From Fear and Worry to Chronic Pain

摘要

The common denominator between chronic pain, anxiety, trauma, and depression is the nervous system, especially a modified, or dysregulated, nervous system.1 With regard to the elderly, what is significantly predictive of onset of chronic pain later in life is a prior history of anxiety, physical and psychological trauma, and depression. It has been shown that a relationship exists between stress and the lowering of pain thresholds, based on prospective studies in humans, and substantiated by direct experimental evidence in animals and humans as well. Overall, what this evidence has suggested is a spectrum ranging from mood and anxiety disorders to painful functional somatic syndromes. Additionally, various types of pre-existing anxiety about pain is related to higher pain sensitivities. Affective spectrum disorders include mood (e.g., major depressive disorder) and anxiety disorders (TABLES 1, 2). The term functional somatic syndrome is used to describe disorders such as fibro-myalgia (TABLE 3) and chronic widespread pain.11 It is important to note that pain is largely considered the same symptom, with the same treatments, whether occurring by itself or as part of any number of chronic pain syndromes, including neuropathic pain (TABLE 4). While the core symptoms of major depression (i.e., loss of interest and depressed mood) differ from the core symptoms of anxiety disorders (TABLE 2),