Depression and neurovegetative symptoms of depression in chronic low back pain

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CHRONIC PAIN AND D.S. Handlinl*, and 2Psychiatry, College of Physicians University, New York, N.Y. 10032, USA

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Aim of Investigation: It has often been observed that chronic pain and depression are associated. Because there hove been few systematic comparisons of chronic pain patients with and without depression, the preliminary oim of this study was to compare these two groups of patients. The primary aim was to examine the hypothesis that treatment response would be predicted by different patterns of variables in these two groups of pain patients. Methods: A consecutive series of 454 chronic pain patients was evaluated and treated by a multimodality pain service. The 79 patients who were considered to have a clinically significant depression by the attending physician were compared to the remaining 375 patients with respect to medical and social history, physical examination, treatment, and treatment response. Results: The chronic pain patients with clinically significant depression did not differ significantly from the remaining pain patients for most variables that were examined. However, even though they were similar in their average response to treatment, different patterns of variables were found to predict treatment response in the two groups of patients. For the depressed patients, employment at the beginning of treatment predicted significantly greater short-term improvement, whereas for the nondepressed patients, absence of workmen’s compensation payments and more visits to the service predicted greater improvement. Conclusions: The finding that chronic pain patients with depression are not very different from those without this diagnosis is consistent with the results of other investigators. The major result of this study is that different patterns of variables predicted treatment response in these two groups of patients; this has important implications for understanding and optimizing treatment outcome in chronic pain.

DEPRESSION AND NEUROVEGETATIVE SYMPTOMS OF DEPRESSION IN 309 Slide CHRONIC LOW -BACK PAIN. K.R.R. Krishnan', R.D. Francel, De;ong 1;;” ~ . , partment of Psychiatry, Duke Ilniversity Medical Center, DurL__ ~~ _I ham, North Carolina 27710, USA. Aim of Investigation: This study is designed to assess the presence of different types of depression based on RDC criteria in chronic low backpain patients with and without organic pathology and to examine the relationship of different types of depression in relation to organic pathology. Methods: Seventy-one consecutive chronic low back pain patients were studied using a standardized psychiatric interview (based on Schedule for AffecThe interview tive Disorder and Schizophrenia-Lifetime Version (SADS-L)). was administered by one of us (RK). The inclusion criteria for the study was the presence of daily occurring low back pain for more than 6 months. Organic pathology was defined as including one of the following findings: 1) physical examination positive for a radiculopathy or other physical abfindiny or normality capable of produciny pain, 2) abnormal radiographic positive myelogram findings, and 3) positive electromyoyraphy. Results: Thirty-one patients satisfied RDC criteria for major depression. Nine of 11 20 of these patients had clearly defined organic pathology. patients without organic pathology satisfied RDC criteria for endogenous depression. 8 of 20 patients with organic pathology satisfied RDC criteria for endogenous depression. 7 of 8 patients with RDC minor depression, 17 of 18 with RDC chronic intermittent depression, and 12 of 14 patients without Typical vegetative symptoms of depression depression had organic findings. were seen more often in patients with major depression. Conclusion: Endogenous depression was more common in patients without orMinor depression and chronic intermittent type of depresganic pathology. sion was more common in patients with organic pathology_