Page 26 - Layout 1

MENTAL HEALTH
CHALLENGES

Depression and Pain

By Somayaji Ramamurthy, MD

Pain is the most common symptom in patients seeking care at a Headache, abdominal, chest and joint pain complaints are com-
physician's office. Depression is the most common mood disorder monly reported by patients with depressive symptoms in a primary
in patients seeking management of their mental health. There is a care setting and in nursing homes.
significant bidirectional correlation between depression and pain.
This comorbidity significantly impacts diagnosis, the severity of Prevalence of depression in pain patients
symptoms and negatively influences clinical outcomes and treat- Depression was prevalent in 60% of the patients with chronic
ment. Comorbidity results in lower functioning compared to de- pain (continuous or intermittent pain lasting greater than 3 months).
pression or pain alone. The prevalence of the combination of these The incidence of depression was even higher in patients with facial
two conditions is greater than when depression or chronic pain are pain and medically unexplained pain. Patients with multiple pain
individually considered. They both share common neurobiological complaints are more likely to be depressed than patients without
pathways and neurotransmitters. Many of the pharmacological, psy- pain. Patients with two or more different pain complaints are six to
chological and other treatment modalities are effective in treating eight times more likely to meet depression criteria. As the pain
both conditions. Unrecognized depression in pain patients con- severity and duration increase, depression increases. If depression
tributes to treatment failure, increased medication use, interven- increases, pain complaints also increase. Fear of pain leads to avoid-
tional procedures and related complications, drug dependence, ance of activity with decreased activity leading to deconditioning.
addiction and increased disability. Simultaneous assessment and Decreased ability to participate in pleasurable activities leads to in-
treatment of both conditions are necessary for better outcomes. creased depression which further aggravates the problem.

Prevalence of Pain symptoms in patients Effect of pain on recognition and treatment
with depression of depression
The prevalence of pain in depressed patients ranged from 15 to The diagnosis of depression was missed in a primary care setting
100% with a mean of 65%. Depressive symptoms predict future in 50% of the patients who were later treated for depression. This
occurrence of back, shoulder and other musculoskeletal pain. Indi- was because the patients presented with somatic complaints, pre-
viduals with depressive symptoms were twice as likely to report back dominantly pain rather than dysphoric mood and or anhedonia (In-
pain when compared to individuals without depressive symptoms. ability to feel pleasure). In pain patients with unrecognized

26 San Antonio Medicine • May 2019