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The Relationship Between Pain and Depression

  • Michael Von Korff (a1) and Gregory Simon (a1)

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.

Copyright

Corresponding author

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

References

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Addison, R. (1984) Chronic pain syndrome. American Journal of Medicine, 77, 5458.
Alexander, F. (1950) Psychosomatic Medicine: Its Principles and Applications. New York: W. W. Norton.
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III) Washington, DC: APA.
Barksy, A. (1979) Patients who amplify bodily sensations. Annals of Internal Medicine, 91, 6370.
Barksy, A. (1992) Amplification, somatization, somatoform disorders. Psychosomatics, 33, 2434.
Barksy, A. & Wyshak, G. (1990) Hypochondriasis and somatosensory amplification. British Journal of Psychiatry, 157, 404409.
Black, R. G. (1975) The chronic pain syndrome. Surgical Clinics of North America, 55, 9991011.
Blumer, D. & Heilbronn, M. (1982) Chronic pain as a variant of depressive disease: the pain-prone disorder. Journal of Nervous and Mental Disease, 170, 381406.
Breslau, N. & Davis, G. (1992) Migraine, major depression and panic disorder: a prospective epidemiologic study of young adults. Cephalalgia, 12, 8590.
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, 852860.
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.
Drossman, D. A. (1982) Patients with psychogenic abdominal pain: six years’ observation in the medical setting. American Journal of Psychiatry, 139, 15491557.
Dworkin, S. F., Von Korff, M. R. & Leresche, L. (1990) Multiple pains and psychiatric disturbance: an epidemiologic investigation. Archives of General Psychiatry, 47, 239244.
Dworkin, S. F., Von Korff, M. R. & Leresche, L. (1992) Epidemiologic studies of chronic pain: a dynamic ecologic perspective. Annals of Behavior Medicine, 14, 311.
Feinmann, C. (1983) Psychogenic facial pain: presentation and treatment. Journal of Psychosomatic Research, 27, 403410.
Feuerstein, M., Carter, R. & Papciak, A. (1987) A prospective analysis of stress and fatigue in recurrent low back pain. Pain, 31, 333344.
Fields, H. (1987) Pain. New York: McGraw Hill.
Fields, H. (1991) Depression and pain: a neurobiological model. Neuropsychiatry, Neuropsychology, Behavior Neurology, 4, 8392.
Fordyce, W. E. (1976) Behavioural Methods in Chronic Pain and Illness. St Louis, MO: Mosby.
Haber, J., Kuczmierczyk, A. & Adams, H. (1985) Tension headaches: muscle overactivity or psychogenic pain. Headache, 25, 2329.
Haythornthwaite, J. A., Sieber, W. J. & Kerns, R. D. (1991) Depression and the chronic pain experience. Pain, 46, 177184.
Katon, W. (1987) The epidemiology of depression in medical care. International Journal of Psychiatry in Medicine, 17, 93111.
Kellner, R. (1985) Functional somatic symptoms and hypochondriasis. Archives of General Psychiatry, 42, 821833.
Kleinman, A. (1988) The Illness Narratives: Suffering, Healing and the Human Condition. New York: Basic Books.
Lesse, S. (1983) The masked depression syndrome – results of a seventeeen year clinical study. American Journal of Psychotherapy, 37, 456475.
Merikangas, K., Angst, J. & Isler, H. (1990) Migraine and psychopathology. Archives of General Psychiatry, 47, 849853.
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, 385390.
Osterweis, M., Kleinman, A. & Mechanic, D. (1987) Pain and Disability: Clinical, Behavioural and Public Policy Perspectives. Washington, DC: National Academy Press.
Romano, J. & Turner, J. (1985) Chronic pain and depression: does the evidence support a relationship? Psychological Bulletin, 97, 1834.
Rudy, T., Kerns, R. & Turk, D. (1988) Chronic pain and depression: toward a cognitive–behavioural mediation model. Pain, 35, 129140.
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, 819824.
Simon, G. & Von Korff, M. (1991) Somatization and psychiatric disorder in the NIMH Epidemiologic Catchment Area Study. American Journal of Psychiatry, 148, 14941500.
Sternbach, R. A. (1978) The Psychology of Pain. New York: Raven Press.
Üstün, T. B. & Sartorius, N. (1995) Mental Illness in General Health Care: An International Study. New York: John Wiley.
Von Korff, M., Dworkin, S. F., Leresche, L., et al (1988) An epidemiologic comparison of pain complaints. Pain, 32, 173183.
Von Korff, M., Ormel, J., Katon, W., et al (1992a) Disability and depression in medical patients: a longitudinal analysis. Archives of General Psychiatry, 49, 91100.
Von Korff, M., Ormel, J., Keefe, F., et al (1992b) Grading the severity of chronic pain. Pain, 50, 133149.
Von Korff, M., Deyo, R. A., Cherkin, D., et al (1993a) Back pain in primary care: outcomes at one year. Spine, 18, 855862.
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.
Webb, J. W. (1983) Chronic pain: psychosomatic illness review. Psychosomatics, 24, 10531063.
Williams, A. & Richardson, P. H. (1993) What does the BDI measure in chronic pain? Pain, 55, 259266.

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The Relationship Between Pain and Depression

  • Michael Von Korff (a1) and Gregory Simon (a1)
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