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Chronic Pain-Associated Depression: Antecedent or Consequence of Chronic Pain? A Review

Fishbain, David A. M.Sc., M.D., F.A.P.A.*†‡; Cutler, Robert Ph.D.*; Rosomoff, Hubert L. M.D., D.Med.Sc.†‡; Rosomoff, Renee Steele B.S.N., M.B.A., C.R.C., C.I.R.S., C.R.R.N.

The Clinical Journal of Pain: June 1997 - Volume 13 - Issue 2 - p 116-137
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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.

Departments of *Psychiatry, †Neurological Surgery, and ‡Anesthesiology, University of Miami, School of Medicine, Comprehensive Pain and Rehabilitation Center at South Shore Hospital, Miami Beach, Florida, U.S.A.

Manuscript submitted February 13, 1996; first revision received August 15, 1996; second revision received November 19, 1996; accepted February 4, 1997.

Address correspondence and reprint requests to Dr. David A. Fishbain, University of Miami, Comprehensive Pain and Rehabilitation Center, 600 Alton Road, Miami Beach, FL 33131, U.S.A.

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