رابطه طولی بین درد و افسردگی و اضطراب بیش از چهار سال

Objective Many patients with depression and/or anxiety (D/A) persistently report pain. However, it is not clear how the course of D/A is associated with pain over time. The present study assessed longitudinal associations between D/A and pain, and compared pain over time between D/A and healthy controls. Methods 2676 participants of the Netherlands Study of Depression and Anxiety were followed-up for four years. At three waves (baseline, 2, 4 years) we assessed depressive and anxiety symptom severity. Using DSM-IV criteria, we also assessed four different D/A disorder courses over time (n = 2093): incident, remitted, chronic, and no D/A (reference group). Pain was assessed at the three waves by severity and number of locations. Results Change in D/A symptoms was positively associated with change in pain symptoms. Compared to healthy controls (n = 519), D/A subjects – incident (n = 333), remitted (n = 548) or chronic (n = 693) – reported more severe pain (b = 0.4–0.7, p < 0.001) and more pain locations (b = 0.8–1.4, p < .001) at all waves, with the highest ratings in chronic D/A. Remission of D/A during follow-up was associated with a significant decline in pain (severity; p = 0.002, number of locations; p < .001), but pain levels remained significantly higher compared to healthy controls. Findings were similar for separate depression or anxiety course. Conclusions This study largely confirms synchrony of change between depression, anxiety and pain. However, even after depression and anxiety remission, subjects report higher pain ratings over time. Individuals with D/A (history) seem to be at increased risk of chronic pain.

Pain is a major global health care problem which is often persistent over time [1] and [2]. Insight into factors that may influence the course of pain could help to optimize treatment strategies. Previously, we already found that pain is a risk indicator for developing D/A when we analyzed the impact of pain on the first onset of D/A in 614 adults, but it may also be expected that – reversely – D/A may exert an influence on the longitudinal course of pain [3]. Depressive and/or anxiety disorders (D/A) are highly prevalent in those with pain [4], [5], [6], [7], [8], [9], [10], [11] and [12] and the combination of D/A and pain leads to reduced quality of life, major societal costs and even increased numbers of suicide death [13], [14], [15] and [16]. Furthermore, D/A are associated with reduced psychosocial functioning and inadequate coping strategies which could result in increased pain ratings over time [17] and [18]. D/A may also lead to changes in the insular cortex and abnormalities in the hypothalamic–pituitary–adrenal axis and autonomic nervous system that could subsequently lead to or aggravate pain [17], [19], [20], [21], [22], [23] and [24]. With these psychosocial and biological changes it is questionable whether D/A recovery will also result in decreasing pain levels. As the course of D/A is known to be diverse, ranging from a single short episode to chronically persistent [25], [26], [27] and [28], the trajectory of D/A may be associated with pain course. There are only a few short-term studies examining how change in D/A is related to the course of pain over time. When depressive symptoms improved in 103 primary care patients, pain also improved over 6 months [29]. A clinical trial showed that the increase of depressive symptoms was associated with more severe pain after 1 year, whereas depression relief was associated with less pain [30]. In another study with neurology outpatients, depression severity predicted pain over one year [31]. In patients with serious burn injuries, more depressive and anxiety symptoms were associated with greater pain at the subsequent time point [32]. Finally, in 529 older patients with osteoarthritis, depressive symptoms did not predict pain during follow-up [33]. Most of these findings from relatively small and specific samples point to a synchrony of change over a short period of time, such that if depressive and anxiety symptoms change then pain symptoms will change in a similar direction. Of the above mentioned studies, four focused on depressive symptoms and only one on anxiety. In daily practice, disorders (such as D/A) guide clinical decisions more than symptom levels. Therefore, rather than solely measuring symptom severity we also considered it interesting to examine whether temporary versus more chronic states of psychiatrically defined depressive and anxiety disorders compared to a mentally healthy state impact on pain over time. Our objectives were to determine how different courses of depressive and/or anxious symptoms and disorders (incident, remitted and chronic D/A versus healthy controls) are associated with pain over a four-year period in a large sample.