Think Depression When Chronic Pain Worsens

News March 01, 2013
IMNG Medical Media, 2013 Mar 01, MA Otto

LAS VEGAS (IMNG) – Treating comorbid depression gives “you the biggest bang for the buck” in the overall care and rehabilitation of patients with chronic pain, according to Dr. Michael Clark, director of Johns Hopkins University’s Chronic Pain Treatment Program in Baltimore.

“When you treat the depression,” pain lessens and function improves, regardless of other treatments and the cause of the pain, he said (JAMA 2009;301:2099-110).

Depression is common in chronic pain and generally thought to be its byproduct. But, at least in some cases, the depression comes first and seems to drive the pain. Depression itself increases the risk for chronic pain syndromes and is the best predictor of persistence. Depression is also associated with higher pain intensity and more comorbities (Psychol. Med. 2004;34:211-9).

“We don’t fully understand” the relationship, but pain perception and depression appear to share common brain pathways, which is “probably why there is so much overlap,” said Dr. Clark, also vice chairman for clinical affairs in Hopkins’ department of psychiatry and behavioral sciences.

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