Depression, anxiety may exacerbate chronic pain

By Joene Hendry

NEW YORK (Reuters Health) - People living with chronic pain may report more intense pain and related disability if they concurrently have depression, anxiety, or both, researchers report.

"Depression and anxiety may be unrecognized among patients with chronic pain," said Dr. Matthew J. Bair, of Roudebush VA Medical Center in Indianapolis, Indiana.

Left untreated, these conditions can have a devastating and profoundly negative impact on people with chronic pain, Bair told Reuters Health.

He and colleagues looked for associations between depression and anxiety, and measures of pain intensity, pain-related disability, and quality of life, by assessing enrollment data for 500 chronic pain patients enrolled in the Stepped Care for Affective Disorders and Musculoskeletal Pain study.

The study population, aged 59 years on average and 55 percent women only had chronic pain, for at least 3 months. Twenty percent had pain plus depression, 3 percent had pain and anxiety and 23 percent had all three conditions, the investigators report in the journal Psychosomatic Medicine.

When the participants reported how many days in the last 3 months they had been unable to perform usual activities at work, school, or home, the 54 percent with only pain answered 18 disability days on average. By contrast, the 3 percent with pain plus anxiety and the 20 percent with pain plus depression averaged 32 and 38 disability days, respectively.

Those with pain plus anxiety and depression, averaged nearly 43 disability days. This group also reported the greatest pain severity, the investigators found.

"Those with comorbid depression and anxiety also had significantly lower health-related quality of life," said Bair, evident by their reports of lower social functioning, less vitality, and their feelings of poorer health.

Bair surmises heightened awareness, through the findings of this study, may lead to greater screening for and treatment of depression and anxiety among this population.

Further intervention studies should assess the frequency of depression and anxiety among chronic pain patients as well as treatment models that obtain the best outcomes.

SOURCE: Psychosomatic Medicine, October 2008