Reciprocal Relationship Between Pain and Depression: A 12-Month Longitudinal Analysis in Primary Care
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Unlabelled Pain and depression are the most prevalent physical and psychological symptom-based disorders, respectively, and co-occur 30 to 50% of the time. However, their reciprocal relationship and potentially causative effects on one another have been inadequately studied. Longitudinal data analysis involving 500 primary care patients with persistent back, hip, or knee pain were enrolled in the Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study. Half of the participants had comorbid depression and were randomized to a stepped care intervention (n = 123) or treatment as usual (n = 127). Another 250 nondepressed patients with similar pain were followed in a parallel cohort. Outcomes were assessed at baseline, 3, 6, and 12 months. Mixed effects model repeated measures (MMRM) multivariable analyses were conducted to determine if change in pain severity predicted subsequent depression severity, and vice versa. Change in pain was a strong predictor of subsequent depression severity (t-value = 6.63, P < .0001). Likewise, change in depression severity was an equally strong predictor of subsequent pain severity (t-value = 7.28, P < .0001). Results from the full cohort were similar in the clinical trial subgroup. In summary, pain and depression have strong and similar effects on one another when assessed longitudinally over 12 months.Perspective This study strengthens the evidence for a bidirectional and potentially causative influence of pain and depression on one another. A change in severity of either symptom predicts subsequent severity of the other symptom. Thus, recognition and management of both conditions may be warranted, particularly when treatment focused on 1 condition is not leading to an optimal response.
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Comorbidity between psychological distress and chronic pain negatively influences the response to pharmacological and non-pharmacological treatments.
“and negatively influences the response to pharmacological and non-pharmacological treatments (Kroenke et al., 2011).”
From A systematic review of cognitive behavioral therapy-based interventions for comorbid chronic pain and clinically relevant psychological distress (2023) · cites this paper as Kroenke et al., 2011
The Introduction and Discussion report that co-occurring pain and depression can adversely affect treatment response. The Discussion also mentions antidepressants and cognitive-behavioral therapy, but the paper addresses depression specifically, not psychological distress more broadly. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe relationship between pain and depression is bidirectional.
“The relationship between pain and depression is bidirectional.7”
From Efficacy, cost-utility and physiological effects of Acceptance and Commitment Therapy (ACT) and Behavioural Activation Treatment for Depression (BATD) in patients with chronic low back pain and depression: study protocol of a randomised, controlled trial including mobile-technology-based ecological momentary assessment (IMPACT study) (2020) · cites this paper as [7]
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- Authors
- Kroenke, K., Wu, J., Bair, M. J., Krebs, E. E., Damush, T. M., & Tu, W.
- Affiliations
- Regenstrief Institute (US)
- Indiana University Indianapolis (US)
- Corresponding author
- Kroenke, Kurt
- Venue
- The Journal of Pain
- Publisher
- Elsevier BV
- Published
- 2011-09
- Volume
- 12
- Issue
- 9
- Pages
- 964-973
- ISSN
- 1526-5900 (ISSN-L)
- PMC
- PMC3222454
- OpenAlex
- W2012410632
- Cited by
- 573
- References
- 52
- Citations by year
- 2026: 34 · 2025: 32 · 2024: 48 · 2023: 33 · 2022: 41 · 2021: 63 · 2020: 44 · 2019: 44 · 2018: 46 · 2017: 26 · 2016: 40 · 2015: 43 · 2014: 38 · 2013: 25 · 2012: 16
- FWCI
- 18.50
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Funders
- Eli Lilly and Company
- National Institute of Mental Health (MH 071268, R01MH071268)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Keywords
- pain, depression, bidirectional relationship, comorbidities, musculoskeletal pain, back pain, hip pain, knee pain, stepped care, primary care, pain intensity, depression severity, longitudinal change
- MeSH terms
- Adult, Aged, Cross-Sectional Studies, Depression, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Middle Aged, Pain, Primary Health Care, Cohort Studies
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