Do chronic low back pain and chronic widespread pain differ in their association with depression symptoms in the 1958 British Cohort?

OBJECTIVE: Depression frequently co-exists with chronic pain. Contemporary models suggest that these conditions share pathobiological mechanisms, prompting a need to investigate their temporal association. This investigation aimed to explore two distinctly different chronic pain conditions, and their cross-sectional and prospective associations with depression.

METHODS: Self-reported information was available on chronic widespread pain (CWP), chronic low back pain (CLBP) (45y), and depression symptoms (45y and 50y) from up to 9377 participants in the 1958 British cohort. Depression symptom outcomes were derived by 'Clinical Interview Schedule-Revised' (45y) and 'Short Form-36' (50y). Relationships between both chronic pain conditions and depression symptoms were investigated by fitting four separate logistic regression models, each with varying levels of covariate adjustment, including depression at baseline.

RESULTS: CWP was associated with depression symptoms cross-sectionally (OR = 2.04, 95% CI 1.65; 2.52, p <0.001, n = 7629), and prospectively when fully-adjusted for baseline, sociodemographic, lifestyle, and health covariates (OR = 1.45, 95% CI 1.17; 1.80, p = <0.001, n = 6275). CLBP was associated with depression symptoms prospectively (full model: OR = 1.28, 95% CI 1.01; 1.61, p = 0.04, n = 6288). In fully-adjusted models the prospective association of CWP with depression symptoms was more heavily influenced by our covariates than CLBP with depression.

CONCLUSION: Pain may be a stressor from which depression can arise. Development of depression is differentially associated upon the type of pain experienced. Screening for depression symptoms amongst individuals with both chronic pain conditions is indicated and should be repeated over time.