Does chronic pain cause the depression or does depression cause the pain? Current evidence indicates that both are occurring in our cases. Research shows that patients with persistent or chronic pain are at risk for developing an anxiety or depressive disorder and that those genetically predisposed to anxiety and depression are prone to experience pain more intently.
A recent analysis of data from the World Health Organization, found that 22% of primary care patients complained of persistent pain, which was defined as experiencing at least 6 months of pain plus disability because of the pain and/or receipt of medical care for the pain. Those with persistent pain were 4 times more likely to have an anxiety or depressive disorder than were pain-free individuals.
* Pain is as strongly associated with anxiety as with depressive disorders;
* The number of pain sites (diffuseness of pain) and the extent to which pain interferes in daily life are the characteristics that most strongly predict depression;
* Certain psychological symptoms of depression, including low energy, sleep disturbances, and worry, are common among pain patients whereas guilt and loneliness are not; and
* Psychological distress and disability often surface and resolve early during the course of a pain disorder that evolves into a chronic condition.
Based upon their findings, researchers proposed 3 theories about the mechanisms underlying the co-existence of pain and depression:
(1) some individuals are genetically susceptible to both physical and psychological symptoms
(2) some are prone to psychological distress which amplifies any unpleasant physical sensations, including pain;
(2) the physical and psychological stress of pain itself may induce or aggravate psychological a psychological disorder
As is indicated and explained in this year_s seminar, there is increased evidence that pain and depression share common physical causes.
Psychotherapy and behavioral modification, either alone or in combination with medication, has been shown to be an effective and important part of the successful treatment of comorbid pain and depression. Patients, however, must be directed to actively participate in their own recovery rather than passively await change to occur.