Sullivan Michael J L, Reesor Kenneth, Mikail Samuel, Fisher Ronald
Departments of Psychology and Psychiatry, Dalhousie University, Halifax Canada Department of Psychology, Ottawa General Hospital, Ottawa Canada Department of Psychology The Rehabilitation Centre, Ottawa Canada Physical Medicine and Rehabilitation, The Rehabilitation Centre, Ottawa Canada.
Pain. 1992 Jul;50(1):5-13. doi: 10.1016/0304-3959(92)90107-M.
The prevalence of major depression in patients with chronic low back pain (CLBP) is approximately three to four times greater than that reported in the general population. In spite of these high prevalence rates, there have been few systematic attempts to investigate the efficacy of treatment for major depression in patients with CLBP. While several studies have examined the efficacy of antidepressant medication and psychological treatment in patients with chronic pain, most of these studies have focused on treating chronic pain rather than depression. The few studies that have specifically addressed the treatment of depression in CLBP indicate that tricyclic antidepressants and cognitive-behavioral approaches may be effective means of treating depressed chronic pain patients. Clinical issues related to diagnostic confounds, rehabilitation outcome, and conceptualizations of the relation between pain and depression are discussed. It is argued that, in patients with clinical levels of depression, treatment modalities specifically targeting depressive symptomatology deserve serious consideration as an integral component of pain management programs.
慢性下腰痛（CLBP）患者中重度抑郁症的患病率约为普通人群的三到四倍。尽管患病率如此之高，但很少有系统的尝试来研究CLBP患者中重度抑郁症的治疗效果。虽然有几项研究考察了抗抑郁药物和心理治疗对慢性疼痛患者的疗效，但这些研究大多集中在治疗慢性疼痛而非抑郁症上。少数专门针对CLBP患者抑郁症治疗的研究表明，三环类抗抑郁药和认知行为疗法可能是治疗慢性疼痛伴抑郁症患者的有效方法。文中讨论了与诊断混淆、康复结果以及疼痛与抑郁症关系的概念化相关的临床问题。有人认为，对于有临床抑郁症水平的患者，专门针对抑郁症状的治疗方式应作为疼痛管理计划的一个组成部分得到认真考虑。
