The Complex Interplay of Pain, Depression, and Anxiety Symptoms in Patients with Chronic Pain

Gómez Penedo, Juan M.; Rubel, Julian A.; Blättler, Larissa; Schmidt, Stefanie J.; Stewart, Julian; Egloff, Niklaus; grosse Holtforth, Martin (2020). The Complex Interplay of Pain, Depression, and Anxiety Symptoms in Patients with Chronic Pain. The clinical journal of pain, 36(4), pp. 249-259. Wolters Kluwer 10.1097/AJP.0000000000000797

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OBJECTIVES:
This study aimed to analyze the associations among depressive/anxiety and pain symptoms in patients diagnosed with chronic pain.
METHODS:
Four hundred and fifty-four inpatients who were consecutively admitted in a multimodal 3-weeks treatment in a tertiary psychosomatic university clinic completed 25 items from the Brief Pain Inventory and the Hospital Anxiety and Depression Scale at baseline and after treatment termination. Associations among symptoms were explored by network analyses using the graphical least absolute shrinkage and selection operator to estimate their partial correlations, while Extended Bayesian Information Criterion was used to select the best network solution for the data. We explored symptoms' centrality and expected influence within the network as well as the minimum spanning tree for the network.
RESULTS:
Besides expected associations within depressive/anxiety and pain symptoms, the estimated network showed several local associations between depressive and pain interference symptoms. The lacks of being cheerful and of laughing are two of the depressive symptoms that showed the greatest associations with pain interference and a strong centrality within the network. Sleep problems were both associated with anxiety/depressive symptoms and pain intensity symptoms. Although at post-treatment, most of the symptoms showed a significant decrease, the strength of the associations between the symptoms within the network were significantly higher than at baseline.
DISCUSSION:
The results support focusing psychosocial interventions in chronic pain treatment not only on reducing pain, anxiety and sleep symptoms but also on enhancing positive affect. Future research is needed to replicate these findings using repeated within-person measures designs.

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