[MadRiverTurtle]

FRIDAY, Nov. 7 - When anticipating pain, the brains of people with depression kick into overdrive and hinder their ability to handle hurt, a new study shows.

The November issue of theArchives of General Psychiatryreports brain imaging also reveals that during the painful experience, activity then decreases in other areas, including those regions that handle pain modulation.

"The anticipatory brain response may indicate hypervigilance to impending threat, which may lead to increased helplessness and maladaptative modulation during the experience of heat pain," the authors wrote. "This mechanism could in part explain the high comorbidity of pain and depression when these conditions become chronic."

Chronic pain and depression often overlap, the authors wrote. More than 75 percent of depression patients have recurring or chronic pain, while between 30 percent and 60 percent of chronic pain patients also report symptoms of depression.


"Understanding the neurobiological basis of this relationship is important, because the presence of comorbid pain contributes significantly to poorer outcomes and increased cost of treatment in major depressive disorder," they wrote.

The research team, from the University of California, San Diego, in La Jolla, studied 30 adults, half with a major depressive disorder but not on medication for the condition and half without it. All wore devices that could heat their arms to painful levels, and all were given visual signals before the exercise as to whether they would feel painful heat or a more mild warmth.

The patients with depression also completed a questionnaire about their tendencies to magnify, ruminate over or feel helpless in the face of pain.

Compared with the controls, patients with depression showed increased activation in certain areas of their brain, including the right amygdala -- a brain region tied to emotional responses. This increased activity also correlated to higher helplessness scores on the questionnaires of the patients with depression.

"Future studies that directly examine whether maladaptive response to pain in major depressive disorder is due to emotional allodynia [a pain response to a non-painful stimulus], maladaptive control responses, lack of resilience and/or ineffectual recruitment of positive energy resources will further our understanding of pain-depression comorbidity," the authors concluded.

More information

The U.S. National Institute of Health has more about depression.

SOURCE:JAMA Archivesjournals, news release, Nov. 3, 2008
http://www.washingtonpost.com/wp-dyn...110702648.html

[Jeffster]

Couldn't we also theorize from this study that depressed people are already bothered by something, and adding some external pain to them is just that much more bothersome? I mean, it may not be that they over react, but rather react given their own context?

As an example, let's say personA is depressed and his or her back hurts. He or she figures, I'll go try to do something about my back hurting, and then at least that won't be bothering me on top of all these other things that are depressing me.

Meanwhile, personB who is not depressed has some back pain. but figures, oh well, everthing else is going OK so I'll just live with it for now.

My point is that from the study above, I'm not sure that one can say that depression heightens sensitivity to pain, when one might instead conclude that it reduces one's tolerance to pain instead.

[Absynthe]

I've suffered depression for 30 years, and the chronic pain incident happened 5 years ago.

What I can tell you, is that depression can make you FOCUS on the pain. But, chronic pain is different from Acute pain, which is what messes doctors up! Explanation is that until they had to deal with War Veterans, most people simply didn't survive chronic pain on the levels we have today - which is why they are ignorant on Opiods and MMJ helping us so much. When I had health insurance (until last year), I had an actual PAIN doctor whom I saw once a month, and 90 Norco a month with everything else helped (10mg of vicodin, and low tylenol). 3 per day, as needed. Good days, I only need 2 per day. Current doc wants to cut me back from 60 a month, and I can't handle that! With 5 unfilled cavities, possibly 2 root canals needed, I'm in pain BLIND.

What used to take me even with depression to draw, say 4 hours, now takes me FOUR DAYS!! The Pain is now making me depressed, because I had achieved near normalcy 2 years ago, but I need a list of Name Brand drugs, according to their way - which is close to $1000 a month (yes, trying to get them from the drug companies - had to do my taxes, because they want to see even THAT0.

Ergo, I feel this study is flawed. I was given different anti-depressants and Lyrica to help me with pain, and NONE of it helped - except made me feel less depressed. Lyrica made me gain 15 lbs. in one months, so I can't take it - but it really helped with peripheral pain. I just can't carry that extra weight with my back out.

Sorry to ramble, bad pain ongoing up & down for nearly a month, I'm exhausted.