Professor Troels Jensen‘s clever group of researchers have published an interesting paper in the European Journal of Pain. We were thinking about writing a little spiel on it so you can get the idea and then we thought – what about asking the authors? So we did. Fortunately for us, Lise Gormsen, who has now got her PhD via this work, kindly agreed to write a brief summary. Here it is.
Depression, anxiety and quality of life in chronic pain patients with fibromyalgia or neuropathic pain
Patients who suffer from chronic pain often also suffer from mental distress such as anxiety and depression, resulting in a low health-related quality of life in this patient group. The mechanisms underlying this association are not clear, but a disturbance in the way the central nervous system processes pain has been suggested; especially the neurotransmitters serotonin and noradrenaline have been implied to be involved in mental symptoms and the underlying pathophysiology of chronic pain in both the brain and the spinal cord.
To investigate this relationship, 30 patients with neuropathic pain, 28 patients with fibromyalgia and 26 pain-free age- and gender-matched healthy volunteers were examined with respect to 1) mental symptoms with a survey covering a variety of mental symptoms including anxiety and depression (SCL-90), 2) depression rated both by the physician with the Hamilton Depression Scale and a survey that measures severity but can also be used for the diagnosis of depression (Major Depression Inventory) and 3) anxiety rated both by the physician with the Hamilton Anxiety Scale and by the participant with the Generalized Anxiety Inventory. In addition, patients assessed their health-related quality of life on the SF-36, which is a survey instrument covering a variety of social, mental and physical abilities and functions.
Our results showed that patients with fibromyalgia as well as patients with neuropathic pain had significantly more mental distress including depression and anxiety than healthy volunteers assessed both by self-rating and a professional rating. However, these scores are low compared with those of other studies on mental distress in chronic pain patients. Only few chronic pain patients met the diagnostic criteria for depression: 3.3% for neuropathic pain and 7.1% for fibromyalgia, and the association between pain and mental distress was only found in the patients with fibromyalgia despite similar pain intensities. Furthermore, chronic pain patients had lower health-related quality of life than healthy volunteers.
The findings suggest that different mechanisms are responsible for the development of anxiety and mood disorders in the two patient groups. While patients with neuropathic pain have a localised peripheral disturbance with less direct cortical involvement and therefore less mental distress, patients with fibromyalgia have a generalised disturbance with more cortical involvement.
Lise Gormsen works at the Danish Pain Research Center, Aarhus University Hospital
Gormsen L, Rosenberg R, Bach FW, & Jensen TS (2010). Depression, anxiety, health-related quality of life and pain in patients with chronic fibromyalgia and neuropathic pain. European journal of pain (London, England), 14 (2), 1270-8 PMID: 19473857
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