In a study conducted by a team of researchers from BGU (Dr. Sheera Lerman and Prof. Golan Shahar), Soroka University Medical Center (Drs. Zvia Rudich and Hadar Shalev), and Soriasky/Ichilov Medical Center (Dr. Silviu Brill), strong support was found for the centrality of psychosomatic processes in chronic physical pain. The study appears on line as a publication ahead of print in the prestigious medical journal Psychosomatic Medicine.
Chronic pain is arguably one of the greatest challenges of modern medicine. It pertains to a host of medical conditions (e.g., chronic low back pain, complex regional pain syndrome, fibromyalgia, diabetic neuropathy, etc.), many of which are poorly understood from the biological perspective. These conditions are also difficult to diagnose and treat, and the suffering and burden they incur on individuals, families, and societies are devastating. Many patients with chronic pain suffer from depression and anxiety, although the direction of causality between pain and depression/anxiety remains unclear.
To clarify this issue, the researchers followed a large sample of chronic pain patients treated at either Soroka or Soriasky Medical Centers for about two years, measuring their level of pain, depression/anxiety, and disability four times over this period. They used complex mathematical modeling to compare two hypotheses: That pain leads to depression/anxiety (the Pain-As-Stress hypothesis) or that depression/anxiety leads to pain (the Psychosomatic Hypothesis). Results of their analyses were clear cut: Depression/anxiety predicted pain, but not vice versa. Depression/anxiety also predicted pain-related disability, further indicating the centrality of emotional distress in chronic pain.
According to Dr. Lerman and Prof. Shahar, the strong methodological features of this study are convincing, and suggest that both depression and anxiety must be routinely assessed and treated in the course of chronic pain, otherwise they will seriously complicate patients' suffering.
"It should be emphasized, however" say Lerman and Shahar, "that depression and anxiety are not in 'one's head'. They too are genuinely psychosomatic, biopsychological conditions. Our study joins others in suggesting the unity of body and mind in pain and other forms of physical suffering”.
The study was conducted as part of Dr. Sheera Lerman's doctoral and post-doctoral research under the supervision of Prof. Golan Shahar, and was funded by a grant from the Israeli Science Foundation (ISF) to Prof. Shahar.