Piñerúa-Shuhaibar Lorena, Estévez Jesús, Suárez-Roca Heberto
Centro de Investigaciones Biomédicas IVIC-Zulia, Fundación para el Desarrollo de la Ciencia y la Teenología en la Región Zuliana, Venezuela.
Invest Clin. 2007 Dec;48(4):469-83.
Clinical and experimental evidence support a relationship between susceptibility to chronic pain and a subjacent depression. Nevertheless, it's not clear if the currently available clinical evaluation instruments for depression allow for linking both disorders. Thus, we evaluated a Zung's autoscale for depression and its different categories: affective, physiological, motor and psychological, as possible predictors of sensorial and autonomic alterations and vulnerability to clinical chronic pain. In 32 healthy controls and 11 subjects with minor depression and free of treatment, ischemic pain was first induced by applying a tourniquet on the dominant arm, and then followed by paresthesias during the reperfusion of arm as the tourniquet is released. Ischemic muscular pain, post-ischemic paresthesias and associated cardiovascular responses were recorded throughout the experimental procedure. The affective category's score was correlated linearly in individual form with the greatest number of variables and it was adjusted to a model of multiple regressions that almost explained the variance in 100% with a contribution of the sensorial and autonomic variables of a 70% and 30%, respectively. In addition, the affective category was 50% greater in subjects with persistent clinical pain. The Zung's index and the other categories had a smaller number of individual linear correlations and models of multiple correlations that only explained between 30-70% of the variance, with a more predominant contribution of the autonomic variables (20-50%), especially in the psychological category. This suggests that the affective category predicts cutaneous-muscular sensorial alterations with greater effectiveness than the Zung's total index.
临床和实验证据支持慢性疼痛易感性与潜在抑郁症之间存在关联。然而,目前用于评估抑郁症的临床评估工具是否能将这两种疾病联系起来尚不清楚。因此,我们评估了Zung抑郁自评量表及其不同类别:情感、生理、运动和心理类别,看其是否可能是感觉和自主神经改变以及临床慢性疼痛易感性的预测指标。在32名健康对照者和11名未接受治疗的轻度抑郁症患者中,首先通过在优势手臂上使用止血带来诱发缺血性疼痛,然后在松开止血带手臂再灌注期间观察感觉异常情况。在整个实验过程中记录缺血性肌肉疼痛、缺血后感觉异常以及相关的心血管反应。情感类别的得分与最多数量的变量呈线性个体相关,并且被纳入多元回归模型,该模型几乎能解释100%的方差,其中感觉变量和自主神经变量的贡献分别为70%和30%。此外,患有持续性临床疼痛的受试者的情感类别得分高出50%。Zung指数和其他类别具有较少的个体线性相关性和多元相关模型,这些模型仅能解释30 - 70%的方差,自主神经变量的贡献更为突出(20 - 50%),尤其是在心理类别中。这表明情感类别比Zung总指数更有效地预测皮肤 - 肌肉感觉改变。