Atkinson J H, Kremer E F, Risch S C, Dana R, Janowsky D S
Biol Psychiatry. 1986 Jun;21(7):612-20. doi: 10.1016/0006-3223(86)90122-8.
Basal and postdexamethasone concentrations of cortisol and prolactin were studied in three groups of male patients: chronic pain patients with no psychiatric diagnosis (n = 12), chronic pain patients with coexisting major depression by Research Diagnostic Criteria (RDC) (n = 24), and pain-free psychiatric patients meeting RDC criteria for major depression (n = 28). Basal cortisol concentrations were significantly higher in pain-major depression and psychiatric-major depression patients compared to pain patients without psychiatric illness. The frequency of cortisol nonsuppression after dexamethasone was significantly greater in pain patients with major depression (41.7%) compared to pain patients without psychiatric disorder (8.3%), and was comparable to that of psychiatric patients (21.4%). Prolactin concentrations, but not cortisol levels, were significantly correlated with observer-rated severity of depression in pain patients. These findings suggest that cortisol and prolactin abnormalities in chronic pain may be related to psychiatric disorder rather than to pain per se, at least in male patients, and may indicate a role for cholinergic mechanisms in the interface of pain and depression.
无精神疾病诊断的慢性疼痛患者（n = 12）、符合研究诊断标准（RDC）的并存重度抑郁症的慢性疼痛患者（n = 24）以及符合RDC重度抑郁症标准的无疼痛精神疾病患者（n = 28）。与无精神疾病的疼痛患者相比，疼痛伴重度抑郁症患者和精神疾病伴重度抑郁症患者的基础皮质醇浓度显著更高。与无精神疾病的疼痛患者（8.3%）相比，伴重度抑郁症的疼痛患者中地塞米松激发后皮质醇不被抑制的频率显著更高（41.7%），且与精神疾病患者（21.4%）相当。在疼痛患者中，催乳素浓度而非皮质醇水平与观察者评定的抑郁严重程度显著相关。这些发现表明，至少在男性患者中，慢性疼痛中皮质醇和催乳素异常可能与精神疾病而非疼痛本身有关，并且可能表明胆碱能机制在疼痛与抑郁的界面中起作用。
