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Chronic Pain-Associated Depression: Antecedent or Consequence of Chronic Pain? A Review
Abstract
OBJECTIVE: To determine the current status for the association of chronic pain and depression and to review the evidence for whether depression is an antecedent or consequence of chronic pain (CP). DESIGN: A computer and manual literature review yielded 191 studies that related to the pain-depression association. These reports were reviewed and sorted into seven categories relating to the topic of this paper. Eighty-three studies were then selected according to inclusion criteria and subjected to a structured review. SETTING: Any medical treatment setting including pain treatment as inclusion criteria for selection of studies. PATIENTS: Any patients with any type of chronic pain. RESULTS: The reviewed studies were consistent in indicating that there is a statistical relationship between chronic pain and depression. For the relationship between pain and depression, there was greater support for the consequence and scar hypotheses than the antecedent hypothesis. CONCLUSIONS: Depression is more common in chronic pain patients (CPPs) than in healthy controls as a consequence of the presence of CP. At pain onset, predisposition to depression (the scar hypothesis) may increase the likelihood for the development of depression in some CPPS. Because of difficulties in measuring depression in the presence of CP, the reviewed studies should be interpreted with caution.
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“In the general population, depression is associated with a wide range of health, mental health, and neurological conditions, such as 1) chronic pain [71–75]; 2) headaches and migraines [76–79]; 3) diabetes [80–82]; 4) low testosterone [83–85]; 5) cardiovascular, cerebrovascular, and small vessel ischemic disease [86–92]; 6) PD [93]; 7) MCI [94–96]; and 8) AD [97].”
From The Need to Separate Chronic Traumatic Encephalopathy Neuropathology from Clinical Features (2017) · cites this paper as [72]
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“Both depression and anxiety are closely related to pain and pain intensity [16, 17].”
In the citing paper
“Pre-existing psychopathology is a factor that promotes CP.”
From Pain and Evil: From Local Nociception to Misery Following Social Harm (2020) · cites this paper as [15]
In the citing paper
“However, according to some studies,15,16 CP may be considered as a prognostic factor for depression, which, in turn, constitutes a prognostic factor for CP, thus underlying the bilateral nature of psychiatric disorders and CP”
From Pain and Evil: From Local Nociception to Misery Following Social Harm (2020) · cites this paper as [15]
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Lewandowski, W., & Jacobson, A. F. (2012) · Pain Management Nursing · doi:10.1016/j.pmn.2011.08.001 · Cited by 23
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Lindholm, P., Lamusuo, S., Taiminen, T. J., Virtanen, A., Pertovaara, A., Forssell, H., Hagelberg, N. M., & Jääskeläinen, S. K. (2016) · Medicine · doi:10.1097/md.0000000000005231 · Cited by 23
Harton, L. R., Richardson, J. R., Armendariz, A., & Nazarian, A. (2017) · Brain Research · doi:10.1016/j.brainres.2017.01.011 · Cited by 23
Metadata
- Authors
- Fishbain, D. A., Cutler, R., Rosomoff, H. L., & Rosomoff, R. S.
- Affiliations
- University of Miami (US)
- Corresponding author
- Fishbain, David A.
- Cutler, Robert
- ORCID
- Fishbain, David A.
- Venue
- The Clinical Journal of Pain
- Published
- 1997-06
- Volume
- 13
- Issue
- 2
- Pages
- 116-137
- ISSN
- 0749-8047 (ISSN-L)
- OpenAlex
- W2038709220
- Cited by
- 1,074
- References
- 111
- Citations by year
- 2026: 10 · 2025: 23 · 2024: 38 · 2023: 30 · 2022: 34 · 2021: 42 · 2020: 42 · 2019: 41 · 2018: 41 · 2017: 46 · 2016: 45 · 2015: 51 · 2014: 48 · 2013: 52 · 2012: 51
- FWCI
- 1.86
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
- Keywords
- chronic pain, depression, pain-depression relationship, pain onset
- MeSH terms
- Brain Chemistry, Chronic Disease, Clinical Trials as Topic, Depression, Humans, Pain
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