Practice Guidelines for Treatment of Somatic Pain and Depression

Background: Somatic pain is often associated with depression. Patients presenting with this combination can be difficult to treat and create a significant financial burden on the medical system. The mechanisms of action linking somatic pain and the myriad of depression are not clearly understood thus highlighting a gap in knowledge between the scientific mechanism, pathogenesis, and psychiatry involved in depression and somatic pain.  The objective of this review article is to address etiologic factors and possible mechanisms associating chronic somatic pain and depression. Additionally, this article provides practice guidelines in the management of somatic pain patients with depression.

Methods: Systematic review of literature on human studies published in English language from 2000-2017 using PubMed, EBSCO, and Google Scholar was performed.

Results: Approximately, 76 studies that were recent and relevant were included in the final review. More than 75% of patients with comorbid depression complain of somatic pain such as headache, neck pain, stomach or back pain including generalized body pain. Socio-demographic factors (advanced age, female gender, marital/relationship status, low educational level), clinical correlates (pain location, duration, score, use of medications), psychosocial correlates (pain self-efficacy, coping skills, quality of life), medical conditions (type 2 diabetes mellitus, fibromyalgia, connective tissue diseases, musculoskeletal or autoimmune disorders), and patient determinants (doctor shopping, aberrant medication-related behaviors like prescription drug misuse or abuse, early refills) are associated with somatic pain in patients with psychiatric comorbidities. Practice guidelines include improving provider-patient relationship, detailed history taking, performing physical exam, obtaining laboratory and radiologic exams, administering validated screening method for pain and depression scales, pharmacotherapy with multi-target agents, psychotherapy, functional restoration program, physiotherapy for chronic pain, self-management strategies (yoga, mindfulness) and including a multi-disciplinary treatment team.

Conclusion: This article has important implications for clinical practice as it not only highlights the epidemiology and correlates of somatic pain and depression but also provides practice guidelines for managing somatic pain patients with comorbid depression.