Highlights
- •Patients with major depressive disorder (MDD) showed increased pain sensitivity.
- •Patients with depression exhibited lower pressure pain thresholds.
- •Lower pressure pain thresholds were mediated by depression-related somatic factors.
- •Patients with depression exhibited increased levels of self-reported pain intensity.
- •Self-reported pain intensity in MDD patients was associated with anxiety symptoms.
Abstract
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.
Perspective
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.
Key words
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Article info
Publication history
Published online: March 17, 2016
Accepted:
January 25,
2016
Received in revised form:
January 14,
2016
Received:
April 14,
2015
Footnotes
R.R. and H.W. contributed equally to this work.
This work was supported by the German Federal Ministry of Education and Research (BMBF, grant numbers 01ER0816 to K.B. and 01ER1205 to H.W.). The sponsor had no involvement in study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.
M.H., J.W., and H.W. have no conflicts of interest to declare. K.B. has received investigator-initiated research funding as principal or coordinating investigator in the areas of stroke, depression, and subclinical atherosclerosis (BiDirect), multimorbidity and health services research, diabetes, multiple sclerosis, and for the German National Cohort from the German Ministry of Education and Research. For the ongoing conduction of an investigator-initiated clinical register for multiple sclerosis he has received a grant from the German Competence Net Multiple Sclerosis with funds from Biogen Idec. For conducting (2007–2014) a study on the course of restless legs syndrome he has received unrestricted grants to the University of Muenster from the German Restless Legs Society and Boehringer Ingelheim Pharma, Mundipharma Research, Neurobiotec, Roche Pharma, UCB Germany, UCB Switzerland, and Vifor Pharma. B.T.B. is a member of the advisory board for Lundbeck. He receives funding from the National Health and Medical Research Council, Australia. R.R. has received speaker fees from Allergan, MSD, Mundipharma, and Pfizer as well as a travel grant from Allergan. She has received funding from the Else-Kröner Fresenius Stiftung and the Friedrich-Baur-Stiftung. These cooperations did not influence the work covered in the report.
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© 2016 The American Pain Society.
