Chronic pain frequently comes hand in hand with depression and anxiety. In an editorial featured in JAMA Network Open, Dr. Kurt Kroenke from the Regenstrief Institute and Indiana University School of Medicine explores the intricate relationship between pain, which is the most common reason for individuals seeking medical care, and depression and anxiety, two of the most widespread mental health conditions worldwide. He emphasizes the significance of acknowledging psychological symptoms in patients grappling with pain.
The interconnection between pain and depression, as well as anxiety, is partly attributed to a feedback loop. Those enduring pain often suffer from poor sleep, impacting their mood and rendering them susceptible to depression and anxiety. Concurrently, grappling with depression or anxiety can heighten susceptibility to pain.
Dr. Kroenke points out that certain brain regions involved in pain perception are closely linked with areas regulating mood, leading to a close association between physical and mental symptoms.
Dr. Kroenke underscores that while addressing depression and anxiety can lead to an improvement in pain, alleviating pain may not yield the same level of improvement for depression and anxiety. Nonetheless, this doesn’t undermine the importance of identifying and treating both physical and psychological symptoms.
Dr. Kroenke asserts, “Physical and mental symptoms often go hand in hand.” However, patients frequently fail to mention common symptoms of depression and anxiety—such as fatigue, lack of motivation, nervousness, and mood swings—when seeking medical help for conditions like headaches, back pain, muscle or leg pain, or stomachaches. Likewise, physicians may not routinely inquire about symptoms beyond the primary complaint.
Neglecting emotional symptoms can result in prolonged suffering and diminished quality of life. Dr. Kroenke advocates that clinicians should measure and monitor both physical and mental symptoms to provide effective treatment. Although there are no specific tests to measure symptoms, tools like the PEG (pain), PHQ-9 (depression), GAD-7 (anxiety), FSI-3 (cancer fatigue), and P-4 (suicide risk) scales developed by Dr. Kroenke can help clinicians assess the type and severity of symptoms based on patient feedback. These measurement tools are available in over 100 languages.
Symptoms account for half of all outpatient primary care visits. Dr. Kroenke’s research, detailed in a 2014 review article, indicated that more than a third of common symptoms lack a clear disease-based explanation. This percentage is now believed to be over half.
Recognizing the need to address both physical and psychological symptoms, Dr. Kroenke’s measurement tools are guiding physicians in this endeavor. He concludes his commentary by referencing Ovid’s words, “I am no better in mind than in body; both alike are sick and I suffer double hurt.”
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Source: Science daily