Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Differentiating Pain and Depression

The Pain Depression Interface

We do not diagnose major depressive disorder by asking a patient about his/her various pain complaints. Instead, we ask them about sleep, appetite, concentration, decision making and mood.

There is a growing body of scientific evidence that patients with major depressive disorders have a large number of pain complaints(Vaccarino, A. L., Sills, T. L., Evans, K. R., and Kallal, A. H. (2009) Multiple pain complaints in patients with major depressive disorder. Psychosomatic Medicine, 71, 2: 159-162).

With that realization in mind, drug companies have released antidepressant agents which claim that their product addresses the physical pain of major depression, and perhaps the differentiating as to which precedes which has become moot.

There are seven areas of pain that are found in patients diagnosed with major depressive disorder:

Headache
Low back pain
Neck pain
Muscle soreness
Chest pain
Abdominal pain

An estimated 26.2% of Americans ages 18 and older – about one in four adults – suffer from a diagnosable mental disorder in a given year. 9.5% percent have a mood disorder. Thus, 1 in 10 adult Americans suffer from a mood disorder. Women are more likely to suffer from major depressive disorder than are men, and the median age for onset is 32 years of age. Major depressive disorder is often accompanied by a concurrent (comorbid) anxiety disorder and/or substance abuse disorder.

The questions most often asked of me is differentiating:
1. From where do this patient’s pain complaints aris since the injury just does not explain their severity?
2. Do we have to treat depression in these patients with pain complaints?
3. Could it be that the patient was depressed prior to injury and had some pain complaints that were simply not addressed until he/she was injured.

The answer to all three is _yes._ Equally as important, it is far easier for a male to complain of pain than to admit to problems with mood.

While pain is not a core symptom in the diagnosis of depression; we now know it is a common feature found among depressed patients. In many cases, pain complaints increase in those who are depressed, and in other cases, depression presents with co-existence of multiple pain complaints.”

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