Depression is a common mental health condition that causes symptoms of profound sadness and loneliness in afflicted people. People of any age and from any socioeconomic background may experience depression at some point in their lives. According to the World Health Organization (WHO), depression affects more than 264 million people worldwide.

Pain is an unpleasant sign that something in the body is not working as it should, or a warning of the entry of, or contact with, a harmful substance. Pain is also the most common symptom for which individuals visit a physician, and can be the debilitating symptom of many underlying diseases.

A new study by researchers at the Regenstrief Institute and Indiana University School of Medicine in the United States found that patients visiting doctors were more likely to speak about their physical symptoms, such as chronic pain and difficulty in performing bodily functions than of psychological symptoms such as depression and anxiety. The study also found that most patients did not associate their chronic pain with depression, or vice versa.

Elaborating on the relationship between pain, and depression and anxiety, the two most prevalent mental health conditions worldwide, the researchers said that their study found that chronic pain is often accompanied by depression and anxiety. Highlighting the importance of psychological symptoms in patients experiencing pain, they noted that the bi-directional linkage between pain and depression, as well as anxiety, was driven by the existence of a feedback loop.

Individuals with pain do not sleep well and their resulting tiredness affects their mood, making them vulnerable to depression and anxiety. Having problems with depression or anxiety can also increase susceptibility to pain. Moreover, areas in the brain that affect the pain that people experience are connected with areas that regulate mood, making physical and mental symptoms closely associated.

While noting that successfully addressing depression and anxiety is associated with improvement in pain, they pointed out that treating pain did not appear to alleviate depression and anxiety to the same degree. However, this did not negate the benefit of identifying and treating both physical and psychological symptoms.

Symptoms of the body and the mind are frequently interlinked, but patients seeing their primary care physician for a headache, back or muscle or leg pain or stomach-ache often neglect to mention that they are also experiencing fatigue, lack of motivation, nervousness and moodiness, all of which are symptoms commonly associated with depression and anxiety. For their part, many physicians do not always ask about symptoms beyond the ones which brought the patient into the office.

Untreated or under-treated emotional symptoms can cause long-term suffering and impaired quality of life. If clinicians measure and monitor both physical and mental symptoms they will be more able and likely to treat them. But there is no blood pressure cuff, lab test or X-ray to screen or diagnose symptoms of depression and anxiety, and doctors often have to rely on what the patient tells them.

The need to address both physical and psychological symptoms has long been recognized, but the lack of validated tools have hampered diagnoses. Research studies in the growing field of ‘symptomatology’ hope to address this shortcoming by promoting the widespread use of validated diagnostic and screening tools for various conditions.

Symptoms account for half of all outpatient primary care visits, but one in three common symptoms do not have a clear-cut disease-based explanation. Diagnostic tools and measures to evaluate symptoms now available include PEG used to measure type and severity of pain, PHQ-9 for depression; and GAD-7 for anxiety. Other measurement tools are FSI-3 for cancer fatigue, and P4 tests for risk of suicide. These brief measurement tools have so far been translated into more than 100 languages.

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