Researchers at Wayne State University, Detroit, MI, examined the prevalence of chronic pain, its coexistence with depression, and demographic factors that might explain a link between pain and depression. They used computer-assisted telephone interviews to obtain a representative community sample (n=1,179) in the state of Michigan.
The sample prevalence of chronic pain due to any cause was about 22%, and more than a third (35%) of those participants with chronic pain also had depression. Overall, participants with either chronic pain or pain-plus-depression were more likely to be female, employed less than full-time, and have less education than persons without either condition. Having depression along with chronic pain was not associated with a particular pain condition or site.
Middle-aged women in the sample were most likely to have both pain and depression, as were African Americans. The authors suggested that in middle-aged women chronic pain might not be the cause of depression, rather preexisting mood problems could be associated with a vulnerability to developing chronic pain in some cases. Concurrent depression appears to decrease with age, although pain tends to be worse among older persons.
Based on their findings, the authors recommend that healthcare providers should screen patients complaining of chronic pain for depression, paying close attention to middle-aged women and African Americans in whom risks of comorbid depression appear to be greatest. While this seems like prudent guidance, it also should be noted that this was a somewhat modest-sized survey, covering a small portion of the United States, and relied upon participant self-reports of their pain and mood disorders rather than verified clinical records.
Reference: Miller LR, Cano A. Comorbid Chronic Pain and Depression: Who Is at Risk? J Pain. 2009;10(6):619-627. [See abstract.]
Sunday, July 19, 2009
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11 comments:
I think that having long cold wet winters has a definite correspondence to pain. The lack of sunshine for long periods of time is not a helpful condition either. My pain is definitely affected by the lows in barametric pressure and the dampness of the air. The more pain the less sleep, the less sleep one gets causes a depressive effect also. WE need lots of sunshime that makes one have less pain and feel much better, both physically and mentally.
As a followup to the above comment -- see our Pain-Topics reports on vitamin D (the sunshine vitamin) for chronic pain. Go to: http://pain-topics.org/vitamind. --SBL
I am a Vietnam veteran with 100 persent PTSD, I also have acute lower back pain and have had upper disk fusen in my neck 3 years ago. When the pain in my neck area improved after surgery so did my depression. Not for over 7 weeks I have serve pain in the area of my neck that was fused, along with the pain my depression has become much worst. And yes I am on pain med's and med's for depression which seem to do nothing.
I'm a pharmacist as well as suffering from chronic pain. It seems to me that doctors are over prescribing anti-depressants, which are strong medications with serious side effects and originally intended mainly for people with major depression. Some doctors now seem to think that "chronic pain" and "depression" are synonyms!
My experience: persons with real chronic pain, e.g., pain over a long period of time with no finality, are depressed.Chronic pain is terribly deblitating even when one is taking the best, most appropriate meds. Depression is inevitable, in my opinion and the reason is; real chronic pain sufferers always have pain no matter what the treatment.This kind of pain never completely goes away. Meds reduce it so one can have a life but the pain is constant. I believe, physiologically, one cannot escape feelings of hopelessness when there is no end in site. Yes, anti-deppresants are strong meds and are necessary for those truly suffereing from chronic pain.Those that dont admit to depression are not really suffering daily w/chronic pain, or are lying to themselves.
I'm a middle-aged women who has suffered from severe, chronic pain for 5+ years. The cause of my pain, Central Pain Syndrome (CPS), offers little hope of cure or end and is difficult to control(Although I'm lucky, I recieve my care at a hospital-affiliated pain center from a physician who is board-certified in neurology and management of chronic pain and is truly caring.) It took time, it took patience and information, but now I can at least look at tommorow without the dread I once felt.
Was I depressed at one time? Of course, I would have had to have been crazy if wasn't.(Especially because I had/have other medical issues at my door which I'd rather not discuss, other than to say they prevent be from working at a job I truly loved.) Admittedly, I'm still depressed from time to time and a bit frightened of what lies ahead, but no; I am not clinically- depressed. Antidepressants, 2 types in fact, however, make up an important part of my analgesic regimen. That's because this class of drug offers considerable value in the treatment of centrally-mediated neropathic pain and as part of multi-drug management of complex pain. As my physician was said of antidepressants in my case " They are being prescribed for their pain-kelling efficacy in this type of pain. In your case, any antidepressive effect could be considered a side-effect." It easy to see how this type of medically-valid, off-label prescribing may have colored some "data-based" supposedly quantitativelly-derived conclutions regarding the chronic pain/depression ,chicken or egg issue.
As far as the comment about the result being from a survey vs clinically-documented records. They both depend on the same source for the reporting of pain- patients (If some one says men tolerate pain better than women I's scream! Except that would be taken as proof.) The time of the call, the tone, the lenghth, the percieved sex behind the voice could all influenced results.
In chronic pain there is no "right" answer: If you not depressed than your crazy. Or,as some seemed to indicate: If your not reporting depression than the pain must not be that bad or that constant. I wish someone would come up with an anti-frustration drug because this kind of thinking.
Frankly If there was a way of developing some kind of truly indicative test or discovering some kind of veryify sign for pain it would be of great help. No longer would physicians harbor doubt, or insurers refuse to pay. Can someone get started on that? This would really be a breakthrough in believe for chronic-pain patients.
I am considered middle-aged (44) and live in the sunshine state and still have clinical depression with the chronic pain of seven (7) years. Although, when I get my daily tears if it is daytime stepping outside into the daylight makes a difference. Now, I make an effort to step outside at least daily. Right now I have a broken toe and the pain in my back is pretty bad as I recover from my fourth fusion surgery so resting flat is something that takes up a great deal of my day.
I like what the person before me commented in reference to pain: 'If you're not depressed than your crazy,' makes me feel more normal. I'm for anything that helps chronic pain the depression that accompanies it. The best wishes and prayers to my fellow pain sufferers. IvoryOne
I have tried antidepressants with an idiosyncratic effect where my suicidal ideation increases.
This was interesting research, but was done in a retrospective approach, therefore making it difficult to really see whether the pain is causing the depression or the other way around. It makes a lot of sense to me that people who are in chronic pain for a long period of time have major life changes in the situation that people find themselves in: Physical changes, job changes (unable to work), financial and social interaction changes that are caused by being physically limited and not able to do the "fun" things that a person did before the pain. It also makes sense that a person would become depressed with chronic pain, because many of the pain medications used for chronic pain, such as opiates have a side affect of causing depression. That is what opiates do, they supress, depress the Central Nervous System. I believe that a person who suffers chronic pain is stuck in a position of being between a rock and a hard place. This double bind is very capable of causing a person to be depressed, especially when doctors, family and friends can't comprehend the level of pain a person is in and therefore the person in chronic pain is discounted and not respected. People in chronic pain are expected to "get over it" or not "complain" about their pain, but because pain is an invisible disability many people around a person in pain can't perceive how much pain a person is in and it is easy for them to forget the struggle that a person in pain must deal with. If they complain that they are in pain, other people don't want to hear it if they don't complain about the pain then too often other people don't believe the person is in pain. Under this dilema of damned if you do and damned if you don't the person in pain is tragically misunderstood and do not receive empathy or compassion. When people feel misunderstood for long periods of time this can become very depressing. Give people in pain a break and quit blaming the victims of pain for the depression they might acquire when they struggle with chronic pain. It is a wonder there are not more people in chronic pain who are depressed.
I think as several others here have mentioned you are either depressed or crazy from being depressed for so long that somedays you don't want to see the dawn. Like the other gentleman above I am a disabled veteran who has suffered with a botched spinal fusion for aver 30 years the last 12 have been the worst in my life. I checked in to a mental ward a few times in past years becasue I knew I was at the brink of killing myself or being killed because once I carried a gun in my pocket for 3 days contemplating when and where I would do it. I'm here today only by the Grace of God and a fine young doctor I finally found who listens and Believes what I say , plus a mound of medical records a foot or better tall from all the test and other injections and garbage I have been through. Those injections may help some people for a brief period but I'm here to tell you long term injections combined with oral steroids are no good because they will destroy you from the inside out. Trust me I know this from being a pin cushion for the veterans administration for almost 15 years. Some of those doctors as sure as I sit here today are crazier than I am by a long shot. Those of you that are still suffering contemplating what I mentioned above I implore you to keep looking there is a doctor out there that will listen to you and respect your wishes.
Good Luck and God Bless.
AFter yeras on Zoloft before I had to get on pain meds, I can say that that antidepressant alone saved my life and gave me a quality of life that I never could have imagined. But when I had to have my FOURTH back surgery,and it didnt work and 100 percent disabled me and left me in chronic pain for the past 10 years -- THOSE antidepressants don't work at ALL.
I never feel the effects of the Cymbolta I've been taking for thelast 10 yeasr. I am clinically depressed. i was diagnosed with that. Pain docs, just give us antidepressants because who wouldn't be depressed with all this pain.
But I really do not think the SSIR antidepressants: Prosac, Paxil Zolopt, Celexa and Cymbotla and the dozens of others that docs dispene DO NOT work at all when combined with either moderate doses of opiates of benzdiapames.
Anybody else notice this?
Thanks GARy
I am a 39 year old woman, also a disabled vet. currently getting 90% I got my service connected disability at 19 years old. I am currently getting treated for severe depression and a mood disorder. I feel it is because the pain and poor condition of my spin has gotten progressively worse through out the years, 3 surgeries did nothing for the pain only ended up with severe nerve damage which is a whole new horrific pain. I think this survey sounds very questionable almost silly to me. anyone with any common sense would know it has nothing to do with middle age or how long you went to school. at this age we have been in pain for numerous years and it has apparently taken its toll. I personally have anger issues due to the fact that i have had to fight almost 20 years now with the V.A. to get my benefits that i am entitled to.
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