Gormsen Lise, Ribe Anette Riisgaard, Raun Peter, Rosenberg Raben, Videbech Poul, Vestergaard Per, Bach Flemming W, Jensen Troels S
Department of Neurology, Danish Pain Research Centre, Aarhus Kommune Hospital, University of Aarhus, Noerrebrogade 44, Building 1, 8000 Aarhus, Denmark.
Eur J Pain. 2004 Oct;8(5):487-93. doi: 10.1016/j.ejpain.2003.11.015.
Pain and depression are often associated suggesting that both conditions share a common neurobiological mechanism, which modulate emotional function and processing of noxious information. Pain thresholds are hypothesized to be altered in depressed patients and normalized with the amelioration of depression. The purpose of this study was therefore to determine pain thresholds in patients during and after treatment with electroconvulsive therapy (ECT) of severe depression and in healthy controls. Seventeen depressed patients (Hamilton depression score > 18) and an age and gender matched control group of same size participated in the study. Pain detection and tolerance thresholds to pressure and pain tolerance thresholds to the Cold Pressor Test by exposure to ice-water was measured twice in depressed patients during and after ECT and twice in controls with a similar time interval. While ECT significantly improved Hamilton depression score (from mean 23.9 (SD:5) to mean 12.5 (SD:5.7)) there was no significant change in pain thresholds during and after ECT in the patient group. However, depressed patients had significantly lower pain tolerance in the Cold Pressor Test on both examinations and on pressure pain tolerance on the second examination day than their corresponding control subjects. The differential effect of ECT on depression score and pain processing indicate that mood and noxious processing are not medicated directly by the same systems but that a complex relationship between pain and depression exists.
疼痛与抑郁常常相关，这表明两者具有共同的神经生物学机制，该机制调节情绪功能和有害信息的处理。据推测，抑郁症患者的疼痛阈值会发生改变，并随着抑郁症状的改善而恢复正常。因此，本研究的目的是确定重度抑郁症患者在接受电休克治疗（ECT）期间及治疗后以及健康对照者的疼痛阈值。17名抑郁症患者（汉密尔顿抑郁量表评分>18）和一个年龄及性别匹配的同等规模对照组参与了本研究。对抑郁症患者在ECT期间及治疗后以及对照组在相似时间间隔内进行两次测量，分别测量对压力的疼痛检测和耐受阈值以及通过接触冰水进行冷加压试验的疼痛耐受阈值。虽然ECT显著改善了汉密尔顿抑郁量表评分（从平均23.9（标准差：5）降至平均12.5（标准差：5.7）），但患者组在ECT期间及治疗后的疼痛阈值并无显著变化。然而，抑郁症患者在两次检查中的冷加压试验疼痛耐受度以及在第二次检查日的压力疼痛耐受度均显著低于相应的对照受试者。ECT对抑郁评分和疼痛处理的不同影响表明，情绪和有害刺激处理并非由相同系统直接介导，而是疼痛与抑郁之间存在复杂的关系。
