head JofIMAB
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2022, vol. 28, issue3
Subject Area: Medicine
DOI: 10.5272/jimab.2022283.4480
Published online: 27 July 2022

Original article
J of IMAB. 2022 Jul-Sep;28(3):4480-4486
Tatyana Telbizova1ORCID logo Corresponding Autoremail, Ivan Aleksandrov2ORCID logo,
1) Department of psychiatry and medical psychology, Medical University – Varna, MHAT "St. Marina" – Varna, Bulgaria.
2) Department of health care, Sliven Affiliate, Medical University – Varna, MHAT "St. Marina" – Varna, Bulgaria.

Depression in chronic pain often manifests with symptoms of anxiety.
Purpose: The aim of the study is to investigate the influence of depression, state and trait anxiety on pain intensity in patients with chronic pain and depression.
Materials and Methods: Sixty-one patients with chronic pain and depression were studied. The study was phased. Тhe second stage was carried out three months after the first. All participants received antidepressant treatment. The severity of depression was assessed with HAM-D-17, the level of state and trait anxiety – with Spielberger's STAI and pain intensity – with VAS. The trait anxiety was studied during the first stage. Regression analysis was used to perform the purpose of the study.
Results: The mean age of the sample was 55.6066±10.90608. Women comprised 91.8% of the sample, and men – 8.2%. A reduction in the mean values of the indicators in the second stage was reported. A regression analysis during the first stage showed that 60% of the variations in pain intensity were explained by the influence of the three variables (R=,616; R2=,379). Depression had the greatest impact and degree of influence on pain (t=3,372; p=,001), compared to state anxiety (t=,513; p=,015). The influence of trait anxiety was negligible (t=-,484; p=,630). The results of the analysis of the second stage were similar (R=,644, R2=,415). The influence of depression was significant (p=,011; t=2,626), compared to that of state anxiety (t=2,012; p=,049).
Conclusions: Depression is the main variable influencing pain intensity. The search for symptoms of depression and their treatment is crucial for the management of chronic pain.

Keywords: chronic pain, depression, state anxiety, trait anxiety, pain intensity, regression analysis,

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Please cite this article as: Telbizova T, Aleksandrov I. Influence of depression and anxiety on pain intensity in patients with chronic pain and depression. J of IMAB. 2022 Jul-Sep;28(3):4480-4486.
DOI: 10.5272/jimab.2022283.4480

Corresponding AutorCorrespondence to: Tatyana Telbizova, MD, PhD, Department of psychiatry and medical psychology, Medical University of Varna, MHAT "St.Marina", Varna; 1, Hr. Smirnenski Blvd., 9000 Varna, Bulgaria; E-mail: ttelbizova@gmail.com

1. Тelbizova Т, Kozhuharov Hr. [Levels of association between chronic pain and depression.] [in Bulgarian] Bul J Psychiatry. 2019; 4(4):40-47. [Internet]
2. Vadivelu N, Kai AM, Kodumudi G, Babayan K, Fontes M, Burg MM. Pain and Psychology-A Reciprocal Relationship. Ochsner J. 2017 Summer;17(2):173-180. [PubMed]
3. Zis P, Daskalaki A, Bountouni I, Sykioti P, Varrassi G, Paladini A. Depression and chronic pain in the elderly: links and management challenges. Clin Interv Aging. 2017 Apr 21;12:709-720. [PubMed]
4. Meints SM, Edwards RR. Evaluating psychosocial contributions to chronic pain outcomes. Prog Neuropsychopharmacol Biol Psychiatry. 2018 Dec 20;87(PtB):168-182. [PubMed]
5. Brooks JM, Polenick CA, Bryson W, Naslund JA, Renn BN, Orzechowski NM, et al. Pain intensity, depressive symptoms, and functional limitations among older adults with serious mental illness. Aging Ment Health. 2019 Apr;23(4):470-474. [PubMed]
6. Arango-Dávila CA, Rincón-Hoyos HG. Depressive Disorder, Anxiety Disorder and Chronic Pain: Multiple Manifestations of a Common Clinical and Pathophysiological Core. Rev Colomb Psiquiatr (Engl Ed). 2018 Jan-Mar;47(1):46-55. [PubMed]
7. Krishnan RRK, France RD, Pelton S, McCann UD, Davidson J, Urban BJ. Chronic pain and depression. II. Symptoms of anxiety in chronic low back pain patients and their relationship to subtypes of depression. Pain. 1985 Jul;22(3):289-294. [PubMed]
8. Woo AK. Depression and Anxiety in Pain. Rev Pain. 2010 Mar;4(1):8-12. [PubMed]
9. Castro MMC, Quarantini LC, Daltro C, Pires-Caldas M, Koenen KC, Kraychete DC, et al. Comorbid depression and anxiety symptoms in chronic pain patients and their impact on health-related quality of life. Rev Psiq Clin. 2011; 38(4):126-9. [Crossref]
10. Aguera-Ortiz L, Failde I, Mico JA, Cervilla J, Lopez-Ibor JJ. Pain as a symptom of depression: Prevalence and clinical correlates in patients attending psychiatric clinics. J Affect Disord. 2011 Apr;130(1-2):106-12. [PubMed]
11. Albert PR. Why is depression more prevalent in women? J Psychiatry Neurosci. 2015 Jul;40(4):219-21. [PubMed]
12. Mansfield KE, Sim J, Jordan JL, Jordan KP. A systematic review and meta-analysis of the prevalence of chronic widespread pain in the general population. Pain. 2016 Jan;157(1):55-64. [PubMed]
13. Munce SE, Stewart DE. Gender differences in depression and chronic pain conditions in a national epidemiologic survey. Psychosomatics. 2007 Sep-Oct;48(5):394-9. [PubMed]
14. Lee HJ, Choi EJ, Nahm FS, Yoon IY, Lee PB. Prevalence of unrecognized depression in patients with chronic pain without a history of psychiatric diseases. Korean J Pain. 2018 Apr;31(2):116-124. [PubMed]
15. Vietri J, Otsubo T, Montgomery W, Tsuji T, Harada E. Association between pain severity, depression severity, and use of health care services in Japan: results of a nationwide survey. Neuropsychiatr Dis Treat. 2015 Mar 13;11:675-83. [PubMed]
16. Hallegraeff JM, Kan R, van Trijffel E, Reneman MF. State anxiety improves prediction of pain and pain-related disability after 12 weeks in patients with acute low back pain: a cohort study. J Physiother. 2020 Jan;66(1):39-44. [PubMed]
17. Knowles KA, Olatunji BO. Specificity of trait anxiety in anxiety and depression: Meta-analysis of the State-Trait Anxiety Inventory. Clinical Psychology Review. 2020 Dec;82:101928. [PubMed]
18. Tang J, Gibson SJ. A psychophysical evaluation of the relationship between trait anxiety, pain perception, and induced state anxiety. J Pain. 2005 Sep;6(9):612-9. [PubMed]
19. Schiavone V, Adamo D, Ventrella G, Morlino M, De Notaris EB, Ravel MG, et al. Anxiety, depression, and pain in burning mouth syndrome: first chicken or egg? Headache. 2012 Jun;52(6):1019-25. [PubMed]
20. Rogers HL, Brotherton HT, de Luis A, Olivera-Plaza SL, Cуrdoba-Patiсo AF, Peсa-Altamar ML. Depressive symptoms are independently associated with pain perception in Colombians with rheumatoid arthritis. Acta Reumatol Port. 2015 Jan-Mar;40(1):40-9. [PubMed]
21. Kroenke K, Wu J, Bair MJ, Krebs EE, Damush TM, Tu W. Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care. J Pain. 2011 Sep;12(9):964-73. [PubMed]

Received: 29 November 2021
Published online: 27 July 2022

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