Pain perception in major depression depends on pain modality

&NA; One frequently described feature of depression is an increased vulnerability to pain complaints, and chronic pain is frequently accompanied by symptoms of depression. In contrast to this, a decreased sensitivity to experimental pain has been described in major depression. The physiological basis of this phenomenon is yet elusive. We investigated 30 patients suffering from a major depressive disorder and matched controls. Pain testing (threshold and tolerance) was performed on both sides of the body and included assessment of thermal, electrical and ischemic pain. While confirming hypoalgesia to heat and electrical pain in comparison to controls, we found hyperalgesia to ischemic muscle pain. Furthermore, thermal pain tolerance and electrical pain tolerance were significantly increased on the right hand side confirming previous results of a lateralized perception of pain in depression. Our main finding suggests that painful stimuli are processed differentially depending on the localization of pain induction in depression. This knowledge may enable us to understand and ultimately treat pain complaints more appropriately in depressed patients.

[1]  L. McWilliams,et al.  Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample , 2003, Pain.

[2]  W. Drevets.  Functional anatomical abnormalities in limbic and prefrontal cortical structures in major depression. , 2000, Progress in brain research.

[3]  J. Guelfi,et al.  Pain Complaints in Depressed Inpatients , 2000, Psychopathology.

[4]  H. Sauer,et al.  Influence of gender and hemispheric lateralization on heat pain perception in major depression. , 2003, Journal of psychiatric research.

[5]  Robert D. Kerns,et al.  Explaining high rates of depression in chronic pain: A diathesis-stress framework. , 1996 .

[6]  Vijay P. Singh,et al.  On the antinociceptive effect of fluoxetine, a selective serotonin reuptake inhibitor , 2001, Brain Research.

[7]  S. Currie,et al.  Chronic back pain and major depression in the general Canadian population , 2004, Pain.

[8]  S. Lautenbacher,et al.  Relationship between clinical pain complaints and pain sensitivity in patients with depression and panic disorder. , 1999, Psychosomatic medicine.

[9]  P. Schüler,et al.  Analgetische Wirkung des selektiven Noradrenalin-Wiederaufnahme-Hemmers Reboxetin Objektive und subjektive Messung , 2002, Der Nervenarzt.

[10]  M. Buchsbaum,et al.  Analgesia to painful stimuli in affective illness. , 1979, The American journal of psychiatry.

[11]  J. David Cassidy,et al.  Depression as a risk factor for onset of an episode of troublesome neck and low back pain , 2004, Pain.

[12]  A. Sollevi,et al.  Experimental pain by ischaemic contractions compared with pain by intramuscular infusions of adenosine and hypertonic saline , 2003, European journal of pain.

[13]  F. Quitkin,et al.  Dichotic Listening Tests of Functional Brain Asymmetry Predict Response to Fluoxetine in Depressed Women and Men , 2004, Neuropsychopharmacology.

[14]  B Beuthien-Baumann,et al.  Changes in brain metabolism associated with remission in unipolar major depression , 2004, Acta psychiatrica Scandinavica.

[15]  S. Lautenbacher,et al.  Pain perception in psychiatric disorders: a review of the literature. , 1994, Journal of psychiatric research.

[16]  M. Berk,et al.  Blunted adenosine A2a receptor function in platelets in patients with major depression , 2001, European Neuropsychopharmacology.

[17]  M. Sullivan,et al.  The treatment of depression in chronic low back pain: review and recommendations , 1992, Pain.

[18]  Wagner F. Gattaz,et al.  Pain perception threshold in major depression , 1993, Biological Psychiatry.

[19]  M. Segerdahl,et al.  Experimentally induced ischaemic pain in healthy humans is attenuated by the adenosine receptor antagonist theophylline. , 2004, Acta physiologica Scandinavica.

[20]  S. Lautenbacher,et al.  Pain Thresholds as a Putative Functional Test for Cerebral Laterality in Major Depressive Disorder and Panic Disorder1 , 2003, Neuropsychobiology.

[21]  S. Stahl.  Does depression hurt? , 2002, The Journal of clinical psychiatry.

[22]  J. Soares,et al.  The anatomy of mood disorders—review of structural neuroimaging studies , 1997, Biological Psychiatry.

[23]  L. Arendt-Nielsen,et al.  Specific effect of venlafaxine on single and repetitive experimental painful stimuli in humans , 2001, Clinical pharmacology and therapeutics.

[24]  M. Kaster,et al.  Adenosine administration produces an antidepressant-like effect in mice: evidence for the involvement of A1 and A2A receptors , 2004, Neuroscience Letters.

[25]  R. Nebes,et al.  Reliability and validity of some handedness questionnaire items. , 1974, Neuropsychologia.

[26]  S. Dworkin,et al.  Psychobiological markers in coexisting pain and depression: toward a unified theory. , 1982, The Journal of clinical psychiatry.

[27]  T. Zullo,et al.  Hypoalgesic Effect of Caffeine in Experimental Ischemic Muscle Contraction Pain , 1997, Headache.

[28]  M. Hamilton.  A RATING SCALE FOR DEPRESSION , 1960, Journal of neurology, neurosurgery, and psychiatry.

[29]  H. Kress,et al.  The Absence of Acute Tolerance During Remifentanil Infusion in Volunteers , 2002, Anesthesia and analgesia.

[30]  R. Yeo,et al.  Depression, Pain, and Hemispheric Activation , 1989, The Journal of nervous and mental disease.

[31]  W. Maixner,et al.  Reduced tolerance and cardiovascular response to ischemic pain in minor depression. , 1999, Journal of affective disorders.

[32]  R. Melzack.  The McGill Pain Questionnaire: Major properties and scoring methods , 1975, PAIN.

[33]  Chris Dickens,et al.  Impact of Depression on Experimental Pain Perception: A Systematic Review of the Literature with Meta-Analysis , 2003, Psychosomatic medicine.

[34]  T. Jensen,et al.  Efficacy of pharmacological treatments of neuropathic pain: an update and effect related to mechanism of drug action , 1999, PAIN®.

[35]  P Videbech,et al.  PET measurements of brain glucose metabolism and blood flow in major depressive disorder: a critical review , 2000, Acta psychiatrica Scandinavica.

[36]  A. Kudoh,et al.  Increased postoperative pain scores in chronic depression patients who take antidepressants. , 2002, Journal of clinical anesthesia.

[37]  S. Lautenbacher,et al.  Pain perception in depression: relationships to symptomatology and naloxone‐sensitive mechanisms. , 1994, Psychosomatic medicine.

[38]  L. Knorring,et al.  EXPERIMENTALLY INDUCED PAIN IN PATIENTS WITH DEPRESSIVE DISORDERS , 1974, Acta psychiatrica Scandinavica. Supplementum.

[39]  W. Maixner,et al.  Gender Differences in Pain and Cardiovascular Responses to Forearm Ischemia , 1993, The Clinical journal of pain.