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Depression and Pain Comorbidity: A Literature Review
Open accessAbstract
Because depression and painful symptoms commonly occur together, we conducted a literature review to determine the prevalence of both conditions and the effects of comorbidity on diagnosis, clinical outcomes, and treatment. The prevalences of pain in depressed cohorts and depression in pain cohorts are higher than when these conditions are individually examined. The presence of pain negatively affects the recognition and treatment of depression. When pain is moderate to severe, impairs function, and/or is refractory to treatment, it is associated with more depressive symptoms and worse depression outcomes (eg, lower quality of life, decreased work function, and increased health care utilization). Similarly, depression in patients with pain is associated with more pain complaints and greater impairment. Depression and pain share biological pathways and neurotransmitters, which has implications for the treatment of both concurrently. A model that incorporates assessment and treatment of depression and pain simultaneously is necessary for improved outcomes.
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In the citing paper
“Chronic pain commonly coexists with depression and anxiety, and these conditions are bidirectional risk factors for one another [1-5].”
From Behavioral Mechanisms That Mediate Mental and Physical Health Improvements in People With Chronic Pain Who Receive a Digital Health Intervention: Prospective Cohort Pilot Study (2023) · cites this paper as [1]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Chronic pain is often associated with psychological distress, which complicates adjustment to chronic pain [3, 4],”
From A 13-weeks mindfulness based pain management program improves psychological distress in patients with chronic pain compared with waiting list controls (2016) · cites this paper as [3]
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In the citing paper
“chronic pain has also been found to be highly comorbid with depression”
From From stress to inflammation and major depressive disorder: A social signal transduction theory of depression. (2014) · cites this paper as Bair, Robinson, Katon, & Kroenke, 2003
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“There are high rates of unemployment and impairments in social functioning among patients with depression and pain (Bair et al., 2003).”
From Presence and predictors of pain in depression: Results from the FINDER study (2010) · cites this paper as Bair et al., 2003
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In the citing paper
“depression is known to be associated with pain and pain-related outcomes,4”
From Telehealth Versus In-Person Acceptance and Commitment Therapy for Chronic Pain: A Randomized Noninferiority Trial. (2017) · cites this paper as Bair et al., 2003
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In the citing paper
“Analyses to address hypotheses 1 and 2 were adjusted for baseline PHQ-9 scores (except when PHQ-9 was the outcome) because depression is known to be associated with pain and pain-related outcomes,4”
From Telehealth Versus In-Person Acceptance and Commitment Therapy for Chronic Pain: A Randomized Noninferiority Trial. (2017) · cites this paper as Bair et al., 2003
In the citing paper
“the development of an enduring pain condition confers a substantially increased vulnerability for the subsequent diagnosis of an affective disorder”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [16]
In the citing paper
“longitudinal, observational research supports a strong bidirectional link between mood disorders and persistent pain”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [16]
In the citing paper
“psychosocial variables such as depression, anxiety, and distress are among the most potent and robust predictors of the transition from acute to chronic pain 13–18.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [16]
In the citing paper
“an average of 52% of patients with pain fulfill the criteria for depression.27”
From Impact of psychological factors in the experience of pain (2011) · cites this paper as [27]
In the citing paper
“The presence of depression in a pain condition is associated with higher levels of pain intensity and is a potent risk factor for disability.27,29”
From Impact of psychological factors in the experience of pain (2011) · cites this paper as [27]
In the citing paper
“Of the over 70 million Americans who have chronic musculoskeletal pain, up to half of them have a comorbid diagnosis of depression and/or anxiety [1-4].”
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Metadata
- Authors
- Bair, M. J., Robinson, R. L., Katon, W., & Kroenke, K.
- Affiliations
- Indiana University Indianapolis (US)
- Corresponding author
- Bair, Matthew J.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2003-11-10
- Volume
- 163
- Issue
- 20
- Pages
- 2433
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2148694444
- Cited by
- 3,463
- References
- 178
- Citations by year
- 2026: 191 · 2025: 202 · 2024: 208 · 2023: 206 · 2022: 189 · 2021: 219 · 2020: 216 · 2019: 197 · 2018: 176 · 2017: 178 · 2016: 161 · 2015: 168 · 2014: 171 · 2013: 169 · 2012: 154
- FWCI
- 3.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- GlaxoSmithKline
- University of Washington
- School of Medicine, Indiana University
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Keywords
- depression, chronic pain, comorbidities, prevalence, diagnosis, clinical outcomes, quality of life, work impairment, health care utilization, refractory pain, neurotransmitters
- MeSH terms
- Antidepressive Agents, Chronic Disease, Depression, Depressive Disorder, Humans, Pain, Comorbidity, Prevalence, Treatment Outcome
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