Skip to main content

Advertisement

SpringerLink
Log in

Pain threshold and intensity in rheumatic patients: correlations with the Hamilton Depression Rating scale

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Individuals suffering from chronic pain are frequently affected by depression, which in turn increases the risk of developing chronic pain over time. This study aims to investigate the relationship between depression and pain intensity and threshold in a group of rheumatic patients compared to healthy subjects. One hundred twenty-four individuals of whom 50 were affected by rheumatoid arthritis (RA), 23 by psoriatic arthritis (PsA), 23 by ankylosing spondylitis (AS), and 28 age-matched controls without chronic pain underwent quantitative sensory testing to assess pressure pain threshold with pressure algometry. Pain intensity was evaluated through the visual analogue scale (VAS) and depression through the Hamilton Depression Rating scale (HAMD). A significant inverse correlation between HAMD values and pressure pain thresholds was found in the entire group of patients (p < 0.0001), in controls (p = 0.02), and also in RA (p = 0.002), PsA (p < 0.0002), and AS (p = 0.02) patients when analyzed separately, while no significant correlation was found between HAMD and VAS values or pressure pain thresholds and VAS. We found lower pain thresholds in RA and PsA patients while no difference has been evidenced in AS patients compared to healthy controls. HAMD scores were also significantly higher in rheumatic patients than in controls. The use of pressure algometry in the evaluation of chronic pain in patients affected by rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis that display comorbid depression could represent an additional and integrative method to improve pain/depression overlap management or research.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Melzack R, Coderre TJ, Katz J, Vaccarino AL (2001) Central neuroplasticity and pathological pain. Ann N Y Acad Sci 933:157–174

    Article  CAS  PubMed  Google Scholar 

  2. Graven-Nielsen T, Arendt-Nielsen L (2010) Assessment of mechanisms in localized and widespread musculoskeletal pain. Nat Rev Rheumatol 6(10):599–606

    Article  PubMed  Google Scholar 

  3. Ong KS, Keng SB (2003) The biological, social, and psychological relationship between depression and chronic pain. Cranio 21(4):286–294

    CAS  PubMed  Google Scholar 

  4. Peyron R, Garcia-Larrea L, Gregoire MC, Costes N, Convers P, Lavenne F et al (1999) Haemodynamic brain responses to acute pain in humans: sensory and attentional networks. Brain 122:1765–1780

    Article  PubMed  Google Scholar 

  5. Von Korff M, Le Resche L, Dworkin SF (1993) First onset of common pain symptoms: a prospective study of depression as a risk factor. Pain 55(2):251–258

    Article  Google Scholar 

  6. Magni G, Moreschi C, Rigatti-Luchini S, Merskey H (1994) Prospective study on the relationship between depressive symptoms and chronic musculoskeletal pain. Pain 56(3):289–297

    Article  CAS  PubMed  Google Scholar 

  7. Zastrow A, Faude V, Seyboth F, Niehoff D, Herzog W, Lowe B (2008) Risk factors of symptom underestimation by physicians. J Psychosom Res 64(5):543–551

    Article  PubMed  Google Scholar 

  8. Hakkou J, Rostom S, Aissaoui N, Berrada KR, Abouqal R, Bahiri R (2011) Psychological status in Moroccan patients with ankylosing spondylitis and its relationships with disease parameters and quality of life. J Clin Rheumatol 17(8):424–428

    Article  PubMed  Google Scholar 

  9. Edwards RR, Cahalan C, Mensing G, Smith M, Haythornthwaite JA (2011) Pain, catastrophizing, and depression in the rheumatic diseases. Nat Rev Rheumatol 7(4):216–224

    Article  CAS  PubMed  Google Scholar 

  10. Wolfe F, Michaud K (2009) Predicting depression in rheumatoid arthritis: the signal importance of pain extent and fatigue, and comorbidity. Arthritis Rheum 61(5):667–673

    Article  PubMed  Google Scholar 

  11. Backonja MM, Walk D, Edwards RR et al (2009) Quantitative sensory testing in measurement of neuropathic pain phenomena and other sensory abnormalities. Clin J Pain 25:641–647

    Article  PubMed  Google Scholar 

  12. Rolke R, Baron R, Maier C et al (2006) Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain 123:231–243

    Article  CAS  PubMed  Google Scholar 

  13. Brucini M, Duranti R, Galletti R et al (1981) Pain thresholds and electromyographic features of periarticular muscles in patients with osteoarthritis of the knee. Pain 10:57–66

    Article  CAS  PubMed  Google Scholar 

  14. Gerecz-Simon EM, Tunks ER, Heale JA et al (1989) Measurement of pain threshold in patients with rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and healthy controls. Clin Rheumatol 8:467–474

    Article  CAS  PubMed  Google Scholar 

  15. Jolliffe VA, Anand P, Kidd BL (1995) Assessment of cutaneous sensory and autonomic axon reflexes in rheumatoid arthritis. Ann Rheum Dis 54:251–255

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Maixner W, Fillingim R, Booker D et al (1995) Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain. Pain 63:341–351

    Article  CAS  PubMed  Google Scholar 

  17. Giesecke T, Gracely RH, Grant MA et al (2004) Evidence of augmented central pain processing in idiopathic chronic low back pain. Arthritis Rheum 50:613–623

    Article  PubMed  Google Scholar 

  18. Jensen K (1990) Quantification of tenderness by palpation and use of pressure algometers. Advances in pain research and therapy. Raven Press Ltd, New York, pp 165–180

    Google Scholar 

  19. Aletaha D, Neogi T, Silman AJ et al (2010) Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Ann Rheum Dis 69:1580–1588

    Article  PubMed  Google Scholar 

  20. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, CASPAR Study Group (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54:2665–2673

    Article  PubMed  Google Scholar 

  21. Sieper J, Rudwaleit M, Baraliakos X et al (2009) The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 68(Suppl II):ii1–ii44

    PubMed  Google Scholar 

  22. Wolfe F, Smythe HA, Yunus MB et al (1990) The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 33:160–172

    Article  CAS  PubMed  Google Scholar 

  23. Vatine JJ, Shapira SC, Magora F, Adler D, Magora A (1993) Electronic pressure algometry of deep pain in healthy volunteers. Arch Phys Med Rehabil 74:526–530

    Article  CAS  PubMed  Google Scholar 

  24. Lee YC, Chibnik LB, Fossel AH, Solomon DH, Clauw DJ, Karlson EW (2008) The reproducibility of pressure pain thresholds in RA patients. In: American College of Rheumatology Annual Scientific Meeting; 2008 October 2008; San Francisco, CA

  25. Papp K, Poulin Y, Vieira A, Shelton J, Poulin-Costello M (2013) Disease characteristics in patients with and without psoriatic arthritis treated with etanercept. J Eur Acad Dermatol Venereol. 2013 Mar 7

  26. Arısoy O, Bes C, Cifci C, Sercan M, Soy M (2013) The effect of TNF-alpha blockers on psychometric measures in ankylosing spondylitis patients: a preliminary observation. Rheumatol Int 33(7):1855–1864

    Article  PubMed  Google Scholar 

  27. Isik A, Koca SS, Ozturk A, Mermi O (2007) Anxiety and depression in patients with rheumatoid arthritis. Clin Rheumatol 26(6):872–878

    Article  PubMed  Google Scholar 

  28. Chiu YH, Silman AJ, MacFarlane GJ et al (2005) Poor sleep and depression are independently associated with a reduced pain threshold. Results of a population based study. Pain 115(3):316–321

    Article  CAS  PubMed  Google Scholar 

  29. Goldenberg DL (2010) The interface of pain and mood disturbances in the rheumatic diseases. Semin Arthritis Rheum 40(1):15–31

    Article  PubMed  Google Scholar 

  30. Sokka T (2005) Assessment of pain in rheumatic diseases. Clin Exp Rheumatol 23(5 Suppl 39):S77–S84

    CAS  PubMed  Google Scholar 

  31. Berkanovic E, Hurwicz ML, Lachenbruch PA (1995) Concordant and discrepant views of patients’ physical functioning. Arthritis Care Res 8(2):94–101

    Article  CAS  PubMed  Google Scholar 

  32. Christensen KS, Sokolowski I, Olesen F (2011) Case-finding and risk-group screening for depression in primary care. Scand J Prim Health Care 29(2):80–84

    Article  PubMed Central  PubMed  Google Scholar 

  33. Lépine JP, Briley M (2004) The epidemiology of pain in depression. Hum Psychopharmacol 19(Suppl 1):S3–S7

    Article  PubMed  Google Scholar 

  34. Staud R, Robinson ME, Vierck CJ Jr, Price DD (2003) Diffuse noxious inhibitory controls (DNIC) attenuate temporal summation of second pain in normal males but not in normal females or fibromyalgia patients. Pain 101(1–2):167–174

    Article  PubMed  Google Scholar 

  35. Serrao M, Rossi P, Sandrini G et al (2004) Effects of diffuse noxious inhibitory controls on temporal summation of the RIII reflex in humans. Pain 112(3):353–360

    Article  PubMed  Google Scholar 

  36. Ge HY, Madeleine P, Arendt-Nielsen L (2004) Sex differences in temporal characteristics of descending inhibitory control: an evaluation using repeated bilateral experimental induction of muscle pain. Pain 110(1–2):72–78

    Article  PubMed  Google Scholar 

  37. Keogh E, McCracken LM, Eccleston C (2006) Gender moderates the association between depression and disability in chronic pain patients. Eur J Pain 10(5):413–422

    Article  PubMed  Google Scholar 

  38. Staud R (2012) Abnormal endogenous pain modulation is a shared characteristic of many chronic pain conditions. Expert Rev Neurother 12(5):577–585

    Article  PubMed Central  PubMed  Google Scholar 

  39. Pollard LC, Ibrahim F, Choy EH, Scott DL (2012) Pain thresholds in rheumatoid arthritis: the effect of tender point counts and disease duration. J Rheumatol 39(1):28–31

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We acknowledge the expert assistance of William Neal Roberts III of the University of Kentucky in the statistical analysis. We acknowledge also Lizard S.r.l. (info@lizardmed.eu) for providing the algometer.

Disclosures

None.

Author information

Authors and Affiliations

  1. Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Messina, A.O.U. “Gaetano Martino”, via Consolare Valeria n°1, 98100, Messina, Italy

    Gianluca Bagnato, Ilenia De Andres, Stefania Sorbara, Elisa Verduci, Giorgio Corallo, Antonino Ferrera, Salvatore Morgante & Gianfilippo Bagnato

  2. Division of Rheumatology, Department of Internal Medicine, University of Louisville, Louisville, KY, USA

    William Neal Roberts Jr

Authors
  1. Gianluca Bagnato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ilenia De Andres
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefania Sorbara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elisa Verduci
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giorgio Corallo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonino Ferrera
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Salvatore Morgante
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. William Neal Roberts Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Gianfilippo Bagnato
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gianluca Bagnato.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bagnato, G., De Andres, I., Sorbara, S. et al. Pain threshold and intensity in rheumatic patients: correlations with the Hamilton Depression Rating scale. Clin Rheumatol 34, 555–561 (2015). https://doi.org/10.1007/s10067-013-2477-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-013-2477-y

Keywords

Search

Navigation