Depression and anxiety predict a future increase in pain levels, but not the other way around

This is according to a study conducted at Ben Gurion University and Soroka and Ichilov Medical Centers

The study even indicates that depression and anxiety predict a future increase in levels of disability and functional difficulties, a finding that establishes the centrality of emotional distress in the phenomenon of chronic pain

A new study carried out by a team of researchers from Ben-Gurion University of the Negev (Dr. Shira Lerman and Prof. Golan Shahar), the Soroka Medical Center (Dr. Tzvia Rodich and Dr. Hadar Shalov) and the Ichilov/Suriaski Medical Center (Dr. Silvio Brill ) indicates the centrality of psychosomatic processes in chronic pain. The study appears in the electronic version, before publication in print, of the medical journal.PSYCHOSOMATIC MEDICINE .

The research was conducted as part of the doctoral and post-doctoral work of Dr. Shira Lerman, under the guidance of Prof. Golan Shahar and was funded by a grant from the National Science Foundation given to Prof. Shahar.

Chronic pain is one of the biggest challenges facing modern medicine. Many diagnoses are included under pain conditions (for example, chronic back pain, complex-diffuse regional pain, fibromyalgia, diabetic-neuropathic pain, and more). Little is known about these diagnoses, and they are difficult to diagnose and treat. The burden and suffering associated with chronic pain is enormous, affecting individuals, families and society as a whole. Many chronic pain patients also suffer from depression and anxiety, although the direction of the relationship ("who affects whom") between pain, on the one hand, and depression/anxiety, on the other, is still unclear.

In order to clarify this issue, the team of researchers followed a large group of chronic pain patients, who were treated at the Soroka and Ichilov Medical Center for two years. They measured levels of pain, depression/anxiety, and pain-related disability over four times, and used advanced statistical/mathematical methods to compare two hypotheses: a. That pain causes depression/anxiety (the hypothesis of stress associated with pain) b. that depression/anxiety causes pain (the psychosomatic hypothesis). The results of their analyzes were clear: depression/anxiety predicted a future increase in pain levels, but not the other way around. Depression/anxiety also predicted a future increase in levels of disability and functional difficulties, a finding that establishes the centrality of emotional distress in the phenomenon of chronic pain.

According to Dr. Lerman and Prof. Shahar, the methodological characteristics of this study are particularly strong, and are therefore convincing regarding the need to perform early diagnosis and preventive interventions for depression and anxiety among chronic pain patients. "But we need to warn," the two emphasize, "that depression and anxiety are not just 'in our heads.' are themselves real psychosomatic phenomena. Our study joins other studies, and points to the unity of the body and mind in the phenomenon of pain and in other situations of physical suffering."