The relationship between pain and depression
The relationship between pain and depression
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DOI：
10.1192/s0007125000298474
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发表时间：
1996-06-01
影响因子：
10.5
通讯作者：
Simon, G
中科院分区：
文献类型：
--
作者：
VonKorff, M;Simon, G
在初级保健和人群样本中进行的关于疼痛-抑郁共病的流行病学研究的经验性结果表明：（a）疼痛与焦虑和抑郁障碍一样密切相关;（B）最能预测抑郁的特征是疼痛的扩散性和疼痛干扰活动的程度;（c）某些心理症状（低能量，睡眠不安，担心）在疼痛患者中很突出，而其他人（d）抑郁和疼痛功能障碍在疼痛自然史的早期是明显的，但功能障碍和痛苦往往是短暂的;以及（e）在功能障碍是慢性的最初功能障碍性疼痛患者中，抑郁水平没有改善，但也没有随着时间的推移而增加。这些结果似乎与疼痛-抑郁共病的这些机制相一致：（1）对焦虑性躯体症状和抑郁性躯体症状的易感性特征（包括疼痛）和心理症状（包括抑郁症），以及一种躯体感觉放大状态，其中心理痛苦放大了烦躁的身体感觉（包括疼痛）;（2）心理疾病和行为功能障碍是对疼痛的适应不良反应的相互关联的特征，在病症的自然史的早期明显，并且通常在早期恢复阶段消退;（3）构成可能诱发或加剧心理困扰的显著的身体和心理应激源的疼痛。因此，疼痛和心理疾病应被视为具有相互的心理和行为影响，涉及疾病表达和适应的过程，以及疼痛对情绪状态和行为功能的具体影响。
Empirical results from epidemiological studies on pain-depression comorbidity in primary care and population samples have shown that: (a) pain is as strongly associated with anxiety as with depressive disorders; (b) characteristics that most strongly predict depression are diffuseness of pain and the extent to which pain interferes with activities; (c) certain psychological symptoms (low energy, disturbed sleep, worry) are prominent among pain patients, while others (guilt, loneliness) are not; (d) depression and pain dysfunction are evident early in the natural history of pain, but dysfunction and distress are often transient; and (e) among initially dysfunctional pain patients whose dysfunction is chronic, depression levels do not improve but neither do they increase over time with chronicity alone. These results seem consistent with these mechanisms of pain-depression comorbidity; (1) a trait of susceptibility to both dysphoric physical symptoms (including pain) and psychological symptoms (including depression), and a state of somatosensory amplification in which psychological distress amplifies dysphoric physical sensations (including pain); (2) psychological illness and behavioural dysfunction being interrelated features of a maladaptive response to pain evident early in the natural history of the condition, and often resolving during an early recovery phase; (3) pain constituting a significant physical and psychological stressor that may induce or exacerbate psychological distress. Thus, pain and psychological illness should be viewed as having reciprocal psychological and behavioural effects involving both processes of illness expression and adaption, as well as pain having specific effects on emotional state and behavioural function.