Sheera F. Lerman

Longitudinal associations between depression, anxiety, pain, and pain-related disability in chronic pain patients.

Objective The current study sets out to examine the longitudinal relationship between pain, pain-related disability, and symptoms of depression and anxiety. The latter symptoms are highly prevalent in chronic pain and seriously impede functioning and quality of life. Nevertheless, the direction of the relationship involving these variables among individuals with chronic pain is still unclear. Methods Four-hundred twenty-eight individuals with chronic pain (238 women, mean age 54.84 years, mean pain duration 85.21 months) treated at two pain clinics completed questionnaires regarding their pain (Short-Form McGill Pain Questionnaire), depression (Center for Epidemiological Studies–Depression Scale), state anxiety (State-Trait Anxiety Inventory), and pain-related disability (Pain Disability Index) at four time points, with an average of 5 months between measurements. Cross-lagged, structural equation modeling analyses were performed, enabling the examination of longitudinal associations between the variables. Results Significant symptoms of both depression and anxiety were reported by more than half of the sample on all waves. A latent depression/anxiety variable longitudinally predicted pain (&bgr; = .27, p < .001) and pain-related disability (&bgr; = .38, p < .001). However, neither pain (&bgr; = .10, p = .126) nor pain-related disability (&bgr; = −.01, p = .790) predicted depression/anxiety. Conclusions Among adult patients with chronic pain treated at specialty pain clinics, high levels of depression and anxiety may worsen pain and pain-related disability.

Depression in Systemic Lupus Erythematosus: The Key Role of Illness Intrusiveness and Concealment of Symptoms

Extant literature on depression in chronic illness points to the association between depression and increased morbidity (Moussavi et al., 2007). There is to date little research on the surmised reciprocal relationship between the two. This longitudinal study of 30 women suffering from systemic lupus erythematosus (SLE) was conducted using self-report measures as well as physical illness markers, in order to place depression among SLE patients within what is known of the psychosocial context of depression. The objective of this study was to differentiate between the broadly illness-related and personality-related aspects of SLE depression. Results show that depression is preceded by concealment of SLE symptoms and by illness intrusiveness, a concept reflecting the subjective illness experience. Furthermore, depression is shown to precede changes in illness intrusiveness. Thus, illness intrusiveness and symptom concealment – but not physical illness markers - emerge as key factors in understanding the co-morbidity of SLE and depression. These findings, viewed within the methodological limitations of this study, indicate the centrality of perceptions, of the ‘lived experience’ of the illness, in the detection and treatment of depression among women with SLE.

Distinguishing affective and somatic dimensions of pain and depression: a confirmatory factor analytic study†‡

In this study, we examined the overlap between pain and depression in a sample of 342 chronic pain patients treated at a specialty pain clinic. Confirmatory factor analysis was conducted to test the differentiation of pain and depression measured as latent factors derived from the subscales of the Short Form McGill Pain Questionnaire and the Center for Epidemiological Studies Depression Scale. The affective pain subscale did not load on latent depression and the somatic depression subscale loaded weakly on latent pain. Although pain and depression are linked, we found that affective pain is distinct from depression, and that somatic depression is distinct from pain. This finding justifies further examination of the casual relationship between pain and depression.

Pain Specialists' Evaluation of Patient's Prognosis During the First Visit Predicts Subsequent Depression and the Affective Dimension of Pain

OBJECTIVE To examine the predictive value of physicians prognosis after patients first visit to a pain specialty clinic. DESIGN This is a prospective-longitudinal study in which patients completed questionnaires regarding their pain and psychological constructs before their first visit to a pain specialist and again after an average of 5 months. Physicians rated patients prognosis immediately after the first visit. SETTING This study was conducted at the outpatient specialty pain clinic at Soroka University Medical Center. PATIENTS Forty-five chronic pain patients suffering from a range of nonmalignant pain conditions. OUTCOME MEASURES Sensory and affective pain measured by the Short-Form McGill Pain Questionnaire and depressive symptoms measured by the Center for Epidemiological Studies-Depression Scale. RESULTS Multiple regression analysis revealed that physicians rating of patient prognosis at Time 1 uniquely predicted subsequent depressive symptoms and affective pain but not sensory pain at Time 2 even after controlling for Time 1 levels of these variables. CONCLUSION Physicians pessimistic evaluation of patients prognosis after the first visit was longitudinally associated with an increase in depression and in the affective dimension of pain over time, but not with changes in the sensory component of pain. Referring to physician pessimism as a marker for pre-depressed patient may lead to early preventive interventions.

Predictors of Satisfaction with Obstetric Care in High-risk Pregnancy: The Importance of Patient–Provider Relationship

The study set out to examine the predictive effects of patients’ emotional distress and their relationships with their health care providers on satisfaction with obstetric services in high-risk pregnancies. Participants were 104 pregnant women with a history of recurrent losses, fetal demise, previous or current fetal genetic abnormality, advanced maternal age, or obstetric or medical complications of the present pregnancy. Self-report measures of emotional distress and the quality of their relationships with their medical provider were administered. Hierarchical multiple regression analyses were conducted to assess the predictive effect of these variables on satisfaction with services. Provision of information, constructive communication, and good relationships predicted elevated satisfaction with health services. Provision of information also buffered against the adverse effect of emotional distress on satisfaction with health services. These findings elucidate the central role of provider–patient interaction, particularly as it is related to provision of information, in high-risk pregnancy.

Does War Hurt? Effects of Media Exposure After Missile Attacks on Chronic Pain

This study focused on the effects of exposure to terrorist missile attacks on the physical and mental well being of chronic pain patients. In this prospective and longitudinal design, 55 chronic pain patients treated at a specialty pain clinic completed self-report questionnaires regarding their pain, depression and anxiety pre- and post a three week missile attack on the southern region of Israel. In addition, levels of direct and indirect exposure to the attacks were measured. Results of regression analyses showed that exposure to the attacks through the media predicted an increase in pain intensity and in the sensory component of pain during the pre-post war period, but did not predict depression, anxiety or the affective component of pain. These findings contribute to the understanding of the effects of terrorism on physical and emotional distress and identify chronic pain patients as a vulnerable population requiring special attention during terrorism-related stress.

Role of Pain-Based Catastrophizing in Pain, Disability, Distress, and Suicidal Ideation

Background: In chronic pain, patients’ coping affects their adaptation. In two studies, we examined the role of pain catastrophizing, a maladaptive coping strategy, in pain, distress, and disability. In Study 2 we compared catastrophizing to pain acceptance and to other coping strategies. Methods: Study 1. Chronic pain patients (N = 428) were assessed four times as to their pain, disability, catastrophizing, and distress (depression and anxiety). Study 2. Patients (N = 165) were assessed as to coping and pain acceptance, pain, related distress, depression, hope, suicidal ideations, perceived burdensomeness, and thwarted belongingness. Results: Study 1. A Structural Equation Modeling (SEM) analysis revealed that Time 1 Pain-based catastrophizing prospectively predicted pain (β =.36, p < .001). Distress prospectively predicted pain related disability (β = .34, p <.001). Study 2. Pain-based catastrophizing predicted sensory pain (β = .22, p = .018), depression (β = .43, p < .001), and suicidal ideation (O.R. = 1.88), which were also predicted by depression and perceived burdensomeness. Distraction predicted sensory pain (β = .21, p = .017, respectively). Activity engagement predicted low levels of depression (β = -.29, p < .001, respectively), and willingness to accept pain predicted low pain-related distress (β = -.16, p = .05). Conclusions: Pain catastro-phizing and pain acceptance constitute risk and resilience factors. Both should be assessed and targeted in pain management.

Depressive personality vulnerability in chronic physical pain: Centrality of sociotropy

OBJECTIVE Chronic physical pain is one of modern medicines principal challenges. Recently, there has been a keen research interest in the role of depressive personality vulnerability (DPV) in the course of chronic pain. This is the first attempt to examine the role of three leading DPV dimensions-sociotropy, autonomy, and self-criticism-in chronic pain. METHOD Chronic pain patients (N = 428) were assessed four times as to their pain, disability, anxious depression, and pain-based catastrophizing. At Time 1, sociotropy, autonomy, and self-criticism were also assessed. The effects of sociotropy, autonomy, and self-criticism on pain, disability, anxious depression, and pain-based catastrophizing were examined using structural equation modeling analyses. RESULTS All DPV dimensions uniquely predicted Time 1, but not Time 2, anxious depression. Sociotropy predicted Time 1 pain and catastrophizing over and above anxious depression, as well as an increase in catastrophizing over time. Autonomy predicted a decrease in catastrophizing and disability, and Time 1 anxious depression predicted an increase in self-criticism. CONCLUSIONS Sociotropy appears to be a unique dimension of DPV in chronic pain.

66 DISTINGUISHING AFFECTIVE AND SOMATIC DIMENSIONS OF PAIN AND DEPRESSION: A CONFIRMATORY FACTOR ANALYTIC STUDY

from the opioids. It is highly likely that the potentiation in synaptic strength translates into enhanced pain behaviour: 1. Induction protocols leading to LTP also cause hyperalgesia in behaving animals and in human subjects. 2. Postsynaptic lamina I neurons that express LTP are indispensable for full expression of hyperalgesia and 3. Signalling pathways and pharmacological profiles of LTP at C-fibre synapses and hyperalgesia largely overlap. Thus, plasticity at the first synapse in pain pathways is a promising target for the prevention and treatment of hyperalgesia of various origins.