Journal of psychosomatic research. 2015;78(1):64-70.
OBJECTIVE: Many patients with depression and/or anxiety (D/A) persistently report
pain. However, it is not clear how the course of D/A is associated with pain over
time. The present study assessed longitudinal associations between D/A and pain, and
compared pain over time between D/A and healthy controls.METHODS: 2676 participants
of the Netherlands Study of Depression and Anxiety were followed-up for four years.
At three waves (baseline, 2, 4years) we assessed depressive and anxiety symptom severity.
Using DSM-IV criteria, we also assessed four different D/A disorder courses over time
(n=2093): incident, remitted, chronic, and no D/A (reference group). Pain was assessed
at the three waves by severity and number of locations.RESULTS: Change in D/A symptoms
was positively associated with change in pain symptoms. Compared to healthy controls
(n=519), D/A subjects - incident (n=333), remitted (n=548) or chronic (n=693) - reported
more severe pain (b=0.4-0.7, p<0.001) and more pain locations (b=0.8-1.4, p<.001)
at all waves, with the highest ratings in chronic D/A. Remission of D/A during follow-up
was associated with a significant decline in pain (severity; p=0.002, number of locations;
p<.001), but pain levels remained significantly higher compared to healthy controls.
Findings were similar for separate depression or anxiety course.CONCLUSIONS: This
study largely confirms synchrony of change between depression, anxiety and pain. However,
even after depression and anxiety remission, subjects report higher pain ratings over
time. Individuals with D/A (history) seem to be at increased risk of chronic pain.