(openPR) Pain in Europe VII – 7th EFIC Congress, 21 - 24 September 2011, Hamburg
Depression makes pain worse – and vice versa
Anxiety and depression are directly linked to chronic pain and among the most frequent psychiatric comorbidities, as several studies presented at the ECIF Congress in Hamburg show. Cognitive pain coping strategies might be a promising way to help patients. This is important since depression can worsen pain and enhances catastrophising tendencies.
Hamburg – 21 September 2011 – A vicious circle: pain often causes anxiety and depression and depression often worsens pain perception. “Pain, as defined by the International Association for the Study of Pain, cannot be viewed as a physical phenomenon alone” explained Dr. Maria Alexandra Ferreira-Valente (Porto, P). “Considering research findings, clinicians should aim to adjust treatment programs in accordance with the degree of anxiety or depression that patients manifest,” she told the 7th EFIC Congress: Pain in Europe VII in Hamburg, where recent research results on this issue were presented.
Pain and anxiety are “doping factors” to pain
Dr. Ferreira-Valente assessed psychosocial factors as predictors of depression and anxiety in patients with chronic pain by analysing 324 persons with four different chronic pain conditions. “Anxiety and depression are strongly associated with higher pain severity and interference. There’s no doubt that an effective therapy should not fill up patients with painkillers while ignoring their psychosocial conditions”, Dr. Ferreira-Valente stressed.
Cognitive paths to pain and depression
Dr. Adina Rusu (Bochum and London, D, UK) and Prof. Dr. Monika Hasenbring (Bochum, D) took the same line, presenting their latest research at the EFIC Congress: “It is often insufficient to treat pain exclusively on a physiological level.” Together with Janina Hülsebusch they investigated whether the relationship between pain and depression is mediated by cognitive pain coping strategies such as catastrophising, help- or hopelessness and thought suppression. The research team analysed 164 acute and sub-acute non-specific pain patients. The results of the path analysis support the hypothesis of a mediating effect of cognitive coping strategies between pain and depression. “We found that pain itself had no direct link to depression. But help- and hopelessness had a direct path to depression, while catastrophising revealed an indirect effect via increased help- and hopelessness,” Dr. Rusu explained. “The current results show clearly that we could optimise treatment by paying more attention to the modification of dysfunctional cognitive pain coping strategies.”
Psychiatric comorbidities and peripheral neuropathic pain
“Psychiatric comorbidities, in particular anxiety and depression disorders, are highly prevalent in patients with peripheral neuropathic pain”, said Dr. Françoise Radat (Bordeaux, F), presenting a recent cross-sectional study at the Hamburg Congress. Current major depression and generalised anxiety were found to be the most frequent psychiatric disorders in 17% and 12% of the 212 patients included in the study. “Due to multivariate analyses we can tell that catastrophising, multiple pain sites and the intensity of minimal pain make an independent contribution to the presence of mood disorders, whereas only catastrophising was a predictor of current anxiety disorder,” Dr. Radat explained.
She suggests treating patients with peripheral neuropathic pain in multidisciplinary teams, including clinical psychologist and other relevant specialists.
No rose-colored glasses for chronic pain patients
How do people with chronic pain perceive their future? “They definitely do not see things through rose-colored glasses,” according to Dr. Adina Rusu (Bochum, D). ). In her latest research together with Prof. Tamar Pincus (London, UK) she analysed 174 adults divided into four groups. One group consisted of patients suffering from musculoskeletal pain and depression; another of pain patients only; a third of clinically depressed patients without pain. Healthy persons were gathered in a control group. The participants were required to think of potential future experiences occurring over three different time periods (next week, next year and next 5 to 10 years) within a given time frame. Depressed pain patients had less anticipation of positive experiences and an increased anticipation of negative experiences compared to non-depressed pain patients and control participants. “As hypothesised, depressed pain patients generated higher scores for total negative health-related future experiences over the three time periods when compared to non-depressed pain patients and controls,” Dr. Rusu said. “Future-related anxieties and distress could prove a massive blow to a positive self-identity. Our findings suggest that the cognitive processing of general future thinking in depressed pain patients is not different in chronic pain patients compared to clinically depressed patients and non-depressed pain patients, but the focus is a completely different: in depressed pain patients the focus of future experiences is more on negative health. If we want to provide more helpful therapy, we need further research into the development of subgroup-specific new treatment modalities. Traditional CBT programmes are normally not targeted towards depressed pain patients, which is a problem,” Dr. Rusu explained.
About EFIC and "Pain in Europe" - The European Federation of IASP® chapters (EFIC®) is a multidisciplinary professional organisation in the field of pain research and medicine, consisting of the 35 so-called chapters of the International Association for the Study of Pain (IASP®), which are the IASP approved official National Pain Societies in each country. Established in 1993, EFIC’s constituent chapters represent Pain Societies from 35 European countries and close to 20,000 physicians, basic researchers, nurses, physiotherapists, psychologists and other healthcare professionals across Europe, who are involved in pain management and pain research. EFIC’s aims are to advance research, education, clinical management and professional practice related to pain, and to serve as an authoritative, scientifically based resource concerning policy issues related to pain and its management. “Pain in Europe VII” in Hamburg (21-24 September 2011) is the 7th EFIC Congress since 1995. EFIC Congresses have become a popular forum in Europe attracting over 4000 participants in 2011. Congress participants are mainly from Europe, but with delegates from more than 75 countries worldwide, the Congress can be considered the major international educational exchange on pain issues of this year 2011.
Source: EFIC Abstracts T426 PSYCHOSOCIAL FACTORS AS PREDICTORS OF DEPRESSION AND ANXIETY IN PATIENTS WITH CHRONIC PAIN; T405 DEPRESSION IN ACUTE AND SUBACUTE BACK PAIN: IS THE RELATIONSHIP BETWEEN PAIN AND DEPRESSION MEDIATED BY COGNITIVE PAIN COPING STRATEGIES?; F508 PSYCHIATRIC COMORBIDITIES OF PERIPHERAL NEUROPATHIC PAIN: A FRENCH CROSS-SECTIONAL STUDY; S408 THE ROLE OF FUTURE COGNITIONS IN PATIENTS WITH CHRONIC PAIN: AN EXAMINATION OF FUTURE EXPERIENCES AND PERCEIVED FUTURE HEALTH
