| Title: |
Differentiating pain-related distress from depression in people with persistent musculoskeletal pain: a mixed methods study |
| Authors: |
Birkinshaw, Hollie; Pincus, Tamar; Hughes, Stephanie; Stuart, Beth; Chew-Graham, Carolyn; Little, Paul; Moore, Michael; Shivji, Noureen; Geraghty, Adam W.A. |
| Source: |
Pain ; ISSN 0304-3959 1872-6623 |
| Publisher Information: |
Ovid Technologies (Wolters Kluwer Health) |
| Publication Year: |
2026 |
| Description: |
Depressive symptoms are commonly experienced by people with persistent musculoskeletal (MSK) pain. There is evidence for some individuals that this may be best characterised as pain-related distress; a reaction to living with the impact of pain, rather than a depressive illness. No explorations exist of how to differentiate between these in primary care. This study aimed to explore key factors that may differentiate between pain-related distress and depression, and the effectiveness of existing symptom screening tools (Patient Health Questionnaire-9 [PHQ-9] and 4-Dimensional Symptom Questionnaire [4DSQ]) in identifying distress through a mixed methods approach. First, 21 general practitioners and 21 people with pain were interviewed about their experiences of pain-related distress. Second, 597 primary care patients with MSK pain completed a cross-sectional questionnaire study reporting on their pain, mental health symptoms, and other life events. Qualitative data suggested key factors distinguishing between pain-related distress and depression included general positive outlook, physical function, and acceptance. Quantitative findings showed that the PHQ-9 may overcategorise participants as depressed; of the 207 participants classified as distressed (but not depressed) on the 4DSQ, 118 (57%) were categorised as moderately or severely depressed on the PHQ-9. Lower positive outlook and sleep interference scores, and higher PHQ-9 and perceived stress scores significantly predicted participants experiencing distress only compared with distress and depression, matching the qualitative findings. These findings indicate that differentiation between pain-related distress and depression may be possible in primary care consultations for persistent musculoskeletal pain. This is essential to ensure that patients are offered appropriate, acceptable, and effective management. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1097/j.pain.0000000000003926 |
| Availability: |
https://doi.org/10.1097/j.pain.0000000000003926; https://journals.lww.com/10.1097/j.pain.0000000000003926 |
| Rights: |
http://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.9FC60114 |
| Database: |
BASE |