Reciprocal Pain and Depression Links Suggest Joint Assessment

Changes in pain severity can predict subsequent depression severity, according to a recent study in The Journal of Pain, the official publication of the American Pain Society (APS). In addition, worsening depression is an equally strong predictor of subsequent pain severity.

Indiana University researchers studied 250 patients who had musculoskeletal pain and comorbid depression and 250 patients who had pain and no depressive symptoms. All patients were treated in primary care practices and enrolled in the Stepped Care for Affective Disorders and Musculoskeletal Pain study. Outcomes were assessed at 3, 6, and 12 months. Pain severity was measured with the Graded Chronic Pain Scale, and depression levels were assessed with the Hopkins Symptom Checklist, a 20-item questionnaire.

Both pain and depression appeared to influence each other. The effects of pain on depression were mediated by its effects on fatigue and disability.

The authors concluded that because of the frequent co-occurrence of pain and depression and their reciprocal influence on each other, clinicians should assess the conditions jointly rather than separately-detection of one should trigger a search for the other. They noted that this approach is warranted because the presence of both pain and depression is associated with suboptimal treatment outcomes, greater disability, and increased health care use and cost.

For more information, visit the APS Web site at http://www.ampainsoc.org. Or, contact the organization at American Pain Society, 4700 W Lake Avenue, Glenview, IL 60025; telephone: (847) 375-4715; fax: (866) 574-2654 or (847) 375-6479; international fax: (732) 460-7318; e-mail: info@ampainsoc.org.

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