Pain Medicine：初级护理患者的疼痛、慢性疾病、抑郁症与IL-6

　　目前一项发表于《疼痛医学》杂志上的一项研究表明抑郁症可能会增加初级护理患者的疼痛易伤性并可能升高炎症标志物如IL-6的水平。

　　疼痛、慢性疾病和抑郁症是经常出现在初级护理中非常普遍的问题，炎症标志物水平升高与这三个条件相关，并可能在患者的合并症中起重要作用。该研究旨在探讨疼痛，慢性疾病和炎症标志物白细胞介素（IL）-6的关联是否依赖于初级护理患者的抑郁状况。

　　该研究受试者为初级护理患者（N=106），年龄在40岁以上，该研究对他们的疼痛（36项医学研究成果调查表），慢性疾病发病率（慢性健康状况清单）和抑郁症状（抑郁量表中心）进行了评定。受试者提供血液样品用于血清IL-6测量。

　　结果表明，在抑郁症状增加的患者中，IL-6水平与更大的疼痛和慢性疾病合并症相关。无临床明显抑郁症状的患者中，IL-6与疼痛和慢性疾病无关。在调停分析（mediation analysis）中，慢性疾病发病率并不能调节介导素IL-6和疼痛之间的关联，在对慢性疾病发病率调节之后，抑郁症的严重程度和疼痛仍然不相关。

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Depressive Symptoms, Pain, Chronic Medical Morbidity, and Interleukin-6 among Primary Care Patients
Objective
Pain, chronic medical morbidity, and depression are highly prevalent problems that frequently co-occur in primary care. Elevated levels of inflammatory markers are linked with all three of these conditions and may play an important role in patients’ comorbidities. The current study aimed to examine if the associations among pain, chronic medical morbidity, and the inflammatory marker interleukin (IL)-6 are dependent on depression status in primary care patients.
Setting, Subjects, and Outcome Measures
Primary care patients (N = 106) aged 40 and older were assessed for pain (36-item Medical Outcomes Study Survey Form), chronic medical morbidity (checklist of chronic health conditions), and depressive symptoms (Center for Epidemiologic Studies Depression Scale), and provided a blood sample for the measurement of serum IL-6.
Results
Among patients with elevated depressive symptoms, higher IL-6 levels were associated with both greater pain and greater chronic medical comorbidity. IL-6 was unrelated to pain or chronic medical comorbidity among patients without clinically significant depressive symptoms. In mediation analyses, chronic medical morbidity did not mediate the association between IL-6 and pain, and depression severity and pain remained independently associated after adjustment for chronic medical comorbidity.
Conclusions
Depression may increase primary care patients’ vulnerability to pain and elevated levels of inflammatory markers such as IL-6.