (1988) Chronic pain and depression: toward a cognitive–behavioural mediation model. Pain, 35, 129–140.CrossRefGoogle Scholar
Sartorius, N., Ustun, T., Costa e Silva, J., et al (1993) An international study of psychological problems in primary care: preliminary report from the World Health Organization Collaborative Project on Psychological Problems in General Health Care. Archives of General Psychiatry, 55, 819–824.CrossRefGoogle Scholar
Simon, G. & Von Korff, M. (1991) Somatization and psychiatric disorder in the NIMH Epidemiologic Catchment Area Study. American Journal of Psychiatry, 148, 1494–1500.Google ScholarPubMed
Sternbach, R. A. (1978) The Psychology of Pain. New York: Raven Press.Google Scholar
Üstün, T. B. & Sartorius, N. (1995) Mental Illness in General Health Care: An International Study. New York: John Wiley.Google Scholar
Von Korff, M., Dworkin, S. F., Leresche, L., et al (1988) An epidemiologic comparison of pain complaints. Pain, 32, 173–183.CrossRefGoogle ScholarPubMed
Von Korff, M., Ormel, J., Katon, W., et al (1992a) Disability and depression in medical patients: a longitudinal analysis. Archives of General Psychiatry, 49, 91–100.CrossRefGoogle ScholarPubMed
Von Korff, M., Ormel, J., Keefe, F., et al (1992b) Grading the severity of chronic pain. Pain, 50, 133–149.CrossRefGoogle ScholarPubMed
Von Korff, M., Deyo, R. A., Cherkin, D., et al (1993a) Back pain in primary care: outcomes at one year. Spine, 18, 855–862.CrossRefGoogle Scholar
Von Korff, M., Leresche, L. & Dworkin, S. (1993b) First onset of common pain symptoms: a prospective study of depression as a risk factor. Pain, 55, 251–158.Google Scholar
Webb, J. W. (1983) Chronic pain: psychosomatic illness review. Psychosomatics, 24, 1053–1063.CrossRefGoogle ScholarPubMed
Williams, A. & Richardson, P. H. (1993) What does the BDI measure in chronic pain? Pain, 55, 259–266.CrossRefGoogle Scholar
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