Journal of Contemporary Psychotherapy

, Volume 46, Issue 3, pp 149–157 | Cite as

How Do We Understand Depression in People with Persistent Pain?

Original Paper
First Online:

Abstract

Depression and depressed mood are common in people with persistent (chronic) pain, exacerbating disability and worsening quality of life. Yet the relationship between persistent pain and depression remains unclear, despite its importance for designing or adapting interventions to address both pain and depression. Meta-analysis of cognitive and behavioral interventions designed for rehabilitation of persistent pain shows small benefits for distress. However, substantial variation between studies in patients’ baseline levels of depression and in quality of treatments militates against any clear conclusions. Apart from these interventions, longitudinal studies on chronic pain and depression in adults from clinical populations provide weak evidence that depression worsens pain outcomes. We systematically searched for and reviewed 14 longitudinal studies that explored the association between persistent pain and depression, aiming to identify: (1) the effects on pain of baseline depression; (2) the effects on depression of baseline pain; and (3) possible mediating variables, with particular attention to methodology. Unfortunately, most studies used unsuitable instruments to measure depression, and we could draw only tentative conclusions about effects over time. Better models and clearer measurement strategies are required for a next generation of clinically useful treatment trials and, meanwhile, some implications for treatment are explored.

Keywords

Chronic pain Systematic review Distress 
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References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  2. Ashton-James, C. E., Richardson, D. C., Williams, A. C., Bianchi-Berthouze, N., & Dekker, P. H. (2014). Impact of pain behaviors on evaluations of warmth and competence. Pain, 155, 2656–2661.CrossRefPubMedGoogle Scholar
  3. Bair, M. J., Robinson, R. L., Katon, W., & Kroenke, K. (2003). Depression and pain comorbidity: A literature review. Archives of Internal Medicine, 163, 2433–2445.CrossRefPubMedGoogle Scholar
  4. Banks, S., & Kerns, R. (1996). Explaining high rates of depression in chronic pain: A diathesis-stress framework. Psychological Bulletin, 119, 95–110.CrossRefGoogle Scholar
  5. Berna, C., Leknes, S., Holmes, E. A., Edwards, R. R., Goodwin, G. M., & Tracey, I. (2010). Induction of depressed mood disrupts emotion regulation neurocircuitry and enhances pain unpleasantness. Biological Psychiatry, 67, 1083–1090.CrossRefPubMedGoogle Scholar
  6. Bishop, D. (2013). Why we need pre-registration. http://deevybee.blogspot.co.uk/2013/07/why-we-need-pre-registration.html. Accessed October 13, 2013.
  7. Blackburn-Munro, G., & Blackburn-Munro, R. E. (2001). Chronic pain, chronic stress and depression: Coincidence or consequence? Journal of Neuroendocrinology, 13, 1009–1023.CrossRefPubMedGoogle Scholar
  8. Blumer, D., & Heilbronn, M. (1982). Chronic pain as a variant of depressive disease: The pain-prone disorder. The Journal of Nervous and Mental Disease, 170, 381–406.CrossRefPubMedGoogle Scholar
  9. Bushnell, M. C., Ceko, M., & Low, L. A. (2013). Cognitive and emotional control of pain and its disruption in chronic pain. Nature Reviews Neuroscience, 14, 502–511.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Chou, R., & Huffman, L. (2007). Medications for acute and chronic low back pain: A review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Annals of Internal Medicine, 147, 505–510.CrossRefPubMedGoogle Scholar
  11. Chung, K.-F., Tso, K.-C., Yeung, W.-F., & Li, W.-H. (2012). Quality of life in major depressive disorder: The role of pain and pain catastrophizing cognition. Comprehensive Psychiatry, 53, 387–395.CrossRefPubMedGoogle Scholar
  12. Cosco, T. D., Doyle, F., Ward, M., & McGee, H. (2012). Latent structure of the Hospital Anxiety and Depression scale: A 10-year systematic review. Journal of Psychosomatic Research, 72, 180–184.CrossRefPubMedGoogle Scholar
  13. Costello, C. G. (Ed.). (1983). Symptoms of depression. New York: Wiley.Google Scholar
  14. Coyne, J., & van Sonderen, E. (2012). No further research needed: Abandoning the Hospital Anxiety and Depression Scale (HADS). Journal of Psychosomatic Research, 72, 173–174.CrossRefPubMedGoogle Scholar
  15. Crombez, G., Beirens, K., Van Damme, S., Eccleston, C., & Fontaine, J. (2009). The unbearable lightness of somatisation: A systematic review of the concept of somatisation in empirical studies of pain. Pain, 145, 31–35. doi: 10.1016/j.pain.2009.04.006.CrossRefPubMedGoogle Scholar
  16. De Ruddere, L., Goubert, L., Stevens, M., Williams, A. C., & Crombez, G. (2013). Discounting pain in the absence of medical evidence is explained by negative evaluation of the patient. Pain, 154, 669–676.CrossRefPubMedGoogle Scholar
  17. Dowrick, C. (2015). Therapeutic consultations for patients with depressive symptoms: What do we know? British Journal of General Practice, 65, 550–551.CrossRefPubMedGoogle Scholar
  18. Dunn, K. M., Croft, P. R., Main, C. J., & Von Korff, M. (2008). A prognostic approach to defining chronic pain: Replication in a UK primary care low back pain population. Pain, 135, 48–54.CrossRefPubMedGoogle Scholar
  19. Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research. The American Psychologist, 69, 153–166.CrossRefPubMedGoogle Scholar
  20. Finan, P. H., Goodin, B. R., & Smith, M. T. (2013). The association of sleep and pain: An update and a path forward. The Journal of Pain, 14(12), 1539–1552.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Fishbain, D. A., Cutler, R., Rosomoff, H. L., & Rosomoff, R. S. (1997). Chronic pain-associated depression: Antecedent or consequence of chronic pain? A review. The Clinical Journal of Pain, 13, 116–137.CrossRefPubMedGoogle Scholar
  22. Galatzer-Levy, I. R., & Bryant, R. A. (2013). 636,120 ways to have post-traumatic stress disorder. Perspectives on Psychological Science, 8, 651–662.CrossRefPubMedGoogle Scholar
  23. Gerrits, M. M. J. G., Vogelzangs, N., van Oppen, P., van Marwijk, H. W. J., van der Horst, H., & Penninx, B. W. J. H. (2012). Impact of pain on the course of depressive and anxiety disorders. Pain, 153, 429–436.CrossRefPubMedGoogle Scholar
  24. Gurung, T., Ellard, D. R., Mistry, D., Patel, S., & Underwood, M. (2015). Identifying potential moderators for response to treatment in low back pain: A systematic review. Physiotherapy, 101, 243–251.CrossRefPubMedGoogle Scholar
  25. Hann, K. E. J., & McCracken, L. M. (2014). A systematic review of randomized controlled trials of Acceptance and Commitment Therapy for adults with chronic pain: Outcome domains, design quality, and efficacy. J Contextual Behavioral Science, 3, 217–227.CrossRefGoogle Scholar
  26. Hardt, J., Gerbershagen, H. U., & Franke, P. (2000). The symptom check-list, SCL-90-R: Its use and characteristics in chronic pain patients. European Journal of Pain, 4, 137–148.CrossRefPubMedGoogle Scholar
  27. Hunot, V., Moore, T. H. M., Caldwell, D. M., Furukawa, T. A., Davies, P., Jones, H., et al. (2013). “Third wave” cognitive and behavioural therapies versus other psychological therapies for depression. The Cochrane Database of Systematic Reviews, 10, CD008704.PubMedGoogle Scholar
  28. Hurwitz, E. L., Morgenstern, H., & Yu, F. (2003). Cross-sectional and longitudinal associations of low-back pain and related disability with psychological distress among patients enrolled in the UCLA Low-Back Pain Study. Journal of Clinical Epidemiology, 56, 463–471.CrossRefPubMedGoogle Scholar
  29. Judd, L. L. (1997). The clinical course of unipolar major depressive disorders. Archives of General Psychiatry, 54, 989–991.CrossRefPubMedGoogle Scholar
  30. Katz, J., Rosenbloom, J. M., & Fashler, S. (2015). Chronic pain, psychopathology, and DSM-5 somatic symptom disorder. Canadian Journal of Psychiatry, 60(4), 160–167.PubMedPubMedCentralGoogle Scholar
  31. Kroenke, K., Bair, M. J., Damush, T. M., Wu, J., Hoke, S., Sutherland, J., & Tu, W. (2009). Optimized antidepressant therapy and pain self-management in primary care patients with depression and musculoskeletal pain: A randomized controlled trial. JAMA, 301, 2099–2110.CrossRefPubMedPubMedCentralGoogle Scholar
  32. Kroenke, K., Shen, J., Oxman, T. E., Williams, J. W., & Dietrich, A. J. (2008). Impact of pain on the outcomes of depression treatment: Results from the RESPECT trial. Pain, 134, 209–215.CrossRefPubMedGoogle Scholar
  33. Kroenke, K., Wu, J., Bair, M. J., Damush, T. M., Krebs, E. E., & Tu, W. (2012). Impact of depression on 12-month outcomes in primary-care patients with chronic musculoskeletal pain. Journal of Musculoskeletal Pain, 20, 8–17.CrossRefGoogle Scholar
  34. Lerman, S. F., Shahar, G., & Rudich, Z. (2012). Self-criticism interacts with the affective component of pain to predict depressive symptoms in female patients. European Journal of Pain, 16, 115–122.CrossRefPubMedGoogle Scholar
  35. Linton, S., & Bergbom, S. (2011). Understanding the link between depression and pain. Scandinavian Journal of Pain, 2, 47–54.CrossRefGoogle Scholar
  36. Main, C. J., Sowden, G., Hill, J. C., Watson, P. J., & Hay, E. M. (2012). Integrating physical and psychological approaches to treatment in low back pain: The development and content of the STarT Back trial’s ‘high-risk’intervention (StarT Back; ISRCTN 37113406). Physiotherapy, 98(2), 110–116.CrossRefPubMedGoogle Scholar
  37. McCracken, L. M., & Eccleston, C. (2005). A prospective study of acceptance of pain and patient functioning with chronic pain. Pain, 118, 164–169.CrossRefPubMedGoogle Scholar
  38. McCracken, L. M., Vowles, K. E., & Gauntlett-Gilbert, J. (2007). A prospective investigation of acceptance and control-oriented coping with chronic pain. Journal of Behavioral Medicine, 30, 339–349.CrossRefPubMedGoogle Scholar
  39. Merskey, H. (2000). Pain, psychogenesis, and psychiatric diagnosis. International Review of Psychiatry, 12, 99–102.CrossRefGoogle Scholar
  40. Morley, S., & Williams, A. C. (2006). Editorial: RCTs of psychological treatments for chronic pain: progress and challenges. Pain, 121, 171–172.CrossRefPubMedGoogle Scholar
  41. Morley, S., Williams, A. C., & Black, S. (2002). A confirmatory factor analysis of the Beck Depression Inventory in chronic pain. Pain, 99, 289–298.CrossRefPubMedGoogle Scholar
  42. Morley, S., Williams, A. C., & Eccleston, C. (2013). Examining the evidence about psychological treatments for chronic pain: Time for a paradigm shift? Pain, 154, 1929–1931.CrossRefPubMedGoogle Scholar
  43. Muller, S., Thomas, E., Dunn, K. M., & Mallen, C. D. (2013). A prognostic approach to defining chronic pain across a range of musculoskeletal pain sites. The Clinical Journal of Pain, 29, 411–416.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Pincus, T., Santos, R., & Morley, S. (2007). Depressed cognitions in chronic pain patients are focused on health: Evidence from a sentence completion task. Pain, 130, 84–92.CrossRefPubMedGoogle Scholar
  45. Pincus, T., & Williams, A. (1999). Models and measurements of depression in chronic pain. Journal of Psychosomatic Research, 47, 211–219.CrossRefPubMedGoogle Scholar
  46. Rudich, Z., Lerman, S. F., Gurevich, B., & Shahar, G. (2010). Pain specialists’ evaluation of patient’s prognosis during the first visit predicts subsequent depression and the affective dimension of pain. Pain Medicine, 11, 446–452.CrossRefPubMedGoogle Scholar
  47. Rusu, A. C., Pincus, T., & Morley, S. (2012). Depressed pain patients differ from other depressed groups: Examination of cognitive content in a sentence completion task. Pain, 153, 1898–1904.CrossRefPubMedGoogle Scholar
  48. Ryall, C., Coggon, D., Peveler, R., Poole, J., & Palmer, K. T. (2007). A prospective cohort study of arm pain in primary care and physiotherapy—Prognostic determinants. Rheumatology, 46, 508–515.CrossRefPubMedGoogle Scholar
  49. Sanderson, S., Tatt, I. D., & Higgins, J. P. T. (2007). Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: A systematic review and annotated bibliography. International Journal of Epidemiology, 36, 666–676.CrossRefPubMedGoogle Scholar
  50. Schwartz, N., Temkin, P., Jurado, S., Lim, B. K., Heifets, B. D., Polepalli, J. S., et al. (2014). Decreased motivation during chronic pain requires long-term depression in the nucleus accumbens. Science, 345(6196), 535–542. doi: 10.1126/science.1253994.CrossRefPubMedPubMedCentralGoogle Scholar
  51. Shafer, A. B. (2006). Meta-analysis of the factor structures of four depression questionnaires: Beck, CES-D, Hamilton, and Zung. Journal of Clinical Psychology, 62, 123–146.CrossRefPubMedGoogle Scholar
  52. Stang, A. (2010). Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European Journal of Epidemiology, 25, 603–605.CrossRefPubMedGoogle Scholar
  53. Tracey, I., & Mantyh, P. (2007). The cerebral signature for pain perception and its modulation. Neuron, 55, 377–391.CrossRefPubMedGoogle Scholar
  54. Turk, D. C., & Salovey, P. (1984). Chronic pain as a variant of depressive disease: A critical reappraisal. Journal of Nervous and Mental Disease, 172, 398–404.CrossRefPubMedGoogle Scholar
  55. Urquhart, D., Hoving, J. L., Assendelft, W. W., Roland, M., & Van Tulder, M. W. (2008). Antidepressants for non-specific low back pain. Cochrane Database of Systematic Reviews, 1, CD001703.PubMedGoogle Scholar
  56. Van Liew, C., Brown, K. C., Cronan, T. A., Bigatti, S. M., & Kothari, D. J. (2013). Predictors of pain and functioning over time in fibromyalgia syndrome: An autoregressive path analysis. Arthritis Care & Research, 65, 251–256.CrossRefGoogle Scholar
  57. Velly, A. M., Look, J. O., Carlson, C., Lenton, P. A., Kang, W., Holcroft, C. A., & Fricton, J. R. (2011). The effect of catastrophizing and depression on chronic pain—A prospective cohort study of temporomandibular muscle and joint pain disorders. Pain, 152, 2377–2383.CrossRefPubMedGoogle Scholar
  58. Vlaeyen, J. W., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85, 317–332.CrossRefPubMedGoogle Scholar
  59. Von Korff, M., & Miglioretti, D. L. (2005). A prognostic approach to defining chronic pain. Pain, 117, 304–313.CrossRefGoogle Scholar
  60. Wells, G., Shea, B., O’Connell, D., & Peterson, J. (2000). The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.medicine.mcgill.ca/rtamblyn/Readings/TheNewcastle-Scaleforassessingthequalityofnonrandomisedstudiesinmeta-analyses.pdf. Accessed July 21, 2015.
  61. Williams, A. C. (1998). Depression in chronic pain: Mistaken models, missed opportunities. Behaviour Therapy, 27, 61–80.CrossRefGoogle Scholar
  62. Williams, A. C., Eccleston, C., & Morley, S. (2012). Psychological therapies for the management of chronic pain (excluding headache) in adults. The Cochrane Database of Systematic Reviews, 11, CD007407.PubMedGoogle Scholar
  63. Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Reader in Clinical Health PsychologyUniversity College LondonLondonUK
  2. 2.Pain Management CentreUniversity College Hospitals NHS Foundation TrustLondonUK
  3. 3.Neonatal UnitQueen Charlotte’s and Chelsea HospitalLondonUK
  4. 4.Hillingdon HospitalMiddlesexUK

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