慢性疼痛与抑郁症

慢性疼痛和抑郁的关系具有临床重要性。现对53例于1993～1997年相继转诊入我院,疼痛连续6个月以上,而无躯体疾病的病人,作临床分析。1　资料与方法作者单位:425300　湖南道县精神病医院选择于1993～1997年相继转诊入我院,主诉各种形式的疼痛,疼痛历时半年以上,每周出现不?..     

慢性疼痛与抑郁症

本综述了慢性疼痛的一般情况与抑郁的相关性。     

是否伴有躯体症状的抑郁症对照研究

目的：探讨抑郁症躯体化的临床特征。方法：采用汉密尔顿抑郁量表（HAMD）,症状自评量表（SCL－90）及自编的抑郁患者躯体症状调查表,对41例患者进行评定。结果：伴躯体症状的抑郁症患者在文化程度、性格、求医方式上与无躯体症状患者有显著差异,治疗上多需合并用药,临床疗效无差异。结论：是否伴有躯体症状的抑郁症尚有其他某些方面的差异。     

以慢性疼痛为特征的隐匿性抑郁症

本文报告了以慢性疼痛为主要临床特征的26例隐匿性抑郁症,囚长期误诊,久治无效。确诊后,经三环类抗抑郁剂治疗,收到显著的效果。     

慢性疼痛和抑郁症临床及生物学相关研究

介绍了抑郁症和慢性疼痛在临床和生物学方面的一些共同研究发现。     

度洛西汀与舍曲林治疗伴有慢性疼痛抑郁症患者的疗效比较

目的观察度洛西汀与舍曲林治疗伴有慢性疼痛抑郁症患者的疗效。方法将60例伴有躯体疼痛症状的抑郁症患者随机分为度洛西汀组（30例）和舍曲林组（30例）,观察8周。采用汉密尔顿抑郁量表17项（HAMD）、研究用疼痛量表（MOSPM）和治疗时出现的症状量表（TESS）于治疗前及治疗后第1、2、4、8周末进行评定。结果度洛西汀组与舍曲林组改善抑郁症状总体疗效及不良反应无显著性差异（P〉0.05）,但治疗疼痛症状度洛西汀组总体疗效显著优于舍曲林组（P〈0.05）。结论度洛西汀治疗慢性疼痛的抑郁症患者安全有效,不良反应少,依从性好,度洛西汀起效时间较舍曲林快。     

抑郁症伴慢性疼痛与基因多态性相关性的研究进展

抑郁症作为精神科常见的疾病,具有高发病率、高复发率、高致残率等特点.流行病学调查显示抑郁症常与慢性疼痛伴随,而慢性疼痛也可能导致抑郁的发生.近年来的研究进一步从基因多态性方面发掘抑郁症及慢性疼痛发生、发展相关的机制,为伴慢性疼痛的抑郁症的诊断及治疗提供有效证据.现旨对近年来有关抑郁症伴慢性疼痛与基因多态性相关性研究进行...     

抑郁症伴慢性疼痛炎性机制的研究进展

治疗抑郁症伴慢性疼痛症状问题一直是临床的中心问题,科学家对该病的病因和发病机制进行探索研究发现,促炎因素和抗炎因素之间的复杂的交互作用是导致抑郁症伴慢性疼痛发生、发展和预后的关键所在.现综述归纳和总结炎症因素在抑郁症伴慢性疼痛的机制,并对药物治疗在这类疾病中未来研究的发展方向进行展望.     

慢性疼痛与抑郁症

本文综述了慢性疼痛的一般情况及与抑郁的相关性     

COMT 基因多态性及社会心理因素与抑郁症伴慢性疼痛的相关性研究

目的 探讨儿茶酚胺氧位甲基转移酶（COMT）基因多态性及社会心理因素对抑郁症伴慢 性疼痛的影响。方法 纳入 2018 年 1 月至 2019 年 12 月在新疆维吾尔自治区人民医院临床心理科和疼 痛科门诊就诊或住院治疗的 292 例抑郁症患者为研究对象。抽取所有患者空腹静脉血,通过 TaqMan 单 核苷酸多态性（SNP）基因分型测序方法筛查 COMT 基因 rs6269、rs4633 位点的 SNP。根据是否伴发慢性 疼痛将患者分为研究组（141 例）和对照组（151 例）,比较两组患者的一般资料、COMT 基因多态性、社会支 持评定量表（SSRS）得分、自我认同感量表（SIS）得分以及简易应对方式问卷（SCSQ）得分。采用整体疼痛 评估量表（GPS）评估抑郁症伴慢性疼痛患者的疼痛程度。采用多因素 Logistic 回归分析抑郁症患者伴慢 性疼痛的相关因素。采用 Pearson 相关分析社会心理因素与抑郁症伴慢性疼痛患者疼痛程度的相关性。 结果 两组患者性别、文化程度比较,差异有统计学意义（P＜ 0.05）。研究组患者的 SIS 得分、SSRS 得 分、SCSQ 中积极应对条目均分低于对照组,SCSQ 中消极应对条目均分高于对照组,差异有统计学意义 （P＜ 0.01）。研究组 COMT 基因 rs6269 位点 A 等位基因频率高于对照组,差异有统计学意义（P＜ 0.05）。 多因素 Logistic 回归分析显示,SIS 得分越高（OR=0.822,95%CI=0.749～0.903）、SSRS 得分越高（OR=0.775, 95%CI=0.704～0.855）、SCSQ 中积极应对条目均分越高（OR=0.001,95%CI= ＜ 0.001～0.011）是抑郁症 患者伴慢性疼痛的保护因素（P＜ 0.05）;女性（OR=16.557,95%CI=2.364～115.936）、小学及以下文化程 度（OR=43.380,95%CI=4.297～437.978）、SCSQ 中消极应对条目均分越高（OR=187.293,95%CI=10.826～ 3 240.198）、COMT 基因 rs6269 位点 A 等位基因频率越高（OR=2.442,95%CI=1.235～4.828）是抑郁症患者 伴慢性疼痛的危险因素（P＜ 0.05）。Pearson 相关分析显示,SIS 得分、SSRS 得分、SCSQ 中的积极应对条 目均分与 GPS 条目均分呈负相关（r=-0.689、-0.677、-0.736;P＜ 0.05）,与 SCSQ 中消极应对条目均分呈 正相关（r=0.811,P＜ 0.05）。结论 COMT 基因 rs6269 位点 A 等位基因频率与抑郁症伴慢性疼痛相关, 同时抑郁症患者的社会心理状态与慢性疼痛症状也存在相关性。     

Alexithymia and depression in the recovery of chronic pain patients: a follow-up study

Background: Childhood adversities and emotional dysregulation are connected with chronic pain, alexithymia, and depression. Longitudinal studies exploring the impact of their co-occurrence on the pain situation are rare.

Aims: The influence of alexithymia, depression, baseline pain situation, and treatment options on the course of chronic pain in a clinical sample was studied.

Methods: The baseline data was collected from chronic pain patients (n?=?154) before their first pain clinic visit, and the follow-up data after 1 year by self-report questionnaires. Study variables consisted of pain intensity, pain disability, alexithymia (TAS-20), depression (BDI-II), and treatment interventions. Statistical analyses were performed to find out differences between baseline and follow-up, as well as between alexithymic and non-alexithymic patients, and to estimate the effect of the treatment provided.

Results: At follow-up, the majority of the patients had pain intensity and disability severe enough to disrupt with their daily living. None of treatment interventions was related to better outcome. Alexithymic patients reported more pain disability and depression at both baseline and at follow-up. The effect of alexithymia on pain disability was mediated by depression. The use of opioids was connected to alexithymia and depressiveness. Alexithymia and depression made a substantial contribution to poorer outcome.

Conclusions: Severe pain intensity and disability with depression and alexithymia predicted difficulties in achieving improvement. Depression and alexithymia probably impair compliance with treatment and adherence to interventions. Their co-occurrence with a more severe pain situation and with the use of opioids indicates psychological problems underlying the pain experience.     

Post-traumatic stress, depression, and anxiety in patients with injury-related chronic pain: A pilot study

Aim

To investigate, in patients with injury-related chronic pain, pain intensity, levels of post-traumatic stress, anxiety and depressions.

Methods

One hundred and sixty patients aged 17–62 years, admitted for assessment to the Pain Rehabilitation Clinic at the Umeå University Hospital, Umeå Sweden, for chronic pain caused by an injury, answered a set of questionnaires to assess post-traumatic stress (Impact of Event Scale [IES]), pain intensity (VAS), depression, and anxiety (Hospital Anxiety and Depression Scale [HAD]).

Results

Moderate to severe post-traumatic stress was reported by 48.1% of the patients. Possible–probable anxiety on the HAD was scored by 44.5% and possible–probable depression by 45.2%. Pain intensity (VAS) was significantly correlated to post-traumatic stress (r = 0.183, p = 0.022), the HAD-scores anxiety (r = 0.186, p = 0.0021), and depression (r = 0.252, p = 0.002). No statistically significant differences were found between genders for post-traumatic stress, pain intensity, anxiety, or depression. Participants with moderate to severe stress reaction reported statistically significant higher anxiety scores on the HAD (p = 0.030) in comparison with patients with mild stress.

Conclusion

The findings of relationships between pain intensity, post-traumatic stress, depression, and anxiety may have implications for clinicians and underline the importance of considering all these factors when managing patients with injury-related chronic pain.     

An age-based comparison of chronic pain clinic patients

OBJECTIVE: The aim of this study was to compare demographic, illness and personality characteristics, and formal rates of mental disorder between younger (< 65 years) and older (>or= 65 years) patients attending a chronic pain clinic. METHOD: Patients with non-malignant pain of > 6 months' duration attending a specialist outpatient clinic were given a structured medical and psychiatric interview, and completed self-report questionnaires assessing disability, personality style and attitudes to illness. RESULTS: Fifty patients (26 of whom were older) participated in the study. None of the older patients had experienced the onset of chronic pain before the age of 50 years. Although current and lifetime major depression were common in both groups, there was no specific association between age and depression. The younger group was more likely to have been injured prior to the onset of pain and to be seeking financial compensation, reported more physical and social disability, and was more likely to be preoccupied with somatic discomfort. The younger group was also more likely to be rated as displaying impulsive personality traits and the older group anxious traits, although there was no difference in neuroticism scores. CONCLUSION: Despite a greater level of multiple medical morbidity and longer duration of pain, older patients with chronic pain were not more likely to suffer from concurrent depression, were less disabled and less somatically preoccupied than younger patients. There were sufficient differences in illness and psychological characteristics to suggest that the older patients represented an aetiologically distinct sub-group, rather than patients with chronic pain of early onset who have simply grown old. Finally, the utility of DSM-IV defined somatoform disorders, in particular pain disorder, is discussed. A model which integrates medical and psychological mechanisms is needed for clinical use.     

伴躯体疼痛抑郁障碍患者血清IL-6水平的对照研究

目的:探讨伴躯体疼痛抑郁障碍患者血清白细胞介素-6(IL-6)水平及与躯体疼痛的相关性。方法:采用HAMD-17评估及视觉模拟评分(VAS)评估抑郁障碍患者,依据躯体疼痛症状的定义将抑郁障碍患者分为伴躯体疼痛组(疼痛组,32例)、不伴躯体疼痛组(单纯组,31例),同期入组30名健康对照组;采用ELISA法检测血清IL-6浓度。结果:1疼痛组HAMD-17总分、焦虑因子分高于单纯组[(23.4±4.0)vs(20.6±2.8),(9.4±1.7)vs(8.1±1.2))],差异均有统计学意义(t=3.297,3.627;P=0.002,0.001);2疼痛组血清IL-6浓度为(14.5±2.3)pg/ml,单纯组为(12.5±2.2)pg/ml,对照组为(11.3±2.3)pg/ml,疼痛组高于单纯组(d=2.0,P=0.001),单纯组高于对照组(d=1.2,P=0.041),差异均有统计学意义;3疼痛组血清IL-6浓度与VAS评分呈显著正相关(r=0.382,P=0.031)。结论:伴有躯体疼痛的抑郁障碍患者血清IL-6浓度较不伴躯体疼痛的抑郁障碍患者高,IL-6可能参与了抑郁障碍患者躯体疼痛症状的产生。     

妄想性抑郁症55例临床对照分析

对５５例妄想性抑郁症与９２例非妄想性抑郁症病人进行临床对照分析。结果表明：妄想性抑郁症幻听、焦虑、自责自罪、绝望、自杀行为等症状出现率较高，自杀率为非妄想性抑郁症的３．７倍，往往需要联合治疗。     

躯体化主诉抑郁症的比较研究

目的：探讨以躯体化为主诉的和以精神症状为主诉的抑郁症病人的差异。方法：采用自编“抑制症病人深入访谈提纲”和ＨＡＭＤ、ＨＡＭＡ对６２例抑 病人进行访谈和评定。结果以躯体化主诉的抑郁症病人最常见的症状为胸闷（５８．１％）、心慌（５４．８％）和肢体乏力（４５．５％）,并且躯体化组病人在教育程度与个性特征,求医方式,以及接受诊断标签等方面与精神症为主的病人比较有显著差异。结论以躯体化为主诉的和以精神症为主     

Platelet paroxetine binding in depressed and nondepressed chronic pain patients

Analysis of ³H-paroxetine binding was used to determine the number of serotonin transporters in platelet membranes of chronic pain patients and controls. The pain patients who also suffered from depression in addition to the pain had significantly more serotonin transporters than the controls.     

Chronic pain and depression among geriatric psychiatry inpatients

OBJECTIVES: We examined whether chronic pain among depressed geriatric inpatients was associated with several clinical variables-comorbid psychiatric and medical diagnoses, length of hospitalization, suicidal ideation, and sleep duration. METHODS: Medical charts of inpatients admitted to a geriatric psychiatry unit over 2 years were examined retrospectively; 148 patients with a depressive disorder were identified. Admission pain assessments were used to classify whether patients had chronic pain. Other variables of interest were collected from charts. RESULTS: 62% of patients reported chronic pain. In multivariate regression analysis, depressed older adults with chronic pain were more likely to report suicidal ideation, be diagnosed with personality disorder, have higher medical burden, and experience decreased total sleep time compared to depressed older adults without chronic pain. CONCLUSIONS: Chronic pain--common in depressed older adults--may influence clinical features of depression and should be assessed as a possible suicide risk factor. Prospective studies should examine causal relationships and determine the effects of adequate pain treatment on depression course and suicide risk in older adults.