Hermesdorf Marco, Berger Klaus, Baune Bernhard T, Wellmann Jürgen, Ruscheweyh Ruth, Wersching Heike
Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
Discipline of Psychiatry, University of Adelaide, Adelaide, Australia.
J Pain. 2016 May;17(5):606-16. doi: 10.1016/j.jpain.2016.01.474. Epub 2016 Feb 9.
Patients with depression often report pain. Evidence regarding altered pain sensitivity in depressed patients remains, however, inconclusive. In a large cross-sectional study we investigated the association between depression and pain sensitivity with regard to 2 different dimensions of pain sensitivity, as well as the effect of somatic cofactors, symptom severity, and subtype of depression. In 735 patients with a current episode of major depression and 456 never-depressed control participants pain thresholds (pressure pain thresholds, PPTs) were measured at the index finger pad and self-rated suprathreshold pain intensity ratings were obtained using the Pain Sensitivity Questionnaire (PSQ)-minor subscore, an instrument that assesses pain intensity in daily life situations. Additionally, lifestyle factors, medical, and psychiatric conditions were assessed. Unadjusted, patients with depression had lower PPTs and higher PSQ-minor scores indicating increased pain sensitivity. After adjusting for potential mediators, such as poor sleep quality and physical inactivity, patients did not differ from control participants regarding PPTs, but still had significantly higher PSQ-minor ratings. Among patients with depression, severity of anxiety symptoms predicted higher PSQ-minor scores. In conclusion, we found a differential effect of depression on the 2 pain sensitivity dimensions: Decreased experimentally obtained pain thresholds were explained by depression-associated somatic factors whereas increased self-rated suprathreshold pain intensity ratings were associated with increased anxiety symptoms.
Because increased pain intensity perception is hypothesized to be a risk factor for the development of chronic pain, our findings may contribute to understanding the high incidence of chronic pain in depressed patients. They also encourage clinicians to consider the role of anxiety in treatment programs for pain in patients with depression.
抑郁症患者常诉说疼痛。然而，关于抑郁症患者疼痛敏感性改变的证据仍不确凿。在一项大型横断面研究中，我们从疼痛敏感性的两个不同维度调查了抑郁症与疼痛敏感性之间的关联，以及躯体辅助因素、症状严重程度和抑郁症亚型的影响。在735例当前患有重度抑郁症的患者和456例从未患过抑郁症的对照参与者中，测量了食指指腹的疼痛阈值（压力疼痛阈值，PPTs），并使用疼痛敏感性问卷（PSQ）-次要子评分获得自我评定的阈上疼痛强度评分，该工具用于评估日常生活中的疼痛强度。此外，还评估了生活方式因素、医疗和精神状况。未经调整时，抑郁症患者的PPTs较低，PSQ-次要评分较高，表明疼痛敏感性增加。在对潜在中介因素（如睡眠质量差和身体活动不足）进行调整后，抑郁症患者与对照参与者在PPTs方面没有差异，但PSQ-次要评分仍显著较高。在抑郁症患者中，焦虑症状的严重程度预示着PSQ-次要评分较高。总之，我们发现抑郁症对两种疼痛敏感性维度有不同影响：通过实验获得的疼痛阈值降低可由与抑郁症相关的躯体因素解释，而自我评定的阈上疼痛强度评分增加与焦虑症状增加相关。
由于疼痛强度感知增加被假设为慢性疼痛发生的一个危险因素，我们的研究结果可能有助于理解抑郁症患者中慢性疼痛的高发病率。这些结果还鼓励临床医生在抑郁症患者疼痛治疗方案中考虑焦虑的作用。
