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The Pain-Depression Relationship

Key Words: Pain-Depression

TO THE EDITOR: In an interesting report, Dickens et al.¹ concluded through their statistical analyses that there was no direct relationship between pain and depression and that any relationship is modulated by disability and illness attitude.

Unfortunately, although they reviewed some of the literature on this research problem, they appear to have neglected a large body of literature that argues that there is a direct relationship between the development of pain and the development of depression. In a review,² we found 37 studies that addressed the relationship between either the severity or frequency of pain and the severity of depression. Of these 37 studies, 33 found a direct statistical relationship between the severity of pain or frequency of pain and the severity of depression. In addition, we investigated whether the literature supported the antecedent hypothesis (depression proceeds development of pain), the consequence hypothesis (depression follows the development of pain), or the scar hypothesis (depression predisposition predisposes to the development of pain). We found 13 studies relating to the antecedent hypothesis.² Of these, nine did not support the antecedent hypothesis. Fifteen studies were found to relate to the consequence hypothesis. Of these, all 15 (or 100%) were consistent in supporting the consequence hypothesis. Twelve studies were found to relate to the scar hypothesis. Of these, nine supported the scar hypothesis. In addition, six studies utilized structural modeling or path analysis to test the relationship between pain and depression. All six studies (or 100%) found the direction of the relationship to be from pain to depression. Overall this large group of studies were relatively consistent in indicating a direct relationship between pain and the development of depression.²

REFERENCES

1. Dickens C, Jayson M, Sutton C, Creed F: The relationship between pain and depression in a trial using paroxetine in sufferers of chronic low back pain. Psychosomatics 2000; 41:490-499[Abstract/Free Full Text]
2. Fishbain DA, Cutler R, Rosomoff HL, Steele-Rosomoff R: Chronic pain associated depression: antecedent or consequence of chronic pain? a review. Clin J Pain 1997; 13:116-137[CrossRef][Medline]

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