Skip to main content
SpringerLink
Log in

Idiopathic pain and depression

  • Research Papers
  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

This report summarizes research on the hypothesis that idiopathic chronic pain syndromes and depressive disorders share certain common pathogenetic mechanisms. There is increasing evidence that this may be partly true. Not only do chronic pain syndromes respond to treatment with antidepressants, but there are also striking clinical similarities between these syndromes and depressive syndromes. However, important differences do exist (e.g., the courses of these disorders are usually dissimilar). Family studies show that affective disorders are common in first-degree relatives of patients with idiopathic pain syndromes, but it is impossible to conclude from this that clear-cut genetic factors are of importance. Factors common to both syndromes include common personality traits, shortened rapid eye movements in sleep EEG, hypercortisolaemia and pathological dexamethasone suppression tests, low levels of melatonin in serum and urine and high levels of endorphins and Fraction I in cerebro-spinal fluid. One important common pathogenetic mechanism seems to be disturbances in the serotoninergic system.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Williams JBW, Spitzer RL. Idiopathic pain disoder: a critique of painprone disorder and a proposal for a revision of the DSM-III category psychonegic pain disorder. J Nerv Mental Disorders 1982; 70: 415–419.

    Google Scholar 

  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised, DSM-III R. Washington, DC: APA, 1987.

    Google Scholar 

  3. Chaturverdi SK. Depressed and non-depressed chronic pain patients. Pain 1987; 29: 355–361.

    Google Scholar 

  4. Sternbach RA. Pain Patients. Traits and Treatment. London: Academic Press, 1974.

    Google Scholar 

  5. von Knorring L. The Experience of Pain in Patients with Depressive Disorders. A Clinical and Experimental Study. Umea University Medical Dissertation, New Series No. 2, Umea University, 1975.

  6. Blumer D, Heilbronn M. Depression and chronic pain, In: Cameron O, ed. Presentation of Depression. New York: Wiley, 1987.

    Google Scholar 

  7. Turk DC, Salovey P. Chronic pain as a variant of depressive disease'. A critical reappraisal. J Nerv Mental Disorders 1984; 172: 398–404.

    Google Scholar 

  8. Eberhard G, von Knorring L, Nilsson HL, eds. Antidepressants in chronic pain syndromes. Nordic J Psychiatry 1989; 43 (Suppl. 20).

  9. Engel G. ‘Psychogenic’ pain and the pain-prone patient. Am J Med 1959; 26: 899–918.

    Google Scholar 

  10. Black RG. The chronic pain syndrome. Surg Clin N Am 1975; 55: 999–1011.

    Google Scholar 

  11. Lindsay PG, Wycoff M. The depression-pain syndrome and its response to antidepressants. Psychosomatics 1981; 22: 571–577.

    Google Scholar 

  12. Blumer D, Heilbronn M. Chronic pain as a variant of depressive disease. The pain-prone disorder. J Nerv Mental Disorders 1982; 170: 381–406.

    Google Scholar 

  13. Chaturverdi SK. Psychalgic depressive disorder: a descriptive and comparative study. Acta Psychiatr Scand 1989; 79: 98–102.

    Google Scholar 

  14. WHO. ICD-10. The ICD-10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. World Health Organization, Geneva, 1992.

    Google Scholar 

  15. American Psychiatric Association. DSM-IV Draft Criteria. Task force on DSM-IV. Washington, DC: APA, 1993.

    Google Scholar 

  16. Pilowsky I. Affective disorders and pain. In: Dubner R, Gebhart GF, Bond MR, eds. Proceedings of the Vth World Congress on Pain. Amsterdam. Elsevier Science Publishers, 1988; 63–275.

    Google Scholar 

  17. Almay BGL. Patients with Idiopathic Pain Syndromes. A clinical, Biochemical and Neuroendocrinological Study. Umea University Medical Dissertation, New series, No. 191, Umea University, 1987.

  18. Eberhard G, von Knorring L, Nilsson HL et al. Predictors for the outcome of treatment with antidepressants in patients with idiopathic pain syndromes. Nordic J Psychiatry 1989; 43 (Suppl. 20): 114–120.

    Google Scholar 

  19. Ward NG, Bloom VL, Friedel RO. The effectiveness of tricyclic antidepressants in the treatment of coexisting pain and depression. Pain 1979; 7: 331–341.

    Google Scholar 

  20. von Knorring L, Perris C, Eisemann M, et al. Pain as a symptom in depressive disorders. I. Relationship to diagnostic subgroup and depressive symptomatology. Pain 1983; 15: 19–26.

    Google Scholar 

  21. LaVonne-Wesley A, Gatchel RJ, Polatin PB, et al. Differentiation between somatic and cognitive affective components in commonly used measurements of depression in patients with chronic low-back pain. Let's not mix apples and oranges. Spine 1991; 16 (Suppl): 213–215.

    Google Scholar 

  22. Linder J. Psychiatric Symptom Profiles, Selected Hormones and Electrolytes in Three Disorders with Depressive Symptoms. Primary Hyperparathyroidism, Idiopathic Pain Syndrome and Major Depressive Disorder. Doctoral Dissertation, Karolinska Institute, Stockholm, 1992.

  23. Haley WE, Turner JA, Romano JM. Depression in chronic pain patients: relation to pain, activity and sex differences. Pain 1985; 23: 337–343.

    Google Scholar 

  24. France RD, Houpt JL, Ellinswood EH. Therapeutic effects of antidepressants in chronic pain. Gen Hosp Psychiatry 1984; 6: 55–63.

    Google Scholar 

  25. Reich J, Tupin JP, Abramowitz SL. Psychiatric diagnosis of chronic pain patients. Am J Psychiatry 1983; 140: 1495–1498.

    Google Scholar 

  26. Katon W, Egan K, Miller D. Chronic pain: lifetime psychiatric diagnosis and family history. Am J Psychiat 1985; 42: 1156–1160.

    Google Scholar 

  27. Large GL. DSM-III diagnosis in chronic pain. Confusion and clarity. J Nerv Mental Disorders 1986; 174: 295–303.

    Google Scholar 

  28. fishbain DA, Goldberg M, Meagher BR, et al. Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain 1986; 26: 181–197.

    Google Scholar 

  29. Hagnell O, Lande J, Rorsman B, Öjesjö L. Are we entering and age of melancholy? Psychol Med 1982; 12: 279–289.

    Google Scholar 

  30. Krishnan KRR. France RD, Pelton S. Chronic pain and depression. I. Classification of depression in chronic low back patients. Pain 1985; 22: 279–287.

    Google Scholar 

  31. Harrop-Griffiths J, Katon W, Walker E, et al. The association between chronic pelvic pain, psychiatric diagnoses and sexual childhood abuse. Obstet Gynecol 1988; 71: 589–594.

    Google Scholar 

  32. Gallagher RM, Marbach JJ, Raphael KG, et al. Is major depression comorbid with temperomandibular pain and dysfunction syndrome? A pilot study. Clin J Pain 1991; 7: 219–225.

    Google Scholar 

  33. Atkinson JH, Slater MA, Patterson TL, et al. Prevalence, onset and risk of psychiatric disorders in men with chronic low back pain. Pain 1991; 45: 111–121.

    Google Scholar 

  34. Dworkin RH, Hartstein G, Rosner HL, et al. A highrisk method for studying psychosocial antecedents of chronic pain: the prospective investigation of herpes zoster. J Abnorm Psychol 1992; 101: 200–205.

    Google Scholar 

  35. Lopez Ibor JJ. Masked depression. Br J Psychiat 1972; 120: 245–258.

    Google Scholar 

  36. Blumer D, Heilbronn M. The pain-prone disorder: a clinical and psychological profile. Psychosomatics 1981; 22: 395–402.

    Google Scholar 

  37. Schaffer CB, Donlon PT, Bittle RM. Chronic pain and depression. A clinical and family story survey. Am J Psychiat 1980; 137: 118–129.

    Google Scholar 

  38. Eberhard G, von Knorring L, Mellerup ET, et al. 3H-imipramine binding in idiopathic pain syndromes. Basal values and changes after treatment with antidepressants. Pain 1989; 38: 261–267.

    Google Scholar 

  39. Valdés M, Garcia L, Treserra J, et al. Psychogenic pain and depressive disorders: an empirical study. J Affect Disorders 1989; 16: 21–25.

    Google Scholar 

  40. Perris C, Eisemann K, von Knorring L, Perris H. Personality traits in former depressed patients and in healthy subjects without past history of depression. Psychopathology 1984; 17: 178–186.

    Google Scholar 

  41. von Knorring L, Perris C, Eisemann M, Perris H. Discrimination of former depressed patients from healthy volunteers on the basis of stable personality traits assessed by means of KSP. Arch Psychiatr Neurol Sci 1984; 234: 202–205.

    Google Scholar 

  42. von Knorring L, Almay BGL, Johansson F. Personality traits in patients with isiopathic pain disorders. Acta Psychiat Scand 1987; 76: 490–498.

    Google Scholar 

  43. Reich J, Green AJ. Effect of personality disorders on outcome of treatment. J Nerv Mental Disorders 1991; 179: 74–82.

    Google Scholar 

  44. Charney DS, Nelson CJ, Quinlan DM. Personality traits and disorder in depression. Am J Psychiatry 1981; 138: 1601–1604.

    Google Scholar 

  45. Pfohl B, Stangl D, Zimmerman M. The implications of DSM-III personality disorders for patients with major affective disorders. J Affective Dis 1984; 7: 309–318.

    Google Scholar 

  46. Friedman RC, Aronoff MP, Clarkin JF. History of suicidal behaviour in depressed borderline patients. Am J Psychiatry 1983; 140: 1022–1026.

    Google Scholar 

  47. Ekselius L, von Knorring L. Personality disorders in patients with affective disorders and chronic pain syndromes. Paper presented at the Annual Meeting of the Swedish Psychiatric Association on Personality Disorders, Uppsala, Jan. 28–29, 1993.

  48. Blumer D, Zorick F, Heilbronn M, Roth T. Biological markers for depression in chronic pain. J Nerv Mental Disorder 1982; 170: 425–428.

    Google Scholar 

  49. Kupfer DJ, foster FG. Interval between onset of sleep and rapid eye movement sleep as an indicator of depression. Lancet 1972; 2: 684–686.

    Google Scholar 

  50. Kupfer DJ, Foster FG, Coble P, et al. The application of EEG sleep for the differential diagnosis of affective disorders. Am J Psychiat 1978; 135: 69–74.

    Google Scholar 

  51. Feinberg M, Carroll BJ. Biological ‘markers’ for endogenous depression. Arch Gen Psychiat 1984; 41: 1080–1085.

    Google Scholar 

  52. Kupfer DJ. EEG, sleep and tricyclic antidepressants in affective disorders. In: Usdin E, ed. Clinical Pharmacology in Psychiatry. New York: Elsevier, 1981: 325–338.

    Google Scholar 

  53. Akiskal HS, Rosenthal TL, haykal RF, et al. Characterological depressions: clinical and sleep EEG findings separating ‘subaffective dysthymics’ form ‘characterspectrum disorders’. Arch Gen Psychiat 1980; 37: 377–380.

    Google Scholar 

  54. Thase KE, Kupfer DJ, Spiker DG. Electroencephalographic sleep in secondary depression: a revisit. Biol Psychiat 1984; 19: 805–814.

    Google Scholar 

  55. Katz JL, Kuperberg A, Pollack CP, et al. Is there a relationship between eating disorders and affective disorders? New evidence from sleep recording. Am J Psychiat 1984; 141: 753–758.

    Google Scholar 

  56. Carroll BJ, Feinberg M, Greden F. A specific laboratory test for the diagnosis of melancholia. Standardization, validation and clinical utility. Arch Gen Psychiat 1981; 38: 15–22.

    Google Scholar 

  57. Ward NG, Turner JA, Ready B, Bigos SJ. Chronic pain, depression and the dexamethasone suppression test. Pain 1992; 48: 331–338.

    Google Scholar 

  58. Hällström T, Samuelsson S, Balldin J, et al. Abnormal dexamethasone suppression test in normal females. Br J Psychiatry 1983; 142: 489–504.

    Google Scholar 

  59. Coppen A, Abou-Saleh M, Milln P, et al. Dexamethasone suppression test in depression and other psychiatric illness. Br J Psychiat 1983; 142: 498–504.

    Google Scholar 

  60. Coppen A. The biochemistry of affective disorders. Br J Psychiat 1967; 113: 1237–1264.

    Google Scholar 

  61. van Praag H, Korf J, Schut D. Cerebral monoamine and depression. Arch Gen Psychiat 1973; 28: 827–831.

    Google Scholar 

  62. Aberg-Wistedt A. A double-blind study of zimelidine, a serotonin uptake inhibitor and desipramine, a noradrenaline inhibitor in endogenous depression. I. Clinical findings. Acta Psychiat Scand 1982; 66: 50–65.

    Google Scholar 

  63. Asberg M, Bertilsson L, Mattensson B et al. CSF monoamine metabolites in melancholia. Acta Psychiat Scand 1984; 69: 201–219.

    Google Scholar 

  64. Messing RB, Lytle D. Serotonin-containing neurons: Their possible role in pain and analgesia. Pain 1977; 4: 1–21.

    Google Scholar 

  65. Basbaum AI, Fields HL. Endogenous pain control mechanism: review and hypothesis. Ann Neurol 1978; 4: 451–462.

    Google Scholar 

  66. Sicuteri F, Anselmi B, Del Bianco PL. 5-Hydroxytryptamine supersensitivity as a new theory of headache and central pain: a clinical, pharmacological approach with p-chlorophenylalanine. Psychopharmacologia 1975; 29: 347–356.

    Google Scholar 

  67. Millinger GS. Neutral amino acid therapy for the management of chronic pain. J Craniomandibular Pract 1986; 4: 157–163.

    Google Scholar 

  68. Johansson F, von Knorring L. A double-blind controlled study of a serotonin uptake inhibitor (Zimelidine) versus placebo in chronic pain patients. Pain 1979; 7: 69–78.

    Google Scholar 

  69. Gourlay GK, Cherry DA, Cousins MJ, et al. A controlled study of a serotonin reuptake blocker, zimelidine, in the treatment of chronic pain, Pain 1986; 25: 35.

    Google Scholar 

  70. Ottevanger EA. Fluvoxamine—highly selective 5-HT-reuptake inhibitor (basic brochure). Holland: Duphar, 1987.

    Google Scholar 

  71. Eberhard G, von Knorring L, Nilsson HL, et al. A double-blind randomized study of clomipramine versus maprotiline in patients with idiopathic pain syndromes. Neuropsychobiology 1988; 9: 25–34.

    Google Scholar 

  72. Almay BGL, Häggendal J, von Knorring L, Oreland L. 5-HIAA and HVA in CSF in patients with idiopathic pain disorders. Biol Psychiat 1987; 22: 403–412.

    Google Scholar 

  73. von Knorring L. Affect and pain: neurochemical mediators and therapeutic approaches. In: Dubner R, Gebhart GF, Bond MR, eds. Proceedings of the Vth World Congress on Pain. Amsterdam: Elsevier Science Publishers, 1988: 276–285.

    Google Scholar 

  74. Almay BGL, von Knorring L, Oreland L. Platelet MAO in patients with idiopathic pain disorders. J Neural Transmission 1987; 69: 243–253.

    Google Scholar 

  75. von Knorring L, Oreland L, Häggendal J, et al. Relationship between platelet MAO activity and concentrations of 5-HIAA and HVA in cerebrospinal fluid in chronic pain patients. J Neural Transmission 1986; 66: 37–46.

    Google Scholar 

  76. Murphy DL, Wright C, Buchsbaum M, et al. Platelet and plasma amine oxidase activity in 680 normals: sex and age difference and stability over time. Biochem Med 1976; 16: 254–265.

    Google Scholar 

  77. Revely MA, Revely AM, Clifford CA, Murray RM. Genetics of platelet MAO activity in discordant schizophrenic and normal twins. Br J Psychiat 1983; 142: 560–565.

    Google Scholar 

  78. Oxenstierna G, Edman G, Iselius L, et al. Concentrations of monoamine metabolites in CSF of twins and unrelated subjects. A genetic study. J Psychiatric Res 1986; 20: 19–29.

    Google Scholar 

  79. von Knorring L, Perris C, Oreland L, et al. Pain as a symptom in depressive disorders and its relationship to platelet monoamine oxidase activity. J Neural Transmission 1984; 60: 1–9.

    Google Scholar 

  80. Hökfelt T, Ljungdahl A, Steinbusch H, et al. Immunohistochemical evidence of substance P-like immunoreactivity in some 5-hydroxytryptamine containing neurons in the rat central nervous system. Neuroscience 1978; 3: 517–538.

    Google Scholar 

  81. Almay BGL, Johansson F, von Knorring L, et al. Substance P in CSF of patients with chronic pain syndromes. Pain 1988; 33: 3–9.

    Google Scholar 

  82. Rimón R, Le Gréves P, Nyberg F, et al. Elevation of substance P in the CSF of psychiatric patients. Biol Psychiatry 1984; 19: 509–516.

    Google Scholar 

  83. Berrettini WH, Rubinow DR, Nurnberger JI, et al. CSF substance P immunoreactivity in affective disorders. Biol Psychiatry 1985; 20: 965–970.

    Google Scholar 

  84. Briley MS, Langer SZ, Raisman R, et al. Tritiated imipramine binding sites decreased in platelets of untreated depressed patients. Science 1980; 209: 303–305.

    Google Scholar 

  85. Mellerup ET, Bech P, Hansen HJ, et al. Platelet 3H-imipramine binding in psychogenic pain disorders. 1989; manuscript.

  86. Fuxe K, Calza L, Benefati F, et al. Quantitative autoradiographic localization of 3H-imipramine binding sites in the brain of the rat: relationship to ascending 5-hydroxytryptamine neuron systems. Proc Natl Acad Sci 1983; 80: 3836–3840.

    Google Scholar 

  87. von Knorring L, Almay BGL. Neuroendocrine response to fenfluramine in patients with idiopathic pain syndromes. Nordic J Psychiatry 1989; 43 (Suppl. 20): 61–65.

    Google Scholar 

  88. Beck-Friis J. Melatonin in Depressive Disorder. A Methodological and Clinical Study of the Pineal-Hypothalamic-Pituitary-Adrenal Cortex System. Doctoral dissertation, Stockholm: Karolinska Institute, 1983.

  89. Almay BGL, von Knorring L, Wetterberg L. Melatonin in serum and urine in patients with idiopathic pain syndromes. Psychiat Res 1987; 22: 179–191.

    Google Scholar 

  90. Eschalier A. Antidepressants and pain management. In: Serotonin and Pain. J. M. Besson (Ed). Amsterdam: Excerpta Medica, International Congress Series 879, 1990: 305–326.

    Google Scholar 

  91. Johansson F, von Knorring L, Sedvall G, Terenius L. Changes in endorphins and 5-hydroxyindoleacetic acid in cerebrospinal fluid as a result of treatment with a serotonin reuptake inhibitor (zimelidine) in chronic pain patients. Psychiatry Res 1980; 2: 167–172.

    Google Scholar 

  92. Bourgoin S, Cesselin F, Gozlan H, Chronic chlorimipramine does not reverse the reduction of cerebrospinal fluid met-enkephalim-like immunoreactivity in chronic pain patients. Clin Neuropharmacol 1987; 10: 424–442.

    Google Scholar 

  93. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., Washington, DC: APA, 1980.

    Google Scholar 

  94. Messing RB, Phebus L, Fischer L. Analgesic effect of fluoxethine HCL (Lilly 110140), a specific uptake inhibitor for serotoninergic neurons. Psychopharmacol Commun 1975; 1: 511–521.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Uppsala University Hospital, S-751 85, Uppsala, Sweden

    L. von Knorring & L. Ekselius

Authors
  1. L. von Knorring
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Ekselius
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

von Knorring, L., Ekselius, L. Idiopathic pain and depression. Qual Life Res 3 (Suppl 1), S57–S68 (1994). https://doi.org/10.1007/BF00433378

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00433378

Key words

Search

Navigation