Depression and pain: an appraisal of cost effectiveness and cost utility of antidepressants

Investigation of Factors Associated With Pain Intensity in Office Workers With Non-Specific Low Back Pain

BACKGROUND

Low back pain is an important health problem causing serious physical, psychological, and economic losses in developed and developing countries.

AIM

The aim of this study is to investigate comprehensively the factors related to the intensity of pain in office workers with non-specific low back pain (NSLBP).

METHODS

The study included 71 university office workers with NSLBP, aged 21-55 years. In addition to evaluating the sociodemographic and clinical characteristics of office workers with NSLBP, visual analog scale (VAS), Short-Form 36 (SF-36), Minnesota Satisfaction Questionnaire (MSQ), Oswestry Disability Index (ODI), Tampa Kinesiophobia Scale (TKS), Beck Depression Inventory (BDI), and Timed Up and Go (TUG) outcome measurements were applied.

RESULTS

There was a statistically significant association between the intensity of pain and TUG test (p = .000), job satisfaction (p = .015), percentages of disability (p = .000), quality of life (role difficulty due to physical limitation, p = .010; pain, p = .000; social the function, p = .044), and depression (p = .004).

CONCLUSIONS

While the functional performance, job satisfaction level, and quality of life in office workers with NSLBP with severe-intensity pain were lower, level of disability, depression were higher in office workers with NSLBP with mild-to-moderate-intensity pain.

The prevalence of painful physical symptoms in major depressive disorder: A systematic review and meta-analysis of observational studies

BACKGROUND

Painful physical symptoms (PPS) are common in patients with major depressive disorder (MDD), but their prevalence has been mixed. This is a systematic review and meta-analysis of the pooled prevalence of PPS in MDD patients.

METHODS

Systematic literature searches were independently conducted in major databases (PubMed, EMBASE, PsycINFO and Web of Science). Data analyses were conducted using a random-effects model.

RESULTS

A total of 20 studies with 53,852 patients were included. The overall prevalence of PPS in MDD patients was 55.2% (95%CI: 47.9-62.3%), with a point prevalence of 64.2% (95%CI: 53.2-73.8%) and a 12-month prevalence of 57.0% (95%CI: 23.9-84.8%). No significant publication bias was found in this meta-analysis.

CONCLUSION

PPS are common in MDD patients. Considering the negative impact of PPS on daily functioning, effective preventive measures and routine screening should be conducted for MDD patients, and timely treatments should be offered to those in need. Registration number: CRD42020179471.

The impact of comorbid pain and depression in the United States: results from a nationally representative survey

Background and aims The co-morbidity between pain and depression is a target of interest for treatment. However most of the published literature on the topic has used clinical cohorts as the population of interest. The goal of this study was to use a nationally representative sample to explore how health outcomes varied across pain and depression status in a cohort sampled from the general US population. Methods This was a cross-sectional analysis of adults ≥18 years in the 2009-2010 National Health and Nutrition Examination Survey. The cohort was stratified into: no pain/depression, pain alone, depression alone, and pain with depression. The primary outcome was self-reported general health status, and secondary outcomes were healthcare visits, overnight hospital stays and functional limitation. Survey weighted logistic regression was used to adjust for potential confounders. Results The cohort consisted of 4,213 individuals, of which 186 (4.4%) reported concurrent pain and depression. 597 (14.2%) and 253 (6.0%) were classified with either pain or depression alone, respectively. The majority of individuals with co-morbid pain and depression reported poor health (65.1%, p<0.001) and were significantly more likely than those with neither condition to rate their health as poor after adjustment (OR: 7.77, 95% CI: 4.24-14.26, p<0.001). Those with pain only or depression only were also more likely to rate their health as poor, albeit to a lesser extent (OR: 2.21, 95% CI: 1.21-2.34, p<0.001; OR: 3.75, 95% CI: 2.54-5.54, p<0.001, respectively). A similar pattern was noted across all secondary outcomes. Most notably, those with co-morbid pain and depression were the most likely to endorse functional limitation (OR: 13.15, 95% CI: 8.00-21.61, p<0.001). Comparatively, a similar trend was noted amongst those with pain only or depression only, though with a reduced effect size (OR: 4.23, 95% CI: 3.12-4.77, p<0.001; OR: 5.13, 95% CI: 3.38-7.82, p<0.001). Conclusions Co-morbid pain and depression in the general population resulted in markedly worse outcomes versus isolated pain or depression. Further, the effect appears to be synergistic. Given the substantial burdens of pain and depression, future treatments should aim to address both conditions simultaneously. Implications As a result of the co-morbidity between pain and depression, patients presenting with either condition should increase the index of suspicion among clinicians and prompt screening for the reciprocal condition. Early intervention for co-morbid pain and depression has the potential to mitigate future incidence of chronic pain and major depression.

Relationship between pain intensity, disability, exercise time and computer usage time and depression in office workers with non-specific chronic low back pain

OBJECTIVE

The purpose of this study was to investigate the relationship between pain intensity, disability, exercise time, and computer use time and depression in office workers with nonspecific chronic low back pain.

STUDY DESIGN/SETTING

A cross-sectional correlational study.

SUBJECTS

Sixty-one office workers diagnosed with nonspecific chronic low back pain METHODS: The participants' body mass index was calculated using their height and weight. The amount of time the participants spent using a computer or exercising per week was analysed. The Beck Depression Inventory was used to determine the degree of depression in the participants. The Oswestry disability index and the numeric pain rating scale were used to assess the severity and pain intensity of the participants.

RESULTS

There was a significant correlation between the Beck Depression Inventory, the Oswestry disability index (r = 0.419, p < .05), and the computer use time (r = 0.369, p < .05) of the participants. There was a correlation between the Oswestry disability index and the numeric pain rating scale (r = 0.677, p < .01). There were significant correlations among the sub items of the Oswestry disability index with the Beck Depression Inventory, in the order of personal management activities (r = 0.539, p < .01), standing (r = 0.519, p < .01), social activities (r = 0.421, p < .05), travelling (r = 0.381, P < .05), and walking (r = 0.357, p < .05).

CONCLUSION

Our hypothesis as a results of this study is that the depression of office workers with non-specific chronic low back pain is correlated with the computer using time and the degree of disability. Especially among their various disabled items, personal management activities, standing, social activities, travelling, and walking is related to depression.

Self-reported pain in patients with schizophrenia. Results from the national first-step FACE-SZ cohort

INTRODUCTION

Little is known about perception of physical pain in schizophrenia (SZ). Some studies have suggested that patients with SZ may have an increased pain threshold, while others have suggested that patients with SZ may suffer from undetected and untreated high physical pain levels. The objectives of this study were (i) to investigate the prevalence of self-reported physical pain in stabilized SZ subjects, and (ii) to determine whether physical pain was associated with psychiatric characteristics and somatic comorbidities (iii) to determine whether antidepressants and benzodiazepine administration were associated with lower self-reported pain.

METHOD

468 community-dwelling stable SZ subjects (73% men, mean aged 32 years) were recruited in the Schizophrenia Expert Center national network. Patients with moderate to extreme pain, assessed with the EQ5D-5L questionnaire, were classified as belonging to the "pain group".

RESULTS

104 (22.2%) reported moderate to extreme pain levels. In multivariate analysis, pain has been associated with headache (OR = 2.63 [1.04-6.63], p = 0.04), higher anxiety (OR = 1.61 [1.18-2.21], p = 0.003), higher current depressive symptoms (OR = 1.09 [1.01-1.17], p = 0.03), history of childhood trauma (1.03 [1.01-1.06], p = 0.01) and older age (OR = 1.04 [1.01-1.07], p = 0.03), independently of current psychotic severity, sociodemographic variables, antipsychotic, antidepressant and benzodiazepine treatments. No association with addictive behaviors or illness characteristics has been found.

CONCLUSION

The present findings suggest that community-dwelling SZ outpatients report a high rate of self-reported physical pain, associated with headache, depression and anxiety and history of childhood trauma. Physical pain should be systematically assessed and specifically treated, when needed, in patients with SZ.

Depression and pain: primary data and meta-analysis among 237 952 people across 47 low- and middle-income countries

BACKGROUND

Depression and pain are leading causes of global disability. However, there is a paucity of multinational population data assessing the association between depression and pain, particularly among low- and middle-income countries (LMICs) where both are common. Therefore, we investigated this association across 47 LMICs.

METHODS

Community-based data on 273 952 individuals from 47 LMICs were analysed. Multivariable logistic and linear regression analyses were performed to assess the association between the International Classification of Diseases, 10th Revision depression/depression subtypes (over the past 12 months) and pain in the previous 30 days based on self-reported data. Country-wide meta-analysis adjusting for age and sex was also conducted.

RESULTS

The prevalence of severe pain was 8.0, 28.2, 20.2, and 34.0% for no depression, subsyndromal depression, brief depressive episode, and depressive episode, respectively. Logistic regression adjusted for socio-demographic variables, anxiety and chronic medical conditions (arthritis, diabetes, angina, asthma) demonstrated that compared with no depression, subsyndromal depression, brief depressive episode, and depressive episode were associated with a 2.16 [95% confidence interval (CI) 1.83-2.55], 1.45 (95% CI 1.22-1.73), and 2.11 (95% CI 1.87-2.39) increase in odds of severe pain, respectively. Similar results were obtained when a continuous pain scale was used as the outcome. Depression was significantly associated with severe pain in 44/47 countries with a pooled odds ratio of 3.93 (95% CI 3.54-4.37).

CONCLUSION

Depression and severe pain are highly comorbid across LMICs, independent of anxiety and chronic medical conditions. Whether depression treatment or pain management in patients with comorbid pain and depression leads to better clinical outcome is an area for future research.

Influence of painful physical symptoms in the treatment of Japanese patients with melancholic major depressive disorder: A prospective cohort study

The aim of this study was to clarify how painful physical symptoms affect treatment outcomes in patients with melancholic major depressive disorder. The subjects comprised 100 consecutive Japanese outpatients with melancholic major depressive disorder who visited our clinic from October 2011 to October 2014. All subjects were interviewed for Diagnostic and Statistical Manual of Mental Disorders Axis 2, 3, and 4 and family history of major depressive disorder, and then grouped according to the presence of painful physical symptoms. We evaluated painful physical symptoms at baseline and after 12, 24, and 36 weeks of treatment and scores on the 17-item Hamilton Rating Scale for Depression, compared major depressive disorder remission between groups, and assessed responsiveness to antidepressants. The group with painful physical symptoms had a significantly more positive family history of major depressive disorder. The major depressive disorder remission rate was high in both groups, and no significant differences were observed. However, a significant relationship between major depressive disorder and painful physical symptoms remission was observed in the group with painful physical symptoms. A significantly higher number of remitted patients with painful physical symptoms (N=61) were administered serotonin-noradrenaline reuptake inhibitors, with significantly more receiving duloxetine than milnacipran.