The meeting of pain and depression: comorbidity in women

Sex Differences in Pain and Quantitative Sensory Testing in Patients With Rheumatoid Arthritis

OBJECTIVE

Women with rheumatoid arthritis (RA) have higher pain and worse functional outcomes compared to men, even when treated with similar medications. The objective of this study was to identify sex differences in pain intensity, pain interference, and quantitative sensory tests (QST), which are independent of inflammation, in patients with RA.

METHODS

This study is a post hoc analysis of participants in the Central Pain in Rheumatoid Arthritis cohort. Pain intensity was assessed using a 0-10 numeric rating scale. Pain interference was measured using a Patient-Reported Outcomes Measurement Information System computerized adaptive test. QST included pressure pain detection thresholds, temporal summation, and conditioned pain modulation. Women and men were compared using multiple linear regression, adjusted for age, education, race, research site, depression, obesity, RA disease duration, swollen joint count, and C-reactive protein.

RESULTS

Mean ± SD pain intensity was 5.32 ± 2.29 among women with RA, compared to 4.60 ± 2.23 among men with RA (adjusted difference 0.83 [95% confidence interval (95% CI) 0.14, 1.53]). Women with RA had lower pressure pain detection thresholds at the trapezius (adjusted difference -1.22 [95% CI -1.73, -0.72]), wrist (adjusted difference -0.57 [95% CI -1.07, -0.06]), and knee (adjusted difference -1.10 [95% CI -2.00, -0.21]). No statistically significant differences in pain interference, temporal summation, and conditioned pain modulation were observed.

CONCLUSION

Women reported higher pain intensity and lower pressure pain detection thresholds (higher pain sensitivity) than men. However, pain interference, temporal summation, and conditioned pain modulation did not differ between men and women.

Higher-order trajectories of pain and depressive symptoms link midlife financial stress to women's well-being in later life

Objectives: Consistent with biopsychosocial models, shared pathophysiological conditions underlying both physical pain and depressive symptoms can result in the clustering of pain and depressive symptoms. However, previous studies have not investigated a higher-order construct capturing both pain and depressive symptoms over time. Furthermore, research has not identified trajectory antecedents (e.g. perceived family financial stress) and their consequences for later-life health and well-being. The present study sought to address these gaps in the research.Method: Using prospective data over 23 years from 244 long-term married women, the present study estimated latent growth curves in a structural equation model (more specifically a parallel trajectory model was estimated).Results: Family financial strain in midlife was, on average, associated with a higher initial level (β = .37, p < .001) and rate of change (β = .20, p = .045) of pain-depressive symptoms trajectories, which, in turn, contributed to health and well-being challenges, including the level and rate of change in physical limitations (β = .50, p < .001 and 0.43, p < .001, respectively), memory impairment (β = .47 and .47, p < .001, respectively), and loneliness (β = .63, p = < .001 and .28, p = .022, respectively) in later years. The adverse influence of family financial strain on pain-depressive symptoms trajectories weakened under high levels of marital closeness (β = -.10, p = .032). Conclusion: These findings emphasize the necessity of policies and interventions that focus on reducing adults' stressful life circumstances and further developing protective factors that can aid in the redirection of adverse pain-depressive symptoms trajectories.Supplemental data for this article are available online at https://doi.org/10.1080/13607863.2021.1993129.

Predictors of COVID-19-related health anxiety among health care workers: a cross-sectional study

Background

One of the psychological issues that may affect health care workers (HCWs) during the outbreak of COVID-19 is health anxiety. Health anxiety disorder goes beyond normal health concerns and can seriously affect occupational and interpersonal performance. The present study was designed to determine the level of COVID-19-related health anxiety and its predictors in Iranian HCWs.

Methods

This is a cross-sectional study. Data were collected online through a demographic information questionnaire and the short version of the Health Anxiety Questionnaire. The online questionnaires were created via Google Form and the URL link was sent to HCWs via email or social networking applications. In total, questionnaires were sent to more than 1,500 HCWs throughout Iran. Data were analyzed with SPSS software version 23.

Results

Five hundred and fifty-two HCWs completed and sent the questionnaires. The mean scores of health anxiety of HCWs were higher than the cutoff point of health anxiety (17.28 ± 8.84) and 58.1% of HCWs had health anxiety. There was a significant inverse relationship between health anxiety score and age (r = − 0.13; P = 0.002), work experience (r = − 0.16; P < 0.001) and income level (r = − 0.097; P = 0.03). The rate of health anxiety was significantly higher in females (P = 0.03). Based on regression results, age and hospital category were significant risk factors for health anxiety.

Conclusion

Based on the results of this study, employees working in health centers in Iran had high health anxiety. Due to the high level of health anxiety in HCWs, it is important to consider strategies to reduce their health anxiety in the current situation.

Exploring the Experiences of Co-morbid Pain and Depression in Older African American Women and Their Preferred Management Strategies

The intersection of race, gender, and age places older African American women at an increased risk for untreated physical pain and depression that can significantly diminish their quality of life. The objectives of this study were to (1) explore older African American women's perceptions of pain and depressive symptoms and how these symptoms influence each other, and (2) explore effective pain and depression alleviation strategies used by the women. We conducted five focus groups with older African American women (N = 18). We used deductive coding to analyze focus group transcripts and qualitative description to summarize themes. We identified five major themes: (1) Spiritual Suffering from Linked Pain and Depression, (2) Lack of Understanding from Healthcare Providers, (3) Push Through and Live Through, (4) Medications Not Worth the Risk and, (5) Strategies for Pain and Depression. This study offers insight into the experiences of pain and depression in older African American women, and alleviation strategies they perceive as effective. These qualitative findings may be used to inform interventions for older African American women who experience pain and depressive symptoms.

Shared liability to pain, common mental disorders, and long-term work disability differs among women and men

Knowledge of factors involved in the associations between pain, common mental disorders, and future work incapacity is still scarce. The aim of this study was to examine the overlap between genetic and environmental factors contributing to depression/anxiety, pain, and future long-term sickness absence (SA) and disability pension (DP) among women and men. The study sample included 47,995 twins born in Sweden 1935 to 1985. Information on self-reported depression/anxiety and back, neck, and shoulder pain was obtained from surveys conducted 1998 to 2002 and 2004 to 2005. Data on long-term SA (>365 days) and DP due to mental and/or musculoskeletal disorders until 2013 were obtained from the National Social Insurance Agency. Shared genetic and environmental influences on depression/anxiety, pain, and SA/DP were estimated by applying structural equation modeling. The prevalence of depression/anxiety was 27% and 14% among women and men, for pain 24% and 19%, and for SA/DP due to mental and musculoskeletal diagnoses 7% and 4%, respectively. Multivariate biometric analyses revealed different patterns of covariation between the 3 phenotypes among women and men. For women, a latent-shared liability to all 3 phenotypes could be identified, mainly attributable to genetic factors (66%). For men, no shared underlying liability was observed. The variation in SA/DP was explained by genetic factors in common with depression/anxiety by 27% and in common with pain by 9%. Common mental disorders, pain, and SA/DP tend to covariate in different ways among women and men. The results may have clinical implications as strategies preventing SA/DP may be different among women and men.

Association between postpartum physical symptoms and mood

OBJECTIVE

Postpartum depression may be associated with higher levels of postpartum pain, but the association with discomfort in general is unclear. We sought to describe an association between postpartum mood disturbances and quantitatively measured physical symptoms at the time of the routine postpartum encounter.

METHODS

We designed a novel quantitative measurement of postpartum symptoms, the Postpartum Symptom Inventory (PSI), to allow comparison to scores of postpartum mood. Women presenting for a routine postpartum visit were asked to complete a brief questionnaire about their delivery, the 20-item PSI, and an Edinburgh Postnatal Depression Scale (EPDS). Depression scores were compared with symptom inventory scores and demographic data.

RESULTS

Two hundred six women responded, of whom 77% had a vaginal delivery. The most common physical symptoms experienced to a bothersome degree were fatigue (35.3%), back/hip pain (22.4%), and headache (13.2%). Twenty-nine women (14.3%) had an EPDS score of 10 or more, thereby screening positive for possible depression. Women screening positive had significantly greater total PSI scores than women who did not screen positive (20.2 vs 12.2, p < 0.001). After adjustment for history of depression and age, the odds of screening positive for depression were 3.6 times higher in women with PSI scores over 10 compared to women with lower scores [95% CI: (1.1, 11.4); p = 0.03].

CONCLUSION

Data suggest that a high level of physical symptomatology as measured by a PSI score >10 at six weeks post-delivery is associated with increased odds of screening positive for postpartum depression.

Sex Differences in the Presentation of Chronic Low Back Pain

Sex differences in 351 patients with chronic low back pain were examined. Biological, psychological, and psychosocial factors were considered. Sex differences in adaptive functioning were consistent with traditional gender roles. Significant interactions were found for sex and employment status, and sex and marital status. Retired women reported more pain and less activity than retired men. Retired men reported the least pain of any group. Outdoor work and social activities show opposite within-group patterns for men and women when stratifiedby employment status. Marriage was associated with more household work for women and less for men. The financial and social contexts of employment status and marriage are different for men and women. Results suggest the treatment of women with chronic low back pain requires attention to work in the home and the financial and social context of work outside the home.

Gender differences in depression and pain: A two year follow-up study of the Survey of Health, Ageing and Retirement in Europe

BACKGROUND

The longitudinal association of depression and pain according to gender was investigated using a population-based sample from 13 European countries.

METHODS

The study population was taken from waves 4-5 of the Survey of Health, Ageing and Retirement in Europe. The sample consisted of 22,280 participants ≥50 years, who were interviewed at baseline, and after two years. Regression models for each gender were used to assess the variables associated with depression and pain incidence and persistence.

RESULTS

Prevalences of depression, pain, and depression-pain co-occurrence, were higher in women than in men (depression: 34.5% vs. 20.3%; OR=2.1; 95% CI=1.9-2.2; pain: 60.2% vs. 53.5%; OR=1.3; 95% CI=1.2-1.4; co-occurrence 25.3% vs. 14.0%; OR=2.3; 95% CI=2.2-2.6). Treated baseline pain in women (OR=1.6; 95% CI=1.3-2.0), and treated/untreated pain in men (untreated OR=1.3; 95% CI=1.1-1.7; treated OR=2.0; 95% CI=1.5-2.7), were associated with incident depression. Untreated baseline depression was associated with incident pain (women OR=1.3; 95% CI=1.1-1.7; men OR=1.8; 95% CI=1.3-2.6), and with persistent pain only in women (OR=1.3; 95% CI=1.1-1.6).

LIMITATIONS

We lack information on pain severity, and the consumption of analgesics was used as a proxy. We lack information on antidepressants and anxiolytics consumption separately. Participants were interviewed twice in two years, and pain/depression at both interviews were considered persistent although they may have relapsed and recurred.

CONCLUSIONS

Treated baseline pain is a risk factor for incident depression in both genders; untreated baseline pain is a risk factor only in men. Treating depression at baseline may protect from developing pain in both genders, and in women, it may also protect from pain persistence.

[Myofascial pain syndrome]

OBJECTIVE

To analyze clinical characteristics of pain syndrome in patients with dorsalgia.

MATERIAL AND METHODS

Authors studied 43 patients (mean age 41.9±1.2 years), 34 women and 9 men, with acute and subacute chronic back pain. The study included neurological examination, MRI and/or CT of the spine, measurement of anxiety and depression with the Hospital Anxiety and Depression Scale (HADS), The Brief Pain Inventory (BPI) and the McGill Pain Inventory.

RESULTS AND CONCLUSION

Chronic myofascial pain syndrome (MFPS) was frequently associated with anxiety-depressive disorders found in patients with cervical and cervical/pectoral pain, fibromyalgia with minimal neurological symptoms and no signs of neural structure compression according to MRI and CT. The results of the study of chronic MFPS should be taken into account in the choice of tactics of treatment of MFPS patients. The use of amelotex in the combination with compligam B in patients with dorsopathy and MFPS is effective together with correction of emotional disorders and treatment with chondroprotectors.

Just like a circus: the public consumption of sex differences

The study of sex differences is a rich, productive area of neuroscience, yielding findings that inform our understanding of basic biology and hold promise for clinical applications. There is a tremendous, problematic mismatch, however, between the actual implications of this research and what has generally been communicated to the public. The message communicated by the media, popular press, and in some cases researchers is often inaccurate with respect to what can and cannot be concluded from the data. This misrepresentation of findings has led to a crisis in public education and threatens to do the same in public health. Here, I suggest a number of ways that neuroscientists might address this growing problem. First, we should acknowledge that the term 'sex difference' is usually interpreted by the media and the public as evidence for dichotomous categories that do not actually exist. Because data rarely sort so cleanly into sex-specific categories, clearer presentation of the nature and size of sex differences is warranted. The term 'sex effect' may be preferable to 'sex difference' when the effect is not large. Second, factors that covary with sex, particularly experience, should be considered as causes of sex differences before the idea of "hardwiring" is invoked. Finally, we should be more vigilant about how our own findings are conveyed to policymakers and the public and speak out when they are misrepresented.

Depressive symptoms and pain complaints as predictors of later development of depression in Portuguese middle-aged women

Pain complaints and depressive symptoms seem to be risk factors for future depressive episodes. We present a one-year follow-up study on Portuguese women and primary health care (initial sample: n = 503). We used the Center for Epidemiologic Studies Depression Scale (CES-D), a short questionnaire on pain, and clinical interviews. We used forward stepwise logistic regression analysis to define models that enable the prediction of developing a major depressive episode in the one-year follow-up. We concluded that nondepressed women with (a) high scores (≥28) at the CES-D, (b) a high severity of pain index, and (c) fatigue complaints at the baseline were particularly at risk.

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?

The purpose of this systematic review was to summarize and critically appraise the results of 10 years of human laboratory research on pain and sex/gender. An electronic search strategy was designed by a medical librarian and conducted in multiple databases. A total of 172 articles published between 1998 and 2008 were retrieved, analyzed, and synthesized. The first set of results (122 articles), which is presented in this paper, examined sex difference in the perception of laboratory-induced thermal, pressure, ischemic, muscle, electrical, chemical, and visceral pain in healthy subjects. This review suggests that females (F) and males (M) have comparable thresholds for cold and ischemic pain, while pressure pain thresholds are lower in F than M. There is strong evidence that F tolerate less thermal (heat, cold) and pressure pain than M but it is not the case for tolerance to ischemic pain, which is comparable in both sexes. The majority of the studies that measured pain intensity and unpleasantness showed no sex difference in many pain modalities. In summary, 10 years of laboratory research have not been successful in producing a clear and consistent pattern of sex differences in human pain sensitivity, even with the use of deep, tonic, long-lasting stimuli, which are known to better mimic clinical pain. Whether laboratory studies in healthy subjects are the best paradigm to investigate sex differences in pain perception is open to question and should be discussed with a view to enhancing the clinical relevance of these experiments and developing new research avenues.

A systematic literature review of 10 years of research on sex/gender and pain perception - part 2: do biopsychosocial factors alter pain sensitivity differently in women and men?

This systematic review summarizes the results of 10 years of laboratory research on pain and sex/gender. An electronic search strategy was designed by a medical librarian to access multiple databases. A total of 172 articles published between 1998 and 2008 were retrieved, analyzed, and synthesized. The second set of results presented in this review (129 articles) examined various biopsychosocial factors that may contribute to differences in pain sensitivity between healthy women and men. The results revealed that the involvement of hormonal and physiological factors is either inconsistent or absent. Some studies suggest that temporal summation, allodynia, and secondary hyperalgesia may be more pronounced in women than in men. The evidence to support less efficient endogenous pain inhibitory systems in women is mixed and does not necessarily apply to all pain modalities. With regard to psychological factors, depression may not mediate sex differences in pain perception, while the role of anxiety is ambiguous. Cognitive and social factors appear to partly explain some sex-related differences. Finally, past individual history may be influential in female pain responses. However, these conclusions must be treated with much circumspection for various methodological reasons. Furthermore, some factors/mechanisms remain understudied in the field. There is also a need to assess and improve the ecological validity of findings from laboratory studies on healthy subjects, and perhaps a change of paradigm needs to be considered at this point in time to better understand the factors that influence the experience of women and men who suffer from acute or chronic pain.

Prevalence of and factors associated with psychiatric morbidity in chronic pain patients

OBJECTIVE

The reported prevalence of psychiatric morbidity in chronic pain patients (CCPs) was high, although it varied tremendously since structured diagnostic instruments were seldom used for diagnosis in previous studies. Study in this area after the launching of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) was scarce. This study serves to estimate the prevalence of psychiatric morbidity in patients attending a chronic pain clinic by using the Structured Clinical Interview for DSM-IV (SCID) Axis I disorders and to identify factors highly associated with psychiatric disorders, particularly depression, which is treatable.

METHOD

Consecutive patients attending a chronic pain clinic were recruited during a 6-month period. Psychiatric diagnoses were made by using the SCID. Logistic regression was used to identify factors predicting overall psychiatric morbidity and depression.

RESULTS

Prevalence of psychiatric disorders in this 89-patient sample was 62.9%. Current major depressive disorder was present in 31.5% and somatoform disorders in 33.7%. Anxiety disorders and current substance use disorders each constituted 18. "Younger age of onset of pain" (odds ratio [OR]=0.956, P<.05) and "higher pain intensity" (OR=1.544, P<.001) were independently associated with presence of psychiatric disorders. "Higher pain intensity" (OR=13.7, P<.05), "negative pain cognition" (OR=0.967, P<.05) and "problems with social and leisure activities" (OR=38.5, P<.05) were associated with depression.

CONCLUSION

Prevalence of psychiatric disorders in this Chinese chronic pain clinic sample with reference to the DSM-IV was similar to that reported in previous studies. Specific factors were identified to alert pain physicians to underlying psychiatric disorders.

Pain and depression in gynecology patients

BACKGROUND

The prevalence and consequences of comorbid pain and depression in gynecology patients are understudied.

OBJECTIVE

The purpose of the study was to determine the prevalence of pain, depression, and their co-occurrence among gynecology patients, and to examine how pain and depression are associated with additional comorbid mental disorders.

METHOD

Self-reported pain, depressive symptoms, other mental-disorder symptoms, functional status, interpersonal distress, and abuse were assessed in 1,647 gynecology patients by use of the Patient Health Questionnaire and the Medical Outcomes Study (SF-20).

RESULTS

Moderate-to-severe pain was reported by 29% of patients; depression, by 21%; with both present in 10.3%. Comorbid pain and depression was associated with anxiety, suicidal or death ideation, functional impairment, interpersonal distress, and physical or sexual abuse.

DISCUSSION

Innovative approaches are needed to assess and treat gynecology patients with comorbid pain and depression, given the degree of overlap between them.

Gender differences in depression and chronic pain conditions in a national epidemiologic survey

The authors explored gender differences in the prevalence of depression in four chronic pain conditions and pain severity indices in a national database. In 131,535 adults, the prevalence of depression in women (9.1%) was almost twice that of men (5%). One-third (32.8%) had a chronic pain condition (fibromyalgia, arthritis/rheumatism, back problems, and migraine headaches). The prevalence of depression in individuals with chronic pain conditions was 11.3%, versus 5.3% in those without. Women reported higher rates of chronic pain conditions and depression and higher pain severity than men. Depression and chronic pain conditions represent significant sources of disability, especially for women.

Pain and Depressive Symptoms among Financially Disadvantaged Women's Health Patients

OBJECTIVES

Women are at greater risk than men for both pain and depression, yet little is known about the frequency and implications of comorbid pain and depression among women in women's health settings. This study aimed to determine the frequency of comorbid depressive symptoms and pain among a sample of gynecology outpatients and to evaluate the associations of comorbid pain and depressive symptoms with physical, emotional, and social functioning and abuse experiences.

METHODS

A total of 242 low-income, primarily African American women presenting at an urban women's health clinic for routine gynecological care consented to participate. Subjects completed the Beck Depression Inventory, Brief Symptom Inventory, Graded Chronic Pain Scale, SF-36, Physical and Sexual Abuse Questionnaire, and Duke Social Support Index. Multivariate analyses were used to test pain and depressive symptoms in their associations with emotional, physical, and social functioning and abuse experience. Age, race, income, and education were controlled in all analyses.

RESULTS

Nearly 20% of participants reported comorbid high depressive symptoms and pain. Both depressive symptoms and pain were independently associated with emotional, physical, and social functioning domains. Depressive symptoms, but not pain, were associated with increased likelihood of history of abuse.

CONCLUSIONS

Comorbid depressive symptoms and pain are a substantial problem, with pervasive implications among financially disadvantaged women seeking routine gynecological care. Subsequent research will determine if psychosocial treatment can be adapted effectively to the needs of this patient population.

Duloxetine for the Treatment of Major Depressive Disorder in Women Ages 40 to 55 Years

The efficacy of duloxetine in the treatment of major depressive disorder in women of approximately perimenopausal age (40-55 years; 62 placebo subjects and 55 subjects taking duloxetine, 60 mg/day) was compared with that observed in cohorts of younger (<40 years, 94 placebo subjects and 85 duloxetine subjects) and older (>55 years, 26 placebo subjects and 25 duloxetine subjects) women. Women (ages 40-55 years) receiving duloxetine demonstrated significantly greater improvement in total scores on the 17-item Hamilton Rating Scale for Depression compared with placebo at the study endpoint (week 9). Significant advantages for duloxetine over placebo were observed on 17-item Hamilton depression scale subscales (core, Maier, anxiety, retardation, and sleep), in addition to the Clinical Global Impression severity and Patient Global Impression of Improvement Scale, the Quality of Life in Depression Scale, and Visual Analog Scales assessing pain severity. The magnitude of duloxetine's treatment effect in women ages 40-55 years was similar to that observed in younger (age <40 years) and older (age >55 years) female patients. In the placebo treatment groups, however, mean changes differed substantially by age group with the smallest placebo responses observed in the 40-55 age group. Duloxetine (60 mg/day) was demonstrated to be an effective treatment for major depressive disorder in this cohort of women ages 40-55 years.

Chronic Pain: The Extra Burden on Canadian Women

Health Issue

Chronic pain is a major health problem associated with significant costs to both afflicted individuals and society as a whole. These costs seem to be disproportionately borne by women, who generally have higher prevalence rates for chronic pain than do men.

Key findings

Data obtained from 125,574 respondents to the Canadian Community Health Survey (2000–2001) indicated that 18% of Canadian women suffered from chronic pain, compared to 14% of men. This gender discrepancy, however, seemed to be linked primarily to differences in age, income, and education between adult men and women in this large sample. Age, income, depression and functional interference with activities were strongly associated with chronic pain in general. No gender differences were found in the intensity of pain experienced. Ethnicity was not strongly associated with chronic pain prevalence, although Asians were the group with the highest chronic pain prevalence in the over-65 age group and Aboriginal Canadians had the highest prevalence in the under-65 age group.

Data Gaps and Recommendations

Current gaps in our knowledge include the types of chronic pain women experience, their impact on domestic responsibilities and parenting and health care utilization patterns of women with chronic pain. Data sources such as provincial databases of billing claims may be useful in the future to enrich our knowledge of health care utilization and analgesic medication use. Enhanced surveillance, assessment, and early identification of pain disorders are recommended to improve outcomes. Considering current demographic patterns toward an older population, there is also some urgency to the development of patient education and self-management programs.

Effects of duloxetine on painful physical symptoms associated with depression

Painful physical symptoms are common features of major depressive disorder and may be the presenting complaints in primary care settings. The effect of the dual serotonin (5-HT) and norepinephrine reuptake inhibitor duloxetine on emotional and painful physical symptoms in outpatients with major depressive disorder was evaluated in three randomized, double-blind, placebo-controlled trials. The trials' primary objective was to evaluate the effect of duloxetine on mood, and subjects were not enrolled on the basis of presence, type, or severity of pain. However, the pain-relieving effects of duloxetine were evaluated by a priori defined analyses of results from a visual analogue scale and the Somatic Symptom Inventory. Compared with placebo, duloxetine was associated with significant reduction in pain severity. The authors concluded that duloxetine reduces the painful physical symptoms of depression.

Gender differences in patterns of cerebral activation during equal experience of painful laser stimulation

A previous functional imaging study demonstrated greater female response in the anterior insula and thalamus and left prefrontal activation in men and right prefrontal activation in women during equal heat intensity but unequal pain experience. For the current study, subjective intensities of noxious heat delivered to the back of the right hand were equalized across subjects, and regional cerebral blood flow was recorded by using positron emission tomography. The female subjects required less laser energy before reporting pain, but the difference was not significant. Correlation of regional cerebral blood flow with subjective pain experience in the whole group showed significant bilateral responses in the parietal, lateral premotor, prefrontal, secondary somatosensory, anterior cingulate and insula cortices, as well as the thalamus. There was significantly greater activation in the left, contralateral, prefrontal, primary and secondary somatosensory, parietal, and insula cortices in the male subjects compared with the female subjects and greater response in the perigenual cingulate cortex in the female subjects. Our study is the first to associate consistent pain experience with gender differences in central response. These differences may relate to differential processing of acute pain with implications for clinical disorders that show a female dominance. The subtle behavioral differences and inconsistent findings across studies, however, suggest the need for caution and further experimentation before speculating further.

Persistent pain and depression: a biopsychosocial perspective

This review highlights recent research findings on the relationship between persistent pain and depression and discusses the implications of these findings for future research in persons who suffer from both pain and depression. First, we briefly discuss advances in theories of pain that underscore the important role that depression can play in the chronic pain experience. Second, we discuss depression in persons suffering from chronic pain from a biopsychosocial perspective that takes into account both biological and psychosocial mechanisms linking pain and depression. Third, we address biomedical, psychosocial, and combined medical-psychosocial approaches to treatment in persons with persistent pain and depression. We conclude by highlighting future directions for research related to screening and diagnosis of depression in persons having persistent pain, treatment of comorbid pain and depression, and individual and subgroup differences in the experience of persistent pain and depression.

Migraine, as compared to other headaches, is worse during midnight-sun summer than during polar night. A questionnaire study in an Arctic population

OBJECTIVE

To investigate potential seasonal variation of migraine and other headaches in an Arctic population where light conditions are extreme during both winter and summer.

BACKGROUND

Due to the immense seasonal variation in sunlight, focus on seasonal migraine variation in a population living in an Arctic area is interesting even from a theoretical point of view.

METHODS

Northern Norway comprises the three Norwegian counties north of the Arctic Circle. There are three neurology centers in this region, which provide service for approximately half a million people. During a 2-year period, 1403 patients (0.3% of the population) were referred to these centers for a specialist assessment of their headache. A questionnaire was mailed to all these patients; the questionnaire included questions on headache characteristics to make it possible to identify migraine according to the International Headache Society criteria. Questions on seasonal variation of headache were also included.

RESULTS

One thousand fifty-two patients (75%) returned the questionnaire. Nineteen percent reported that their headaches clearly did vary with season; 11% experienced more headache during polar night, while 7% had more symptoms during midnight sun season. When the migraine and nonmigraine groups were compared, significant differences were demonstrated. Patients with nonmigrainous headache were more likely to have increased headaches during the dark winter season, while patients with migraine experienced more headache during the summer (P =.002).

CONCLUSIONS

Patients with migraine were more likely to have headache during the bright Arctic summer season, and this distinguishes migraine from other headaches in this study. This observation may pertain to the increased light sensitivity and recently demonstrated cortical hyperexcitability in patients with migraine, and may perhaps suggest a role of the hypothalamus and/or melatonin secretion in migraine pathophysiology.