I have seen significant associations between high scores of anxiety and depression to worse outcome after cervical spine surgery. This is already known, but can anybody give me some information about the mechanisms?
Hi Martin, it has to do with attention and the interpretation the patient makes about pain. It also has to do with inflamatory process and peripheral activation due to stress. You can read about it on these papers.
Catastrophizing involves feelings of helplessness when in pain, rumination about pain symptoms, and magnification of pain-related complaints.....we propose that catastrophizing exerts biologic effects such as effects on the neuromuscular, cardiovascular, immune, and neuroendocrine systems, and on the activity in the pain neuromatrix within the brain... according to a paper from Claudia M. Campbell and Robert R. Edwards named: Mind–body interactions in pain: the neurophysiology of anxious and catastrophic pain-related thoughtspublished in Transl Res. Mar 2009; 153(3): 97–101.
Article Mind–body interactions in pain: The neurophysiology of anxio...
The same pain hurts more in a depressed patient. And an appropriate therapeutic management of depression improves pain symptoms and related disability
http://jama.jamanetwork.com/article.aspx?articleid=183973
Hi Martin
Another useful conceptual paper is
Cohen S, Rodriquez MS. Pathways linking affective disturbances and physical disorders. Health Psychol 1995;14:374-80.
this paper considers biological, behavioural, cognitive and social pathways to explain the relationship between physical disorders and affect disorders, and importantly the opposite pathways. We have used this model in a few of our studies to look at the effects of pain on subsequent depressive symptoms.
Dear Martin,
maybe you can explain it using the concept of "Total Pain".
Sorry, I sent the last, before I finished it....
This concept is usually used for patients at end of life. But, I think you can extend this concept to your population, considering the high morbidity of this surgery.
Best.
A slightly different angle on this question. Social pain (painful emotions at a time of social exclusion) shares neurobiological features with physical pain.
Eisenberger, N.I., M.D. Lieberman, and K.D. Williams, Does rejection hurt? An FMRI study of social exclusion. Science, 2003. 302(5643): p. 290-292.
Interesting question! From my standpoint, it is very interesting that two kinds of medicines used extensively to treat chronic pain (gabapentin and pregabalin on one hand and various tricyclic antidepressants and duloxetine on the other) also are used to treat depression and/or anxiety. Some biological psychiatrists liken the state of generalized anxiety to hypervigilance (that ends up causing danger-related responses to non-dangerous stimuli). I think that calling this state of affairs "catastrophizing" makes it sound more like chronic pain is "just in your head" and minimizes the real biological effects.
Biochemical studies show since years that depression modifies brain function, especially that of pain pathways, increasing or decreasing intensity of afferent pain. Moreover, projections on area, increasing suffering and vegetative reactions.
It's a an common but severe logical error to attribute a causality and precise its direction without envisaging of a common cause, like for cough, loss of weight and tuberculosis.
If have a extensive bibliography in my book and I join the most important in my opinion.
Bradley JJ. Severe localized pain associated with the depressive syndrome. Brit J Psychiatry 1963;109:741-5.
Maroy B Spontaneous and evoked coccygeal pain in depression Dis Colon Rectum 1988;31:210-5.
Nolan TE et al. Unrecognized association of sleep disorders and depression with chronic pelvic pain. Southern Med J 1992;85:1181-3.
Magni G et al. Chronic abdominal pain and depression. Epidemiologic findings in the US. Pain 1992;49:77-85.
Maroy B et al. Office-based colonoscopy: what factors influence difficulty, tolerance and the need for sedation? Are there predictable?Endoscopy 199;31(suppl 1):E93.
Caumo W et al. Preoperative predictors of moderate to intense acute post-operative pain in patients undergoing abdominal surgery. Acta Anaesth Scand 2002;46:1265-71.
Ohayon M et al. Using chronic pain to predict depressive morbidity in general population Arh Gen Psychiatry 2003;60:39-47.
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