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01-12-2013 | Complex Medical-Psychiatric Issues (MB Riba, Section Editor)

Pain and Depression: An Integrative Review of Neurobiological and Psychological Factors

Authors: Jenna Goesling, Daniel J. Clauw, Afton L. Hassett

Published in: Current Psychiatry Reports | Issue 12/2013

Abstract

The comorbidity of pain and depression has been well established in the literature and is associated with a greater burden to the individual and society than either condition alone. The relationship between pain and depression is quite complex and multiple factors must be considered when trying to disentangle the pain-depression link including shared neurobiology, precipitating environmental factors and cognitive influences. This article aims to provide an overview of the leading neurobiological and psychosocial theories that have advanced our understanding of the link between pain and depression. To this end we describe the shared neurobiological mechanisms in the brain thought to explain the overlap and consider psychological processes and how they inform a cognitive behavioral model. The article also provides an overview of the evidence based treatment for comorbid pain and depression.

Institute of Medicine. Relieving pain in America: a blueprint for transforming prevention, care, education and research. 2011.

World Health Organization. Depression fact sheet. 2012. http://www.who.int/mediacentre/factsheets/fs369/en/index.html.

Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289:3095–105.PubMedCrossRef

Murray CJL, Vos T, Lozano R, AlMazroa MA, Memish ZA. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010 (vol 380, pg 2197, 2012). Lancet. 2013;381:628.CrossRef

Arnow BA, Blasey CM, Lee J, et al. Relationships among depression, chronic pain, chronic disabling pain, and medical costs. Psychiatr Serv. 2009;60:344–50.PubMedCrossRef

Mossey JM, Gallagher RM. The longitudinal occurrence and impact of comorbid chronic pain and chronic depression over two years in continuing care retirement community residents. Pain Med. 2004;5:335–48.PubMedCrossRef

Arnow BA, Hunkeler EM, Blasey CM, et al. Comorbid depression, chronic pain, and disability in primary care. Psychosom Med. 2006;68:262–8.PubMedCrossRef

Miller LR, Cano A. Comorbid chronic pain and depression: who is at risk? J Pain. 2009;10:619–27.PubMedCrossRef

Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163:2433–45.PubMedCrossRef

10.

Epstein SA, Kay GG, Clauw DJ, et al. Psychiatric disorders in patients with fibromyalgia. A multicenter investigation. Psychosomatics. 1999;40:57–63.PubMedCrossRef

11.

Kroenke K, Shen J, Oxman TE, Williams Jr JW, Dietrich AJ. Impact of pain on the outcomes of depression treatment: results from the RESPECT trial. Pain. 2008;134:209–15.PubMedCrossRef

12.

Katona C, Peveler R, Dowrick C, et al. Pain symptoms in depression: definition and clinical significance. Clin Med. 2005;5:390–5.PubMedCrossRef

13.

Borsbo B, Peolsson M, Gerdle B. The complex interplay between pain intensity, depression, anxiety and catastrophising with respect to quality of life and disability. Disabil Rehabil. 2009;31:1605–13.PubMedCrossRef

14.

Baumeister H, Knecht A, Hutter N. Direct and indirect costs in persons with chronic back pain and comorbid mental disorders-A systematic review. J Psychosom Res. 2012;73:79–85.PubMedCrossRef

15.••

Kroenke K, Wu J, Bair MJ, Krebs EE, Damush TM, Tu W. Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care. J Pain. 2011;12:964–73. Understanding that the nature of the pain-depression link is bidirectional has implications for treatment. The results from this well-designed longitudinal study shed light onto the importance of screening for and treating both pain and depression.PubMedCrossRef

16.

Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain. 1997;13:116–37.PubMedCrossRef

17.

Gupta A, Silman AJ, Ray D, et al. The role of psychosocial factors in predicting the onset of chronic widespread pain: results from a prospective population-based study. Rheumatology. 2007;46:666–71.PubMedCrossRef

18.

Gerrits MM, Oppen PV, van Marwijk HW, Penninx BW, van der Horst HE. Pain and the onset of depressive and anxiety disorders. Pain 2013. http://dx.doi.org/10.1016/j.pain.2013.09.005.

19.

McBeth J, Macfarlane GJ, Silman AJ. Does chronic pain predict future psychological distress? Pain. 2002;96:239–45.PubMedCrossRef

20.

Jensen MP. A neuropsychological model of pain: research and clinical implications. J Pain. 2010;11:2–12.PubMedCrossRef

21.

Meerwijk EL, Ford JM, Weiss SJ. Brain regions associated with psychological pain: implications for a neural network and its relationship to physical pain. Brain Imaging Behav. 2013;7:1–14.PubMedCrossRef

22.

Eisenberger NI. The neural bases of social pain: evidence for shared representations with physical pain. Psychosom Med. 2012;74:126–35.PubMedCrossRef

23.

Eisenberger NI, Lieberman MD. Why rejection hurts: a common neural alarm system for physical and social pain. Trends Cogn Sci. 2004;8:294–300.PubMedCrossRef

24.

Giesecke T, Gracely RH, Williams DA, Geisser M, Petzke F, Clauw DJ. The relationship between depression, clinical pain, and experimental pain in a chronic pain cohort. Arthritis Rheum. 2005;52:1577–84.PubMedCrossRef

25.

Hauser W, Wolfe F, Tolle T, Uceyler N, Sommer C. The role of antidepressants in the management of fibromyalgia syndrome: a systematic review and meta-analysis. CNS Drugs. 2012;26:297–307.PubMedCrossRef

26.

Mercier A, Auger-Aubin I, Lebeau JP, et al. Evidence of prescription of antidepressants for non-psychiatric conditions in primary care: an analysis of guidelines and systematic reviews. BMC Fam Pract. 2013;14:55.PubMedCrossRef

27.

O'Malley PG, Balden E, Tomkins G, Santoro J, Kroenke K, Jackson JL. Treatment of fibromyalgia with antidepressants: a meta-analysis. J Gen Intern Med. 2000;15:659–66.PubMedCrossRef

28.

Marangell LB, Clauw DJ, Choy E, et al. Comparative pain and mood effects in patients with comorbid fibromyalgia and major depressive disorder: secondary analyses of four pooled randomized controlled trials of duloxetine. Pain. 2011;152:31–7.PubMedCrossRef

29.

Skljarevski V, Desaiah D, Liu-Seifert H, et al. Efficacy and safety of duloxetine in patients with chronic low back pain. Spine. 2010;35:578–85.CrossRef

30.

Wernicke JF, Pritchett YL, D'Souza DN, et al. A randomized controlled trial of duloxetine in diabetic peripheral neuropathic pain. Neurology. 2006;67:1411–20.PubMedCrossRef

31.

Arnold LM, Hess EV, Hudson JI, Welge JA, Berno SE, Keck Jr PE. A randomized, placebo-controlled, double-blind, flexible-dose study of fluoxetine in the treatment of women with fibromyalgia. Am J Med. 2002;112:191–7.PubMedCrossRef

32.••

Wager TD, Atlas LY, Lindquist MA, Roy M, Woo CW, Kross E. An fMRI-based neurologic signature of physical pain. N Engl J Med. 2013;368:1388–97. This study utilized fMRI and experimental pain testing to identify objective measures of pain in healthy participants and successfully identified signatures for different types of pain.PubMedCrossRef

33.

Gracely RH, Geisser ME, Giesecke T, et al. Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain. 2004;127:835–43.PubMedCrossRef

34.

Normand E, Potvin S, Gaumond I, Cloutier G, Corbin JF, Marchand S. Pain inhibition is deficient in chronic widespread pain but normal in major depressive disorder. J Clin Psychiatry. 2011;72:219–24.PubMedCrossRef

35.

De Souza JB, Potvin S, Goffaux P, Charest J, Marchand S. The deficit of pain inhibition in fibromyalgia is more pronounced in patients with comorbid depressive symptoms. Clin J Pain. 2009;25:123–7.PubMedCrossRef

36.

Wang Q, Jayasuriya R, Man WY, Fu H. Does functional disability mediate the pain-depression relationship in older adults with osteoarthritis? A longitudinal study in China. Asia-Pacific Journal of Public health / Asia-Pacific Academic Consortium for Public Health 2012.

37.

Shuster J, McCormack J, Pillai Riddell R, Toplak ME. Understanding the psychosocial profile of women with fibromyalgia syndrome. Pain Res Manag. 2009;14:239–45.PubMed

38.

Gustafsson M, Gaston-Johansson F. Pain intensity and health locus of control: a comparison of patients with fibromyalgia syndrome and rheumatoid arthritis. Patient Educ Couns. 1996;29:179–88.PubMedCrossRef

39.

Arnstein P, Caudill M, Mandle CL, Norris A, Beasley R. Self efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain patients. Pain. 1999;80:483–91.PubMedCrossRef

40.

Swinkels-Meewisse IE, Roelofs J, Oostendorp RA, Verbeek AL, Vlaeyen JW. Acute low back pain: pain-related fear and pain catastrophizing influence physical performance and perceived disability. Pain. 2006;120:36–43.PubMedCrossRef

41.

Swinkels-Meewisse IE, Roelofs J, Verbeek AL, Oostendorp RA, Vlaeyen JW. Fear-avoidance beliefs, disability, and participation in workers and non-workers with acute low back pain. Clin J Pain. 2006;22:45–54.PubMedCrossRef

42.

Pjanic I, Messerli-Burgy N, Bachmann MS, Siegenthaler F, Hoffmann-Richter U, Znoj H. Predictors of depressed mood 12 months after injury. Contribution of self-efficacy and social support. Disabil Rehabil. 2013;27:105. doi:10.3109/09638288.2013.837971.

43.

Beck JS. Cognitive therapy: basics and beyond. New York: Guilford Press; 1995.

44.

Hassett AL, Cone JD, Patella SJ, Sigal LH. The role of catastrophizing in the pain and depression of women with fibromyalgia syndrome. Arthritis Rheum. 2000;43:2493–500.PubMedCrossRef

45.

Radat F, Margot-Duclot A, Attal N. Psychiatric co-morbidities in patients with chronic peripheral neuropathic pain: a multicentre cohort study. Eur J Pain. 2013;17:1547–57.PubMed

46.

Velly AM, Look JO, Carlson C, et al. The effect of catastrophizing and depression on chronic pain–a prospective cohort study of temporomandibular muscle and joint pain disorders. Pain. 2011;152:2377–83.PubMedCrossRef

47.

Edwards RR, Bingham 3rd CO, Bathon J, Haythornthwaite JA. Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. Arthritis Rheum. 2006;55:325–32.PubMedCrossRef

48.

McWilliams LA, Asmundson GJG. The relationship of adult attachment dimensions to pain-related fear, hypervigilance, and catastrophizing. Pain. 2007;127:27–34.PubMedCrossRef

49.

Nicholas MK, Asghari A, Blyth FM, et al. Self-management intervention for chronic pain in older adults: a randomised controlled trial. Pain. 2013;154:824–35.PubMedCrossRef

50.

Fahland RA, Kohlmann T, Hasenbring M, Feng YS, Schmidt CO. Which route leads from chronic back pain to depression? A path analysis on direct and indirect effects using the cognitive mediators catastrophizing and helplessness/hopelessness in a general population sample. Schmerz. 2012;26:685–91.PubMedCrossRef

51.

Hassett AL, Simonelli LE, Radvanski DC, Buyske S, Savage SV, Sigal LH. The relationship between affect balance style and clinical outcomes in fibromyalgia. Arthritis Rheum. 2008;59:833–40.PubMedCrossRef

52.

Lyubomirsky S. Positive psychologists on positive constructs. Am Psychol. 2012;67:574. author reply 576-577.PubMedCrossRef

53.

Sin NL, Lyubomirsky S. Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis. J Clin Psychol. 2009;65:467–87.PubMedCrossRef

54.

Huffman JC, Mastromauro CA, Boehm JK, et al. Development of a positive psychology intervention for patients with acute cardiovascular disease. Heart Int. 2011;6:e14.PubMed

55.

Pressman SD, Cohen S. Does positive affect influence health? Psychol Bull. 2005;131:925–71.PubMedCrossRef

56.

Zautra AJ, Johnson LM, Davis MC. Positive affect as a source of resilience for women in chronic pain. J Consult Clin Psychol. 2005;73:212–20.PubMedCrossRef

57.

Finan PH, Zautra AJ, Davis MC. Daily affect relations in fibromyalgia patients reveal positive affective disturbance. Psychosom Med. 2009;71:474–82.PubMedCrossRef

58.

Finan PH, Quartana PJ, Smith MT. Positive and negative affect dimensions in chronic knee osteoarthritis: effects on clinical and laboratory pain. Psychosom Med. 2013;75:463–70.PubMedCrossRef

59.

Finan PH, Okun MA, Kruszewski D, Davis MC, Zautra AJ, Tennen H. Interplay of concurrent positive and negative interpersonal events in the prediction of daily negative affect and fatigue for rheumatoid arthritis patients. Health Psychol. 2010;29:429–37.PubMedCrossRef

60.

Dowd H, Zautra A, Hogan M. Emotion, stress, and cardiovascular response: an experimental test of models of positive and negative affect. Int J Behav Med. 2010;17:189–94.PubMedCrossRef

61.

Franklin JC, Lee KM, Hanna EK, Prinstein MJ. Feeling worse to feel better: pain-offset relief simultaneously stimulates positive affect and reduces negative affect. Psychol Sci. 2013;24:521–9.PubMedCrossRef

62.

Ulus Y, Akyol Y, Tander B, Durmus D, Bilgici A, Kuru O. Sleep quality in fibromyalgia and rheumatoid arthritis: associations with pain, fatigue, depression, and disease activity. Clin Exp Rheumatol. 2011;29:S92–6.PubMed

63.

Bigatti SM, Hernandez AM, Cronan TA, Rand KL. Sleep disturbances in fibromyalgia syndrome: relationship to pain and depression. Arthritis Rheum. 2008;59:961–7.PubMedCrossRef

64.

Tang NK, Goodchild CE, Hester J, Salkovskis PM. Pain-related insomnia versus primary insomnia: a comparison study of sleep pattern, psychological characteristics, and cognitive-behavioral processes. Clin J Pain. 2012;28:428–36.PubMedCrossRef

65.

Tang NK, Goodchild CE, Salkovskis PM. Hybrid cognitive-behaviour therapy for individuals with insomnia and chronic pain: a pilot randomised controlled trial. Behav Res Ther. 2012;50:814–21.PubMedCrossRef

66.

Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85:317–32.PubMedCrossRef

67.

Zale EL, Lange KL, Fields SA, Ditre JW. The relation between pain-related fear and disability: a meta-analysis. J Pain. 2013;14:1019–30.PubMedCrossRef

68.

Turk DC. Cognitive-behavioral approach to the treatment of chronic pain patients. Reg Anesth Pain Med. 2003;28:573–9.PubMed

69.

Hassett AL, Williams DA. Non-pharmacological treatment of chronic widespread musculoskeletal pain. Best Pract Res Clin Rheumatol. 2011;25:299–309.PubMedCrossRef

70.

Williams DA, Kuper D, Segar M, Mohan N, Sheth M, Clauw DJ. Internet-enhanced management of fibromyalgia: a randomized controlled trial. Pain. 2010;151:694–702.PubMedCrossRef

71.

Kroenke K, Krebs EE, Bair MJ. Pharmacotherapy of chronic pain: a synthesis of recommendations from systematic reviews. Gen Hosp Psychiatry. 2009;31:206–19.PubMedCrossRef

72.

Krebs EE, Gaynes BN, Gartlehner G, et al. Treating the physical symptoms of depression with second-generation antidepressants: a systematic review and metaanalysis. Psychosomatics. 2008;49:191–8.PubMedCrossRef

73.

Lynch ME. Antidepressants as analgesics: a review of randomized controlled trials. J Psychiatry Neurosci. 2001;26:30–6.PubMed

74.

Kroenke K, Bair MJ, Damush TM, et al. Optimized antidepressant therapy and pain self-management in primary care patients with depression and musculoskeletal pain: a randomized controlled trial. JAMA. 2009;301:2099–110.PubMedCrossRef

75.

Sveinsdottir V, Eriksen HR, Reme SE. Assessing the role of cognitive behavioral therapy in the management of chronic nonspecific back pain. J Pain Res. 2012;5:371–80.PubMed

76.

Kohl A, Rief W, Glombiewski JA. How effective are acceptance strategies? A meta-analytic review of experimental results. J Behav Ther Exp Psychiatry. 2012;43:988–1001.PubMedCrossRef

77.

Wetherell JL, Afari N, Rutledge T, et al. A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain. 2011;152:2098–107.PubMedCrossRef

78.

Vowles KE, McCracken LM, O'Brien JZ. Acceptance and values-based action in chronic pain: a three-year follow-up analysis of treatment effectiveness and process. Behav Res Ther. 2011;49:748–55.PubMedCrossRef

79.

Hassett AL, Williams DA. Non-pharmacological treatment of chronic widespread musculoskeletal pain. Best Pract Res Clin Rheumatol. 2011;25:299–309.PubMedCrossRef

80.

Maiers MJ, Westrom KK, Legendre CG, Bronfort G. Integrative care for the management of low back pain: use of a clinical care pathway. BMC Health Serv Res. 2010;10:298.

81.

Hedman E, Ljotsson B, Lindefors N. Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost-effectiveness. Expert Rev Pharmacoeconomics Outcome Res. 2012;12:745–64.CrossRef

82.•

Dear BF, Titov N, Perry KN, et al. The pain course: a randomised controlled trial of a clinician-guided internet-delivered cognitive behaviour therapy program for managing chronic pain and emotional well-being. Pain. 2013;154:942–50. Increasing utilization of evidence based interventions is of great importance. This study describes one possible avenue for treating comorbid pain and depression-Internet based Cognitive Behavioral Therapy.PubMedCrossRef

Title: Pain and Depression: An Integrative Review of Neurobiological and Psychological Factors
Authors: Jenna Goesling
Daniel J. Clauw
Afton L. Hassett
Publication date: 01-12-2013
Publisher: Springer US
Published in: Current Psychiatry Reports / Issue 12/2013
Print ISSN: 1523-3812
Electronic ISSN: 1535-1645
DOI: https://doi.org/10.1007/s11920-013-0421-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pain and Depression: An Integrative Review of Neurobiological and Psychological Factors

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Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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