Department of Medicine, Indiana University, Indianapolis, IN, USA.
J Pain. 2011 Sep;12(9):964-73. doi: 10.1016/j.jpain.2011.03.003. Epub 2011 Jun 16.
Pain and depression are the most prevalent physical and psychological symptom-based disorders, respectively, and co-occur 30 to 50% of the time. However, their reciprocal relationship and potentially causative effects on one another have been inadequately studied. Longitudinal data analysis involving 500 primary care patients with persistent back, hip, or knee pain were enrolled in the Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study. Half of the participants had comorbid depression and were randomized to a stepped care intervention (n = 123) or treatment as usual (n = 127). Another 250 nondepressed patients with similar pain were followed in a parallel cohort. Outcomes were assessed at baseline, 3, 6, and 12 months. Mixed effects model repeated measures (MMRM) multivariable analyses were conducted to determine if change in pain severity predicted subsequent depression severity, and vice versa. Change in pain was a strong predictor of subsequent depression severity (t-value = 6.63, P < .0001). Likewise, change in depression severity was an equally strong predictor of subsequent pain severity (t-value = 7.28, P < .0001). Results from the full cohort were similar in the clinical trial subgroup. In summary, pain and depression have strong and similar effects on one another when assessed longitudinally over 12 months.
This study strengthens the evidence for a bidirectional and potentially causative influence of pain and depression on one another. A change in severity of either symptom predicts subsequent severity of the other symptom. Thus, recognition and management of both conditions may be warranted, particularly when treatment focused on 1 condition is not leading to an optimal response.
疼痛和抑郁分别是最常见的基于身体和心理症状的障碍，分别有 30%到 50%的时间同时发生。然而，它们之间的相互关系及其对彼此的潜在因果影响尚未得到充分研究。涉及 500 名持续性背部、臀部或膝盖疼痛的初级保健患者的纵向数据分析被纳入情感障碍和肌肉骨骼疼痛的阶梯式护理（SCAMP）研究。一半的参与者患有共病性抑郁，并被随机分配到阶梯式护理干预组（n = 123）或常规治疗组（n = 127）。另外 250 名疼痛相似但没有抑郁的非抑郁患者在平行队列中进行了随访。在基线、3、6 和 12 个月时评估了结局。采用混合效应模型重复测量（MMRM）多变量分析来确定疼痛严重程度的变化是否预测随后的抑郁严重程度，反之亦然。疼痛的变化是随后抑郁严重程度的一个强有力的预测因素（t 值= 6.63，P <.0001）。同样，抑郁严重程度的变化也是随后疼痛严重程度的一个同等有力的预测因素（t 值= 7.28，P <.0001）。临床试验亚组的全队列结果相似。总之，在 12 个月的时间里，当从纵向角度评估时，疼痛和抑郁对彼此有强烈且相似的影响。任一症状严重程度的变化都预示着随后另一症状的严重程度。因此，当针对一种病症的治疗不能带来理想的效果时，可能需要同时识别和管理这两种病症。
