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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This article reviews the relationship between depressive disorders and somatoform disorders, somatization, and pain. These disorders and symptoms are clinically interrelated, yet the nature of the interrelation is not well understood. This review of the literature from 1975 through mid-year 1990 addresses the epidemiology and treatment of these conditions and/or symptoms when they occur together. When robust criteria are used to determine which publications are included, only 14 are available that address depressive disorders, somatoform disorders, and somatization. Similarly, there are only 13 that address depressive disorders and pain. Taken together, these studies indicate that 1) in somatization disorder patients, there is a high prevalence of depression; 2) in patients with major depression, there are substantial levels of hypochondriacal and somatizing symptoms; 3) that depression in the face of coexisting somatization disorder can be successfully treated; 4) in chronic pain patients, there is a high prevalence of depressive disorders; 5) in patients with major depression, pain is a frequent complaint; 6) and finally, that pain improves with the treatment of depression. What is most striking from this review, however, is the very limited number of studies that address these important problems. This lack of research-based data calls for new aggressive research efforts in this area.
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PMID:The epidemiology and treatment of depression when it coexists with somatoform disorders, somatization, or pain. 150 48

Behavioral and cognitive-behavioral approaches to chronic pain are receiving increasing attention from researchers and clinicians. This article reviews and highlights recent research advances and future research directions. Assessment research reviewed includes studies examining the social context of pain, the relationship of chronic pain to depression, cognitive variables affecting pain, and comprehensive assessment measures. Treatment outcome studies reviewed are those evaluating the effects of behavioral and cognitive-behavioral treatments for chronic pain. These studies focus on comparisons of behavioral treatment with control conditions, comparisons of two behavioral treatments, and prevention of chronic pain. Future directions for assessment and treatment research are outlined.
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PMID:Behavioral and cognitive-behavioral approaches to chronic pain: recent advances and future directions. 150 1

The past decade has seen important progress in understanding the localization, pharmacology, and function of serotonin (5-HT) receptor subtypes. At least seven subclasses have been shown to exist, and evidence is emerging to suggest further subclassification. Serotonin is involved in numerous physiological processes (e.g. feeding, sleep, pain, sexual behavior, temperature regulation) and pathophysiological ones. Serotonin reuptake blockers have been found effective in the alleviation of depression and attacks of panic, and are at varying stages of clinical evaluation in the treatment of obsessive compulsive disorder, chronic pain, and bulimia nervosa. Selective potent serotonin receptor agonists and antagonists show promise in the treatment of migraine, nausea and vomiting, schizophrenia, anxiety, hypertension, and Raynaud's disease.
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PMID:[New therapeutic possibilities with drugs affecting serotonin receptors]. 150 27

Assessment of physical and psychosocial dysfunction is recognized as essential in chronic pain patient evaluation. One instrument, the Sickness Impact Profile (SIP), has demonstrated good reliability and validity as a measure of dysfunction among chronic pain patients. An alternate measure, the Chronic Illness Problem Inventory (CIPI), is shorter and more easily scored than the SIP, but as yet has not been applied widely to chronic pain problems. In the present study, 95 chronic low back pain patients completed the SIP, the CIPI, activity diaries, the McGill Pain Questionnaire (MPQ), and the Center for Epidemiologic Studies-Depression scale (CES-D), before participating in a chronic pain treatment study. Overt pain behaviors were also coded from videotapes of a standardized assessment protocol. Seventy-five subjects completed the measures post-treatment. The results indicate that although the SIP and the CIPI are significantly correlated and appear to be measuring similar constructs, there is also substantial unshared variance between them, suggesting that they may tap somewhat different aspects of dysfunction in chronic pain. The CIPI shows promise as a useful alternative measure of dysfunction in chronic low back pain patients, but requires further validation for this purpose.
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PMID:The Chronic Illness Problem Inventory as a measure of dysfunction in chronic pain patients. 153 1

Although patients with chronic pain are often psychologically distressed, it has been difficult to determine whether this distress is an antecedent of chronic pain or whether it is caused by the experience of living with chronic pain. The aim of this investigation was to develop a method that would allow individuals who are at risk for the development of chronic pain to be studied before their pain has become chronic. Patients with acute herpes zoster were assessed with demographic, medical, pain, and psychosocial measures. Pain was assessed in follow-up interviews at 6 weeks and 3, 5, 8, and 12 months after these initial assessments. There were no significant differences between patients who developed short-term herpes zoster pain and patients who did not develop short-term pain for any of the measures at the initial assessment, except for one measure of pain intensity. Patients who developed chronic herpes zoster pain, however, had significantly greater pain intensity, higher state and trait anxiety, greater depression, lower life satisfaction, and greater disease conviction at the initial assessment than patients who did not develop chronic pain. In discriminant analyses, disease conviction, pain intensity, and state anxiety each made a unique contribution to discriminating patients who did and who did not develop chronic pain. This study demonstrates the feasibility of investigating psychosocial antecedents of the development of chronic pain by prospectively examining the longitudinal course of herpes zoster.
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PMID:A high-risk method for studying psychosocial antecedents of chronic pain: the prospective investigation of herpes zoster. 153 67

For 75 consecutive days, 54 Ss with rheumatoid arthritis supplied daily reports of their mood and joint pain. After aggregating daily reports, the relation between chronic mood and chronic pain remained statistically significant when controlling for neuroticism, depression, disease activity, disability, and characteristic responses to increasing pain. Findings of a path analysis suggest that (a) individuals higher in neuroticism experience more chronic distress regardless of their responses to pain, their pain intensity, and depressive symptomatology, and (b) the relation between neuroticism and chronic pain is mediated by the propensity of high-neuroticism individuals to catastrophize their pain. Within-subject analyses that controlled for autocorrelation and linear trends in the time series revealed that 40% of the Ss experienced significantly worse moods on more painful days. Although individuals higher in neuroticism reported more intense pain and more negative mood, their daily mood was less strongly linked to their daily pain.
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PMID:Neuroticism and the pain-mood relation in rheumatoid arthritis: insights from a prospective daily study. 155 74

Even though epidural analgesia is effective and has advantages over conventional postoperative analgesia, it is also labor intensive, requiring 24-hour supervision by an anesthesiologist. In an effort to decrease the manpower requirements, some hospitals allow the nursing staff to administer epidural narcotics to adult patients. In children, however, this practice has been limited. We retrospectively reviewed our experience over 12 months with this procedure. Epidural catheters (caudal, lumbar, or thoracic) were placed in 43 pediatric patients for acute and chronic pain management. All patients received a continuous epidural infusion of bupivacaine hydrochloride with fentanyl citrate. Eleven (26%) of the 43 patients required supplemental analgesia and were given 45 doses of epidural fentanyl. Adequate analgesia was achieved in all patients. No intravascular or intrathecal injections were noted, nor did any inadvertent epidural injections of medications occur. No patient had respiratory depression (respiratory rate less than 10% for age). We believe epidural administration of fentanyl by a carefully educated nursing staff is safe and effective in children.
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PMID:Pediatric analgesia with epidural fentanyl citrate administered by nursing staff. 156 40

Epidural clonidine produces analgesia in humans with acute and chronic pain. Its use is limited because of short-lasting analgesia, hemodynamic depression, sedation, and respiratory depression. Intrathecal guanfacine has a longer duration of action than intrathecal clonidine. The present study compares these two drugs administered epidurally. Pulmonary artery, carotid artery, and epidural catheters were inserted into five goats. Each animal received guanfacine 5 mg/10 mL, clonidine 750 micrograms/10 mL, or a 10-mL saline control solution on separate occasions. Antinociception (tested via a point pressure stimulation device), arterial blood pressure, heart rate, cardiac output, pulmonary capillary wedge pressure, and arterial and mixed venous blood gases were measured every 30 min for 8 h. Guanfacine produced a longer duration of antinociception (guanfacine = 8 h vs clonidine = 5.5 h). Increases in PaCO2 were more pronounced in the clonidine group. There were no marked hemodynamic differences between the two drugs. Pretreatment with epidural idazoxan, an alpha 2-antagonist, blocked the antinociceptive effects of guanfacine. Because of a longer duration of action and less respiratory depression, epidural guanfacine may be superior for postoperative analgesia and chronic pain syndromes.
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PMID:A comparison of two epidural alpha 2-agonists, guanfacine and clonidine, in regard to duration of antinociception, and ventilatory and hemodynamic effects in goats. 156 40

The patient-activated analgesic system was introduced in 1968. Early trials, although uncontrolled, supported the safety and efficacy of patient-controlled analgesia (PCA) in several kinds of pain, such as that relating to surgery, cancer, trauma, and obstetric procedures. In the past decade, prospective, randomized trials have reported several advantages of PCA over conventional analgesia in the early postoperative period. Although not supported by all controlled trials, they include improved pain relief, less sedation, lower level of narcotic consumption, fewer postoperative complications, greater patient satisfaction, and improved pulmonary function. Preliminary results in the management of chronic pain indicate that PCA can lead to significant lifestyle improvements in ambulatory patients with cancer. The most significant, although infrequent, adverse effect is respiratory depression, the majority of cases occurring in patients predisposed secondary to concomitant illness or as a result of human error. The clinical use of PCA will likely see a significant increase among persons with cancer, and an increase in epidural administration. The cost benefit of PCA has yet to be assessed in inpatient and outpatient settings.
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PMID:Patient-controlled analgesia: a review. 157 Feb 28

The purpose of this double-blind crossover study was to determine whether a sustained-release morphine sulfate (SRMS) tablet given orally every 12 hours could adequately replace immediate-release morphine sulfate solution (IRMS) given orally every 4 hours in hospitalized patients with chronic pain from advanced cancer. Of 33 patients entered, 27 completed the study and were included in the efficacy and safety analysis. Patients were initially randomized to receive either 30-mg SRMS tablets every 12 hours or IRMS at the same mg/24 hours dose, every 4 hours. After 2 days, a crossover was performed, and patients received the alternate treatment for 3 days. Pain and side effects were assessed using a standard 100 mm visual analogue scale (VAS). There were no statistically significant differences between the two treatment groups for mean VAS pain scores or scores for sleepiness, nausea, depression, and anxiety. The incidence of breakthrough pain was similar for both treatment groups, as was the incidence of confusion and constipation. The results demonstrated that SRMS is a safe, effective analgesic preparation for patients who require oral opioids for cancer pain. The data also support the conclusion that sustained-release morphine tablets administered every 12 hours can replace an immediate-release morphine solution administered every 4 hours.
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PMID:A controlled study of sustained-release morphine sulfate tablets in chronic pain from advanced cancer. 159 Feb 84


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