Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center and Academic Outpatient Clinic for Affective Disorders, GGZ inGeest, Amsterdam, The Netherlands; Department of General Practice and Elderly Care Medicine, EMGO institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center and Academic Outpatient Clinic for Affective Disorders, GGZ inGeest, Amsterdam, The Netherlands; Department of General Practice and Elderly Care Medicine, EMGO institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
J Psychosom Res. 2015 Jan;78(1):64-70. doi: 10.1016/j.jpsychores.2014.10.011. Epub 2014 Oct 28.
Many patients with depression and/or anxiety (D/A) persistently report pain. However, it is not clear how the course of D/A is associated with pain over time. The present study assessed longitudinal associations between D/A and pain, and compared pain over time between D/A and healthy controls.
2676 participants of the Netherlands Study of Depression and Anxiety were followed-up for four years. At three waves (baseline, 2, 4years) we assessed depressive and anxiety symptom severity. Using DSM-IV criteria, we also assessed four different D/A disorder courses over time (n=2093): incident, remitted, chronic, and no D/A (reference group). Pain was assessed at the three waves by severity and number of locations.
Change in D/A symptoms was positively associated with change in pain symptoms. Compared to healthy controls (n=519), D/A subjects - incident (n=333), remitted (n=548) or chronic (n=693) - reported more severe pain (b=0.4-0.7, p<0.001) and more pain locations (b=0.8-1.4, p<.001) at all waves, with the highest ratings in chronic D/A. Remission of D/A during follow-up was associated with a significant decline in pain (severity; p=0.002, number of locations; p<.001), but pain levels remained significantly higher compared to healthy controls. Findings were similar for separate depression or anxiety course.
This study largely confirms synchrony of change between depression, anxiety and pain. However, even after depression and anxiety remission, subjects report higher pain ratings over time. Individuals with D/A (history) seem to be at increased risk of chronic pain.
许多患有抑郁和/或焦虑症（D/A）的患者持续报告疼痛。然而，目前尚不清楚 D/A 的病程随时间的推移如何与疼痛相关。本研究评估了 D/A 与疼痛之间的纵向关联，并比较了 D/A 与健康对照组随时间的疼痛差异。
2676 名荷兰抑郁和焦虑研究的参与者被随访了四年。在三个时间点（基线、2 年、4 年），我们评估了抑郁和焦虑症状的严重程度。使用 DSM-IV 标准，我们还评估了随时间变化的四种不同的 D/A 疾病病程（n=2093）：新发病例、缓解、慢性和无 D/A（参考组）。疼痛在三个时间点通过严重程度和疼痛部位数量进行评估。
D/A 症状的变化与疼痛症状的变化呈正相关。与健康对照组（n=519）相比，D/A 患者 - 新发病例（n=333）、缓解（n=548）或慢性（n=693）- 在所有时间点报告更严重的疼痛（b=0.4-0.7，p<0.001）和更多的疼痛部位（b=0.8-1.4，p<.001），慢性 D/A 的评分最高。随访期间 D/A 的缓解与疼痛显著下降有关（严重程度；p=0.002，疼痛部位数量；p<.001），但与健康对照组相比，疼痛水平仍然明显更高。单独的抑郁或焦虑病程的结果相似。
本研究在很大程度上证实了抑郁、焦虑和疼痛之间变化的同步性。然而，即使在抑郁和焦虑缓解后，患者随时间的推移仍报告更高的疼痛评分。患有 D/A（病史）的个体似乎有患慢性疼痛的风险增加。
