Dworkin R H, Gitlin M J
Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York.
Clin J Pain. 1991 Jun;7(2):79-94. doi: 10.1097/00002508-199106000-00004.
It has been widely recognized that an appreciable proportion of chronic pain patients have depressive disorders. Although numerous studies and several literature reviews have examined the relationship between chronic pain and depression, disorders of mood come in many forms, and little attention has been paid to the different types of depressive disorders found among patients with chronic pain. In this article, the different ways in which a chronic pain patient may manifest depression are discussed. Diagnostic criteria for major depression, dysthymia, and atypical depression are described, and the relevance of these disorders and of masked depression to chronic pain is discussed. The medical illnesses and medications that can cause symptoms of depressive disorders are also briefly described. Depressive disorders and their concomitants are an integral part of the experience of chronic pain and are important in developing an optimal treatment plan. For these reasons, they should be carefully evaluated in all patients with chronic pain.
人们已经广泛认识到，相当一部分慢性疼痛患者患有抑郁症。尽管众多研究和几篇文献综述都探讨了慢性疼痛与抑郁之间的关系，但情绪障碍有多种形式，而慢性疼痛患者中存在的不同类型抑郁症却很少受到关注。本文讨论了慢性疼痛患者可能表现出抑郁的不同方式。描述了重度抑郁症、心境恶劣障碍和非典型抑郁症的诊断标准，并讨论了这些障碍以及隐匿性抑郁症与慢性疼痛的相关性。还简要介绍了可能导致抑郁障碍症状的内科疾病和药物。抑郁障碍及其伴随症状是慢性疼痛体验中不可或缺的一部分，对制定最佳治疗方案很重要。基于这些原因，所有慢性疼痛患者都应接受仔细评估。
