Subject(s)
Back Pain/drug therapy , Bupropion/therapeutic use , Adult , Back Pain/diagnosis , Chronic Disease , Female , Humans , Male , Pain Measurement , Treatment OutcomeABSTRACT
Cerebrospinal fluid (CSF) beta-endorphin concentrations were determined before and after treatment in 28 patients suffering chronic neuralgic low back pain/sciatica. Nine patients carried the additional diagnosis of major depressive disorder. Pain treatment was multimodal and resulted in variable pain reduction. CSF beta-endorphin concentrations spanned a wide range with no association to age, gender, pain ratings, depressive symptomatology, and drug intake. CSF beta-endorphin concentrations were not influenced by the presence of major depressive disorder and did not change with successful treatment of pain and resolution of depression.
Subject(s)
Back Pain/therapy , Depressive Disorder/therapy , Sciatica/therapy , Sick Role , beta-Endorphin/cerebrospinal fluid , Adult , Aged , Back Pain/cerebrospinal fluid , Back Pain/psychology , Combined Modality Therapy , Depressive Disorder/cerebrospinal fluid , Depressive Disorder/psychology , Female , Humans , Male , Middle Aged , Pain Measurement , Sciatica/cerebrospinal fluid , Sciatica/psychologyABSTRACT
Antidepressants are often effective in the management of chronic pain syndromes. They are most useful for certain types of pain complaints, such as headache, diabetic neuropathy, arthritis and facial pain. The choice of antidepressant depends on the side effects and the patient's ability to tolerate the medication. The dose is usually half of that used in the management of depression.
Subject(s)
Antidepressive Agents/pharmacology , Pain/drug therapy , Antidepressive Agents/administration & dosage , Chronic Disease , Humans , SyndromeABSTRACT
Healing or successful intervention usually leads to the resolution of pain. However, in some patients biologic or psychologic symptoms associated with pain persist despite treatment or apparent healing. In cases in which the etiology is not known, persistent pain is categorized as a clinical syndrome known as "chronic pain." Organic, psychologic, and socioenvironmental factors contribute to the development of chronic pain. Major organic illnesses leading to chronic pain include headaches, back problems, arthritis, and cancer. Significant psychological reactions occur in many pain patients, with depression being the most common. Pain is often seen in patients with psychiatric disorders such as depression, anxiety, and somatization, as well as in substance abusers. Before successful management can begin, the major etiologic factors and sequelae of the chronic pain syndrome must be understood. Antidepressants, neuroleptics, anticonvulsants, nonsteroidal anti-inflammatory drugs, and hydroxyzine have been proven effective in the treatment of pain syndromes. The treatment of patients who present with chronic pain must be individualized based on a comprehensive understanding of the factors underlying the chronic pain syndrome of each patient.
Subject(s)
Mental Disorders/psychology , Pain/psychology , Acute Disease , Adult , Chronic Disease , Humans , Male , Mental Disorders/complications , Middle Aged , Pain/etiologyABSTRACT
Recent studies have shown that depression can be assessed in patients who have chronic pain. This study shows that various subtypes of depression can be differentiated in such patients using a standardized diagnostic schema for psychiatric disorders and a self-rating instrument for assessing the level of psychologic distress. In addition, when examining the onset of pain and subtypes of depression, there was no correlation between the onset of major depression and pain, whereas there was a strong positive correlation between the onset of chronic depression and pain. The recognition of the subtypes of depression has clinical implications in the management of the patient with chronic pain and depression.
Subject(s)
Depression/diagnosis , Depressive Disorder/diagnosis , Pain/psychology , Adult , Chronic Disease , Female , Humans , Interview, Psychological , Male , Psychiatric Status Rating Scales , Stress, PsychologicalABSTRACT
Patients with chronic pain syndromes often have concomitant depression. In this paper we discuss the clinical and biologic characteristics of depression, and also briefly discuss the various subtypes of depression, potential modes in the development of depression, neuroendocrine markers of depression, and patient response to antidepressant medication.
Subject(s)
Depressive Disorder/etiology , Pain/complications , Antidepressive Agents/therapeutic use , Chronic Disease , Depressive Disorder/diagnosis , Depressive Disorder/drug therapy , Dexamethasone , Humans , Pain/psychology , Thyrotropin/blood , Thyrotropin-Releasing HormoneABSTRACT
Antidepressant drugs have been used successfully in the treatment of chronic pain syndromes. Clinical trials have supported the use of these drugs for pain and the depression that often accompanies pain syndromes. Although the exact mechanisms of action have not been clearly elucidated, it has been suggested that these agents have analgesic properties independent of their antidepressant effect on mood and behavior. Pain patients without concomitant depression experienced pain relief with antidepressant therapy; these patients represent the most convincing evidence that antidepressant drugs have a direct analgesic effect. Studies presented in this paper support the clinical efficacy of antidepressant medications in the treatment of patients suffering from headaches (migraine, tension, and mixed types), diabetic neuropathy, arthritis, and facial pain. These data also suggest that antidepressant drugs may be effective in the treatment of postherpetic neuralgia, back pain, and pain from mixed etiologies; however, data for these pain syndromes are less clear, and, thus, further testing is required.
Subject(s)
Antidepressive Agents/therapeutic use , Forecasting , Pain/drug therapy , Chronic Disease , HumansABSTRACT
An association between chronic pain and depression has been recognised for a long time. However, the exact nature of this association remains unclear. The authors studied 80 consecutive patients with chronic low back pain. Different types of depression were diagnosed using Research Diagnostic Criteria. The relationship between different types of depression and clinical and demographic variables are presented. Beck Depression Inventory and the Montgomery-Asberg Depression Rating Scale were used in an attempt to discriminate between the different types of depression.
Subject(s)
Back Pain/psychology , Depressive Disorder/psychology , Adjustment Disorders/psychology , Adolescent , Adult , Aged , Chronic Disease , Female , Humans , Male , Middle Aged , Prognosis , Psychological Tests , PsychopathologyABSTRACT
The authors studied the Dexamethasone Suppression Test (DST) in chronic pain patients with and without major depression, using items from a modified version of the Hamilton Depression Scale, the Hamilton Anxiety Scale, and the Montgomery-Asberg Depression Rating Scale. The purpose of the study was to identify the factor or factors which discriminated DST suppressors from nonsuppressors. The data suggest that depression and its profile are efficient discriminators of suppressors and nonsuppressors. Anxiety-related items were not as good as discriminators. The items that identified nonsuppression were the items that are often seen in combination in endogenous depression.
Subject(s)
Depressive Disorder/physiopathology , Dexamethasone , Hypothalamo-Hypophyseal System/physiopathology , Pain/physiopathology , Pituitary-Adrenal System/physiopathology , Adult , Chronic Disease , Depressive Disorder/complications , Humans , Middle Aged , Pain/complicationsABSTRACT
The concept of chronic pain has become enmeshed with depression. In an attempt to unravel this complex relationship, the authors studied a uniform group of 42 patients with chronic pain, i.e., patients who had chronic low back pain with defined organic pathology, in relation to the dexamethasone suppression test (DST). The results were analyzed in relation to the presence or absence of major depression and cortisol suppression. Forty-one percent of the patients with major depression had abnormal cortisol responses to dexamethasone administration; all patients without major depression had normal responses. These results suggest that chronic pain patients differ from patients with major depression and a positive DST.
Subject(s)
Back Pain/diagnosis , Depressive Disorder/diagnosis , Dexamethasone , Manuals as Topic , Adolescent , Adult , Aged , Back Pain/blood , Depressive Disorder/blood , Diagnosis, Differential , Female , Humans , Hydrocortisone/blood , Male , Middle Aged , Psychophysiologic Disorders/blood , Psychophysiologic Disorders/diagnosisABSTRACT
Three patients taking conjugated estrogens developed akathisia induced by tricyclic antidepressants. The interaction between tricyclic antidepressants and conjugated estrogens could play a role in the development of akathisia.
