Advertisement

Pain Sensitivity in Patients With Major Depression: Differential Effect of Pain Sensitivity Measures, Somatic Cofactors, and Disease Characteristics

      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

      To read this article in full you will need to make a payment
      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Abrishami A.
        • Chan J.
        • Chung F.
        • Wong J.
        Preoperative pain sensitivity and its correlation with postoperative pain and analgesic consumption: A qualitative systematic review.
        Anesthesiology. 2011; 114: 445-457
        • Agüera-Ortiz L.
        • Failde I.
        • Mico J.A.
        • Cervilla J.
        • López-Ibor J.J.
        Pain as a symptom of depression: Prevalence and clinical correlates in patients attending psychiatric clinics.
        J Affect Disord. 2011; 130: 106-112
        • Andrzejewski W.
        • Kassolik K.
        • Brzozowski M.
        • Cymer K.
        The influence of age and physical activity on the pressure sensitivity of soft tissues of the musculoskeletal system.
        J Bodyw Mov Ther. 2010; 14: 382-390
        • Arendt-Nielsen L.
        • Lautenbacher S.
        Assessment of pain perception.
        in: Lautenbacher S. Fillingim R.B. Pathophysiology of Pain Perception. Plenum/Kluver, New York, NY2004: 25-42
        • Bair M.J.
        • Robinson R.L.
        • Katon W.
        • Kroenke K.
        Depression and pain comorbidity: A literature review.
        Arch Intern Med. 2003; 163: 2433-2445
        • Bär K.J.
        • Brehm S.
        • Boettger M.K.
        • Boettger S.
        • Wagner G.
        • Sauer H.
        Pain perception in major depression depends on pain modality.
        Pain. 2005; 117: 97-103
        • Bär K.J.
        • Greiner W.
        • Letsch A.
        • Köbele R.
        • Sauer H.
        Influence of gender and hemispheric lateralization on heat pain perception in major depression.
        J Psychiatr Res. 2003; 37: 345-353
        • Bär K.J.
        • Terhaar J.
        • Boettger M.K.
        • Boettger S.
        • Berger S.
        • Weiss T.
        Pseudohypoalgesia on the skin: A novel view on the paradox of pain perception in depression.
        J Clin Psychopharmacol. 2011; 31: 103-107
        • Breivik H.
        • Collett B.
        • Ventafridda V.
        • Cohen R.
        • Gallacher D.
        Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment.
        Eur J Pain. 2006; 10: 287-333
        • Buysse D.J.
        • Reynolds C.F.
        • Monk T.H.
        • Berman S.R.
        • Kupfer D.J.
        The Pittsburgh Sleep Quality Index (PSQI): A new instrument for psychiatric research and practice.
        Psychiatry Res. 1989; 28: 193-213
        • Craig C.L.
        • Marshall A.L.
        • Sjöström M.
        • Bauman A.E.
        • Booth M.L.
        • Ainsworth B.E.
        • Pratt M.
        • Ekelund U.
        • Yngve A.
        • Sallis J.F.
        • Oja P.
        International Physical Activity Questionnaire: 12-country reliability and validity.
        Med Sci Sports Exerc. 2003; 35: 1381-1395
        • Dickens C.
        • McGowan L.
        • Dale S.
        Impact of depression on experimental pain perception: A systematic review of the literature with meta-analysis.
        Psychosom Med. 2003; 65: 369-375
        • Edwards R.R.
        Individual differences in endogenous pain modulation as a risk factor for chronic pain.
        Neurology. 2005; 65: 437-443
        • Edwards R.R.
        • Fillingim R.B.
        Self-reported pain sensitivity.
        Eur J Pain. 2008; 11: 594-598
        • Edwards R.R.
        • Sarlani E.
        • Wesselmann U.
        • Fillingim R.B.
        Quantitative assessment of experimental pain perception: Multiple domains of clinical relevance.
        Pain. 2005; 114: 315-319
        • Ellingson L.D.
        • Colbert L.H.
        • Cook D.B.
        Physical activity is related to pain sensitivity in healthy women.
        Med Sci Sports Exerc. 2012; 44: 1401-1406
        • Faul F.
        • Erdfelder E.
        • Lang A-G.
        • Buchner A.
        G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences.
        Behavior Research Methods. 2007; 39: 175-191
        • Fillingim R.B.
        • Maixner W.
        The influence of resting blood pressure and gender on pain responses.
        Psychosom Med. 1996; 58: 326-332
        • Gormsen L.
        • Ribe A.R.
        • Raun P.
        • Rosenberg R.
        • Videbech P.
        • Vestergaard P.
        • Bach F.W.
        • Jensen T.S.
        Pain thresholds during and after treatment of severe depression with electroconvulsive therapy.
        Eur J Pain. 2004; 8: 487-493
        • Granot M.
        • Ferber S.G.
        The roles of pain catastrophizing and anxiety in the prediction of postoperative pain intensity: A prospective study.
        Clin J Pain. 2005; 21: 439-445
        • Hamilton M.
        A rating scale for depression.
        J Neurol Neurosurg Psychiatry. 1960; 23: 56-62
        • Hamilton M.
        The assessment of anxiety states by rating.
        Br J Med Psychol. 1959; 32: 50-55
        • Hennings A.
        • Schwarz M.J.
        • Riemer S.
        • Stapf T.M.
        • Selberdinger V.B.
        • Rief W.
        The influence of physical activity on pain thresholds in patients with depression and multiple somatoform symptoms.
        Clin J Pain. 2012; 28: 782-789
        • Johannes C.B.
        • Le T.K.
        • Zhou X.
        • Johnston J.A.
        • Dworkin R.H.
        The prevalence of chronic pain in United States adults: Results of an Internet-based survey.
        J Pain. 2010; 11: 1230-1239
        • Kinser A.M.
        • Sands W.A.
        • Stone M.H.
        Reliability and validity of a pressure algometer.
        J Strength Cond Res. 2009; 23: 312-314
        • Klauenberg S.
        • Maier C.
        • Assion H.J.
        • Hoffmann A.
        • Krumova E.K.
        • Magerl W.
        • Scherens A.
        • Treede R.D.
        • Juckel G.
        Depression and changed pain perception: Hints for a central disinhibition mechanism.
        Pain. 2008; 140: 332-343
        • Knorring von L.
        • Perris C.
        • Eisemann M.
        Pain as a symptom in depressive disorders. I. Relationship to diagnostic subgroup and depressive symptomatology.
        Pain. 1983; 15: 19-26
        • Kohn R.
        • Saxena S.
        • Levav I.
        • Saraceno B.
        The treatment gap in mental health care.
        Bull World Health Organ. 2004; 82: 858-866
        • Lamers F.
        • van Oppen P.
        • Comijs H.C.
        • Smit J.H.
        • Spinhoven P.
        • Van Balkom A.J.
        • Nolen W.A.
        • Zitman F.G.
        • Beekman A.T.
        • Penninx B.W.
        Comorbidity patterns of anxiety and depressive disorders in a large cohort study: The Netherlands Study of Depression and Anxiety (NESDA).
        J Clin Psychiatry. 2011; 72: 341-348
        • Lautenbacher S.
        • Kundermann B.
        • Krieg J.C.
        Sleep deprivation and pain perception.
        Sleep Med Rev. 2006; 10: 357-369
        • Lautenbacher S.
        • Roscher S.
        • Strian D.
        • Fassbender K.
        • Krumrey K.
        • Krieg J.C.
        Pain perception in depression: Relationships to symptomatology and naloxone-sensitive mechanisms.
        Psychosom Med. 1994; 56: 345-352
        • Lautenbacher S.
        • Spernal J.
        • Schreiber W.
        • Krieg J.C.
        Relationship between clinical pain complaints and pain sensitivity in patients with depression and panic disorder.
        Psychosom Med. 1999; 61: 822-827
        • Lépine J.P.
        • Briley M.
        The epidemiology of pain in depression.
        Hum Psychopharmacol. 2004; 19: S3-S7
        • McKelvey R.D.
        • Zavoina W.
        A statistical model for the analysis of ordinal level dependent variables.
        J Math Sociol. 1975; 4: 103-120
        • Meredith P.
        • Strong J.
        • Feeney J.A.
        Adult attachment, anxiety, and pain self-efficacy as predictors of pain intensity and disability.
        Pain. 2006; 123: 146-154
        • Merskey H.
        The effect of chronic pain upon the response to noxious stimuli by psychiatric patients.
        J Psychosom Res. 1965; 8: 405-419
        • Miller L.R.
        • Cano A.
        Comorbid chronic pain and depression: Who is at risk?.
        J Pain. 2009; 10: 619-627
        • Nielsen C.S.
        • Staud R.
        • Price D.D.
        Individual differences in pain sensitivity: Measurement, causation, and consequences.
        J Pain. 2009; 10: 231-237
        • Normand E.
        • Potvin S.
        • Gaumond I.
        • Cloutier G.
        • Corbin J.F.
        • Marchand S.
        Pain inhibition is deficient in chronic widespread pain but normal in major depressive disorder.
        J Clin Psychiatry. 2011; 72: 219-224
        • Ohayon M.M.
        Pain sensitivity, depression, and sleep deprivation: Links with serotoninergic dysfunction.
        J Psychiatr Res. 2009; 43: 1243-1245
        • Ohayon M.M.
        • Schatzberg A.F.
        Chronic pain and major depressive disorder in the general population.
        J Psychiatr Res. 2010; 44: 454-461
        • Ploghaus A.
        • Narain C.
        • Beckmann C.F.
        • Clare S.
        • Bantick S.
        • Wise R.
        • Matthews P.M.
        • Rawlins J.N.
        • Tracey I.
        Exacerbation of pain by anxiety is associated with activity in a hippocampal network.
        J Neurosci. 2001; 21: 9896-9903
        • Racine M.
        • Tousignant-Laflamme Y.
        • Kloda L.A.
        • Dion D.
        • Dupuis G.
        • Choinière M.
        A systematic literature review of 10 years of research on sex/gender and experimental pain perception - part 1: Are there really differences between women and men?.
        Pain. 2012; 153: 602-618
        • Ruscheweyh R.
        • Marziniak M.
        • Stumpenhorst F.
        • Reinholz J.
        • Knecht S.
        Pain sensitivity can be assessed by self-rating: Development and validation of the Pain Sensitivity Questionnaire.
        Pain. 2009; 146: 65-74
        • Ruscheweyh R.
        • Verneuer B.
        • Dany K.
        • Marziniak M.
        • Wolowski A.
        • Çolak-Ekici R.
        • Schulte T.L.
        • Bullmann V.
        • Grewe S.
        • Gralow I.
        • Evers S.
        • Knecht S.
        Validation of the Pain Sensitivity Questionnaire in chronic pain patients.
        Pain. 2012; 153: 1210-1218
        • Rush A.J.
        • Trivedi M.H.
        • Ibrahim H.M.
        • Carmody T.J.
        • Arnow B.
        • Klein D.N.
        • Markowitz J.C.
        • Ninan P.T.
        • Kornstein S.
        • Manber R.
        • Thase M.E.
        • Kocsis J.H.
        • Keller M.B.
        The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): A psychometric evaluation in patients with chronic major depression.
        Biol Psychiatry. 2003; 54: 573-583
        • Sheehan D.V.
        • Lecrubier Y.
        • Sheehan K.H.
        • Amorim P.
        • Janavs J.
        • Weiller E.
        • Hergueta T.
        • Baker R.
        • Dunbar G.C.
        The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10.
        J Clin Psychiatry. 1998; 59 (quiz 34–57): 22-33
        • Soee A.B.
        • Thomsen L.L.
        • Tornoe B.
        • Skov L.
        Reliability of four experimental mechanical pain tests in children.
        J Pain Res. 2013; 6: 103-110
        • Spernal J.
        • Krieg J.C.
        • Lautenbacher S.
        Pain thresholds as a putative functional test for cerebral laterality in major depressive disorder and panic disorder.
        Neuropsychobiology. 2003; 48: 146-151
        • Stahl S.
        • Briley M.
        Understanding pain in depression.
        Hum Psychopharmacol. 2004; 19: 9-13
        • Suija K.
        • Timonen M.
        • Suviola M.
        • Jokelainen J.
        • Järvelin M.R.
        • Tammelin T.
        The association between physical fitness and depressive symptoms among young adults: Results of the Northern Finland 1966 birth cohort study.
        BMC Public Health. 2013; 13: 535
        • Tang N.K.
        • Salkovskis P.M.
        • Hodges A.
        • Wright K.J.
        • Hanna M.
        • Hester J.
        Effects of mood on pain responses and pain tolerance: An experimental study in chronic back pain patients.
        Pain. 2008; 138: 392-401
        • Teismann H.
        • Wersching H.
        • Nagel M.
        • Arolt V.
        • Heindel W.
        • Baune B.T.
        • Wellmann J.
        • Hense H.W.
        • Berger K.
        Establishing the bidirectional relationship between depression and subclinical arteriosclerosis - rationale, design, and characteristics of the BiDirect Study.
        BMC Psychiatry. 2014; 14: 174
        • Tobin J.
        Estimation of relationships for limited dependent variables.
        Econometrica. 1958; 26: 24
        • Von Korff M.
        • Dworkin S.F.
        • Le Resche L.
        • Kruger A.
        An epidemiologic comparison of pain complaints.
        Pain. 1988; 32: 173-183
        • Wagner G.
        • Koschke M.
        • Leuf T.
        • Schlösser R.
        • Bär K.J.
        Reduced heat pain thresholds after sad-mood induction are associated with changes in thalamic activity.
        Neuropsychologia. 2009; 47: 980-987
        • Wiech K.
        • Tracey I.
        The influence of negative emotions on pain: Behavioral effects and neural mechanisms.
        Neuroimage. 2009; 47: 987-994