In this issue of the Scandinavian Journal of Pain Voitto Järvimäki and co-workers publish a study documenting association between depressive symptoms and poor outcome after lumbar spine surgery 1. They found that patients with melancholic depression (11% of all) had more pain and more pain-interference with function, and they used more but had less relief from pain-medication, compared with patients who were not depressed. Patients with non-melancholic depression (almost 30% of all) also had less benefit from spine surgery than non-depressed patients, but slightly better outcomes than those with melancholic depression. They recommend strongly that patients with indications for spine surgery be screened for co-morbid depression and that those with depression have preoperative and postoperative well-tailored rehabilitation programmes 1.The Järvimäki et al. study is a cross-sectional study, but they focus well on these important and common problems that burden chronic back pain patients: When pain and depression co-occur, they impact on each other and they play important roles in development and maintenance of chronic health problems [2,3].A number of papers and editorial comments have been published in the Scandinavian Journal of Pain focusing on aspects of these comorbid health problems, attempting to understand the link between depression and pain and how to examine and manage both [2,3,4,5,6,7,89]. Depression is a problem in the young adolescent [4,5] as well as in the older adults with persistent pain 6. Depression increases the burden of pain and pain deepens the depressed mood. Unfortunately it is a fact that the risk of suicide attempts is significantly higher in patients with chronic pain than in patients without pain [7,8].For all these reasons it is important for clinicians to assess both depression and pain as early as possible, using the Beck [1,10] or the HADS-D screening tools 11. Both symptoms should be monitored and addressed in treatment programmes to maximize outcome results. Because pharmacological treatment has limited effects for depression, and analgesic drugs are not much better for chronic pain, psychological approaches and cognitive-behavioural therapy are alternatives [2,9].Patients with back pain who are candidates for spinal surgery, certainly are no exceptions to the linking of depression and chronic pain: Whereas the surgeon’s tools may correct and sometimes remove a cause of spinal pain, observing and handling the comorbid depression is mandatory for optimal outcome of spinal surgery for pain 1.Conflict of interestNone declared.ReferencesJärvimäki V, Kautiainen H, Haanpää M, Koponen H, Spalding M, Alahuta S, Vakkala M. Depressive symptoms are associated with poor outcome for lumbar spine surgery. Scand J Pain 2016;12:13-7.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000383375000003&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f328850484JärvimäkiVKautiainenHHaanpääMKoponenHSpaldingMAlahutaSVakkalaMDepressive symptoms are associated with poor outcome for lumbar spine surgeryScand J Pain201612137Linton SJ, Bergbom S. Understanding the link between depression and pain. Scand J Pain 2011;2:47-54.LintonSJBergbomSUnderstanding the link between depression and painScand J Pain201124754Nicholas MK. Depression in people with pain: there is still work to do: commentary on ‘Understanding the link between depression and pain’. Scand J Pain 2011;2:45-6, http://dx.doi.org/10.1016/j.sjpain.2011.02.003NicholasMKDepression in people with pain: there is still work to do: commentary on ‘Understanding the link between depression and pain’Scand J Pain20112456http://dx.doi.org/10.1016/j.sjpain.2011.02.003Stabell N, Flægstad T, Stubhaug A, Nielsen CS. Associations between abdominal pain symptom dimensions and depression among adolescents. Scand J Pain 2014;5:184-90.StabellNFlægstadTStubhaugANielsenCSAssociations between abdominal pain symptom dimensions and depression among adolescentsScand J Pain2014518490Breivik H. Depression and anxiety in adolescents aggravate abdominal pain, and abdominal pain deepens depression which increases suffering from chronic pain. Scand J Pain 2014;5:182-3.BreivikHDepression and anxiety in adolescents aggravate abdominal pain, and abdominal pain deepens depression which increases suffering from chronic painScand J Pain 201451823Wood BM, Nicholas MK, Blyth F, Asghari A, Gibson S. The mediating role of catastrophizing in the relationship between pain intensity and depressed mood in older adults with persistent pain: a longitudinal analysis. Scand J Pain 2016;11:157-62.WoodBMNicholasMKBlythFAsghariAGibsonSThe mediating role of catastrophizing in the relationship between pain intensity and depressed mood in older adults with persistent pain: a longitudinal analysisScand J Pain 20161115762Stenager E, Christiansen E, Handberg G, Jensen B. Suicide attempts in chronic pain patients. A register-based study. Scand J Pain 2014;5:4-7.StenagerEChristiansenEHandbergGJensenBSuicide attempts in chronic pain patientsA register-based studyScand J Pain 2014547Breivik H, Endresen Reme S, Linton SJ. High risk of depression and suicide attempt among chronic pain patients: always explore catastrophizing and suicide thoughts when evaluating chronic pain patients. Scand J Pain 2014;5:1-3.10.1016/j.sjpain.2013.11.004BreivikHEndresen RemeSLintonSJHigh risk of depression and suicide attempt among chronic pain patients: always explore catastrophizing and suicide thoughts when evaluating chronic pain patientsScand J Pain2014513Linton SJ, Fruzzetti AE. A hybrid emotion-focused exposure treatment for chronic pain: a feasibility study. Scand J Pain 2014;5:151-8.LintonSJFruzzettiAE.A hybrid emotion-focused exposure treatment for chronic pain: a feasibility studyScand J Pain 201451518Williams AC, Richardson PH. What does the BDI measure in chronic pain? Pain 1993;55:259-66.10.1016/0304-3959(93)90155-I8309713WilliamsACRichardsonPHWhat does the BDI measure in chronic pain?Pain19935525966Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 2002;52:69-77, http://dx.doi.org/10.1016/S0022-3999(01)00296-310.1016/S0022-3999(01)00296-311832252BjellandIDahlAAHaugTTNeckelmannDThe validity of the Hospital Anxiety and Depression Scale. An updated literature reviewJ Psychosom Res2002526977http://dx.doi.org/10.1016/S0022-3999(01)00296-3
Scandinavian Journal of Pain – de Gruyter
Published: Dec 29, 2017
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