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Pain Management Health Center

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Physical Pain a Sign of Depression

Pain Triples Depression Risk
WebMD Health News

Aug. 29, 2002 -- Across cultures, patients who complain of pain tend to be depressed. The finding comes from a huge international study by Prozac manufacturer Eli Lilly and Company.

"Experiencing painful physical symptoms as part of depression is common," Lilly researcher Rebecca L. Robinson, MS, tells WebMD. "The worse the pain, the more severe the depression."

Eli Lilly is a WebMD partner.

It's obviously depressing to feel pain. But there's a deeper link between pain and depression. The brain circuits and chemistry that sense pain are also active in depression.

"Chemicals that are related to depression and painful physical symptoms share the same pathway along the nervous system [the body's nerves and brain]," Robinson says. "An imbalance in these chemicals may explain the frequent presence of painful physical symptoms in depressed patients. That is, the imbalanced chemicals may be sending more intense messages that there is too much pain. It's not that the pain is 'in your head' as once believed. When you have depression there is a chemical reason why you may truly feel more pain."

Patients often feel less pain when their depression gets better, says Charles L. Raison, MD, assistant professor in the mind/body program at Atlanta's Emory University.

"It is a two-way relationship," Raison tells WebMD. "Not only does pain cause depression, but if people get depressed they will experience more pain. We do testing where you have this little wand that gets uncomfortably hot. When people are depressed, they will complain that touching the wand hurts. When you get them undepressed, the same temperature doesn't hurt them."

Robinson's study looked at 18,456 patients seen by primary-care doctors. The patients were from all over the world: Spain, Israel, Brazil, Australia, Russia, and the U.S. They took brief tests for depression and severity of pain.

No matter where they came from, Robinson found the same thing. Patients who came in complaining of pain tended to be depressed. Overall, patients with pain were nearly three times more likely than other patients to report high levels of depressive symptoms.

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