Eva Gontrum

Background: Prior studies show the causal relationship between chronic pain and depression is bidirectional; and their co-occurrence is associated with worse functional outcomes1,2,3. Few studies have untangled factors influencing the relationship between depressive disorder and multisite pain4,5. We examined the relationship between timeline of depressive disorder onset, multisite pain, and dimensions of affective pain.

Methods: Participants were 35 adults reporting chronic musculoskeletal pain for >3 months (54.3% female, age=35.6±7.2). Depressive disorder onset was assessed through SCID-IV interviews, affective pain intensity and multisite pain were measured using the McGill Pain Questionnaire, and pain catastrophizing was evaluated with the Pain Catastrophizing Scale. Mediation analysis assessed the role of affective pain in the relationship between pre-existing depressive disorder and multisite pain. Interaction analyses examined the role of pain catastrophizing in the relationship between depression timeline and anxiety symptoms.

Results: Pre-existing depressive disorder predicted both affective pain intensity (B=3.72,p=0.02) and multisite pain (B=1.78, p=0.02) while depressive disorder post-chronic pain onset did not. A mediation model indicated that affective pain intensity mediated the relationship between pre-existing depressive disorder and increased sites of pain (indirect effect: B=0.68, p=0.02, CI=[0.07, 1.67]). Including affective pain intensity in the model removed the direct effect of pre-existing depressive disorder on number of pain sites (B=0.74, p=0.29), indicating full mediation. Interaction analysis revealed a significant interaction between post-pain onset depressive disorder and pain catastrophizing in predicting anxiety symptoms (B=0.98, p=0.02), such that increased pain catastrophizing correlates with more anxiety symptoms in this group.

Conclusions: For individuals with chronic pain and a pre-existing depressive disorder, affective pain intensity increases the risk for experiencing multisite pain. For those with depressive disorder post-chronic pain onset, pain catastrophizing had a greater effect on anxiety symptoms. These findings highlight the importance of considering psychiatric history in personalizing chronic pain recovery strategies.

References:

1. Viana MC, Lim CCW, Garcia Pereira F, Aguilar-Gaxiola S, Alonso J, Bruffaerts R, et al. Previous Mental Disorders and Subsequent Onset of Chronic Back or Neck Pain: Findings From 19 Countries. J Pain 2018;19:99–110. https://doi.org/10.1016/j.jpain.2017.08.011.

2. Antioch I, Ilie O-D, Ciobica A, Doroftei B, Fornaro M. Preclinical Considerations about Affective Disorders and Pain: A Broadly Intertwined, yet Often Under-Explored, Relationship Having Major Clinical Implications. Medicina (Kaunas) 2020;56:504. https://doi.org/10.3390/medicina56100504.

3. Zhao SS, Holmes MV, Alam U. Disentangling the relationship between depression and chronic widespread pain: A Mendelian randomisation study. Semin Arthritis Rheum 2023;60:152188. https://doi.org/10.1016/j.semarthrit.2023.152188.

4. Ahlholm V-H, Rönkkö V, Ala-Mursula L, Karppinen J, Oura P. Modeling the Multidimensional Predictors of Multisite Musculoskeletal Pain Across Adulthood-A Generalized Estimating Equations Approach. Front Public Health 2021;9:709778. https://doi.org/10.3389/fpubh.2021.709778.

5. Nicholl BI, Mackay D, Cullen B, Martin DJ, Ul-Haq Z, Mair FS, et al. Chronic multisite pain in major depression and bipolar disorder: cross-sectional study of 149,611 participants in UK Biobank. BMC Psychiatry 2014;14:350. https://doi.org/10.1186/s12888-014-0350-4.