Chronic Pain May Lead to False Diagnosis of Clinical Depression

Military veterans represent one segment of the population that deals with an all-too-common problem in the medical and psychological arenas: chronic pain. People who suffer chronic pain can experience significant physical symptoms and, often, psychological symptoms. Because the physical discomfort caused by chronic pain can mimic the somatic symptoms of depression, it is imperative that clinicians be able to distinguish between the two. One of the most widely used tools for measuring depression is the Beck Depression Inventory (BDI-II) Revised. This scale measures physical, psychological, and behavioral symptoms; therefore, its accuracy in identifying depression among chronic pain sufferers has been questioned. Michael N. Lopez, a researcher from the Veterans Affairs’ Neuropsychology Testing Laboratory, wanted to determine if the existing BDI-II could predict depression in individuals with chronic pain, or if specific factors on the BDI-II should be considered separately in order to obtain accurate identification of depressive symptoms.

In a recent study, Lopez assessed 345 male veterans who were part of an outpatient chronic pain treatment program. After examining all factors on the BDI-II, Lopez found that three stood out as relevant for the indication of depression among people with chronic pain. Lopez discovered that “somatic complaints” (SC), “mood” (M), and “negative rumination” (NR) were unique predictors of depression. Although suicidal thoughts and other symptoms should be considered, they did not warrant independent factor analyses. Lopez believes that clinicians who work with chronic pain clients should consider how responses on these particular factors of SC, M, and NR fluctuate from normal ranges. Doing so could help professionals better distinguish between which clients have clinical levels of depression and which are having depression symptoms overestimated on the BDI-II. Lopez hopes that future research will look at female and male chronic pain clients in order to gauge the limits of the BDI-II in both sexes. He also hopes that future attempts will support the predictive ability of the three factors outlined here. “Meanwhile, we highly recommend that clinicians and researchers that work with male chronic pain veterans to apply the norms presented in this study when using the BDI-II to better detect and treat depression,” Lopez said.

Lopez, M. N., Pierce, R. S., Gardner, R. D., Hanson, R. W. (2012). Standardized Beck Depression Inventory-II scores for male veterans coping with chronic pain. Psychological Services. Advance online publication. doi: 10.1037/a0027920

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  • Melanie


    October 11th, 2012 at 3:53 AM

    Chronic pain and the management of that pain is so widely misunderstood in the medical community. Many tell those of us who suffer that it’s all in our heads, or maybe that we are even seeking attention, when that is the farthes thing from the actual truth. This is pain that I want to know where it is coming from just as much as the doctors want to know. Don’t you think that many of us would feel better if we just knew what was causing this discomfort and if there was anything that we could do to make it stop? I am depressed, yes, because this has affected my life in a very real and debilitating way. This is not about attention; this is about wanting and needing answers, and I like so many others don’t think that this is an unreasonable request.

  • Peter


    October 11th, 2012 at 4:30 AM

    There is a very high level of frustration present when you are looking at specifically the management of chronic pain issues, stress, and depression.

    I think that in general it is only natural to feel depressed when you are experiencing symptoms for which there is no answer, no clear cut diagnosable illness to which we can point and say aha! That’s it, the source of your pain is this.

    As humans we are forever seeking clarity and answers. Chronic pain offers us neither, and this becomes particularly difficult to know that there may no end in sight for the pain nor will there be any readu answers to better help manage how you are feeling.



    October 11th, 2012 at 1:15 PM

    I could be wrong but chronic pain could well lead to depression.It can take over a person’s mind if it is severe enough and that would be enough for depression to set in.But in cases where that isn’t the case,then yes it can become difficult and newer and improved methods are certainly needed for an accurate diagnosis.

  • zane


    October 11th, 2012 at 4:18 PM

    Well what more would I expect? If I am hurting that bad all the time kind of seems I am entitled to do a little sulking every now and then.

  • Nate


    October 12th, 2012 at 4:14 AM

    I have a question that just occurred to me- why are so many of these studies done with veterans?

    Is it that there are that many people who are interested solely in veterans affairs or is it that at the facilities where they are it is easier to get a large random population for sampling and testing?

  • Payton


    October 13th, 2012 at 9:21 AM

    There are so many different ways that chronic pain can be treated and managed, why is it that the default method of treatment always seems to revolve around new drugs to the already full regimen? I would much rather see someone who would encourage me to try some different and alternative ways to manage my pain over someone who was constantly urging me to try a new pill. I honestly have this theory that when you are living with chronic pain you have to find ways that are therapeutic to you that do not involve adding even more chemicals to the body. Overall I think that this approach can be far too dangerous for those who are already struggling with this ailment.

  • Russell


    November 18th, 2012 at 11:41 AM

    @Nate: I am one of the study’s authors. People are interested solely in veterans, veterans have a high incidence of chronic pain, and in our case this was research done with a convenience sample of archival data.

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