Pitkäaikainen kipu ja depressio : yhteyttä säätelevät tekijät

Abstract

Patrik Kuusinen tutki väitöskirjassaan Kelan maksamassa laitoskuntoutuksessa olleiden tuki- ja liikuntaelinten kivuista pitkään kärsineiden kokemusta kipuongelmastaan, itsestään ihmisenä ja tulevaisuudestaan sekä näiden käsitysten yhteyttä masennusoireisiin. Useimmilla potilailla niska- ja selkäkivut olivat kestäneet jo vuosia ilman mitään merkittävää helpottumista.

The purpose of this study was to explore the relationship between chronic pain and depression. It was assumed that depression is a secondary reaction to pain and is mediated by how the patient perceives his/her life control and pain-induced personal interference and social interactions. These assumptions, derived from the mediation model of depression, were integrated with assumptions derived from Aaron T. Beck’s concept of cognitive triad. It was assumed, therefore, that depression in chronic pain patients is not related only to patient’s tendency to negatively interpret his/hers pain-related experiences, but also to the patient’s negative view of him-/herself and negative view of the future. Also the assumption of different sets of depressive diathesis, defined by pain patient sub-grouping (i.e. adaptive copers, dysfunctionals, interpersonally distressed, socially isolated) was tentatively explored. The subjects for this study were 786 consecutive chronic back pain patients admitted to the inpatient multidisciplinary rehabilitation financed by the Finnish Social Insurance Institution. Both cross-sectional and longitudinal data were used in this study. Four main findings emerged. First, consistent with past research, perceived life interference and life control mediated the impact of pain on depression. However, perceived life interference was more strongly associated with somatic and behavioural symptoms of depression, whereas perceived life control was associated with cognitive and affective symptoms. Second, the results indicate that, although negative life experiences may trigger depressive symptoms, a negative view of the self and the future are also associated with cognitive-affective symptoms. Third, changes in depressive symptoms were associated with simultaneous changes in perception of pain-related experiences and feelings of competence, while feelings of incompetence and negative view of the future remained intact. Fourth, 78 % of the depressive chronic pain patients fell into the dysfunctional (i.e. problems mainly in personal performance) and interpersonally distressed (i.e. problems in social interactions) patient groups. Unemployment and living without a partner was more common among the interpersonally distressed. In sum, the findings indicate that depression among chronic pain patients is similar to depression in the general population: personal and interpersonal losses trigger depressive mood. The results on the differences in content of the experienced loss in depression (dysfunctional: personal loss; interpersonally distressed: interpersonal loss) are tentative only. This subject merits additional study. Future studies should also examine the effect of transaction between patient and his/hers partner