Report and analysis of cases of depression disorder with physical pain disorder and accompanying pain symptoms

1Case data1.1 cases 1patientsmale, 76 years old, admitted to hospital for "left hip and left foot back pain of more than 3 months, aggravated by 1 week"There was a burst of acid-like pain, the pain at night was obvious, more than 10 daily seizures, each attack about half a minute, VAS score 3 to 5 pointsThe previous heart stent implanted 4 years, the history of cerebral infarction 3 years, the left limb movement is slightly limitedThere were no obvious abnormalities such as lumbar MRI, pelvic CT, bone density, body PET/CT, etcin the outer hospital, and no obvious abnormalities were observedbloodrelated examinationsConsider "neuropathic pain" and give oral ampictopolis 1 tablet (1./d) for treatment, the pain is slightly relievedincreased the degree of pain before 1 week, the frequency of seizures increased, the duration of pain was extended, each lasting 7 to 8 min, VAS score 8 to 10 points, compound kamaxipine 0.1 g (oral, 2 times /d), the pain did not significantly relieveAfter admission to our hospital, the physical examination has no relevant positive signsThere were no abnormalities in the review of tumor-related antigens, inflammatory indicators, antinuclear antibodies, etcA review of the head MRI showed mild cerebral infarction and a normal electromyogram of the lower limb Still considering neuropathic pain, the pain did not improve significantly after 1 week of oral primalys 150 mg (1 times/12 h) and 1 week of treatment with the ampicillin tramadol tablets (3 times/d) Local pain point block (local anaesthetic and methyl izednylon) treatment, the patient pain relief about 12 h When the re-attack, local pain point block treatment, the relief time is shortened, and then again blocking time complaint is invalid the patient's left foot pain reduction during the , the post-line endomorphine test, the patient pain relief about 20 h, to be implanted with the intrauterine drug infusion system, the first day after surgery pain disappeared, but the second day again left hip pain, the same as before Adjust the dose of the drug, the patient's pain is repeated, after 1 week is not effective Again to local pain point blocking, pain relief about 2 h, and then the attack is not effective When injected by different physicians, pain relief is different, occasional injection of saline is effective, occasional oral ampicphyol oxycodone is effective, and oral placebo is also effective considering that the patient may be due to mental factors, and then go to the psychiatric evaluation, diagnosis "somatoforrn pain disorder, SPD, anxiety state", to be given oral mitulyn 15 mg (1 time/d), droscietin 20 mg (1 time, d), d, disciated10 mg (1 time/d), nemodiflat 30 mg (3 times, d), after 1 week of pain relief, after half a month of pain, pain loss after half a month 2 patients, a woman, aged 52, was admitted to hospital with "chest pain for seven months" Patients 7 months ago no obvious cause of chest pain, mainly for the front of the heart area, the local hospital cardiology, the relevant examination did not see significant abnormalities, did not see a change in the quality To the nitrate glycerin, aspirin and other improved circulation and ibuprofen pain relief and other treatment, the pain has not been alleviated After my medical treatment, physical examination: no positive signs, patients with poor mental state, poor sleep thoracic enhancement MRI examination did not show any abnormalities The pain was not alleviated when he began to treat Pribarin and other medications with nerve pain Consider that the patient may be for SPD, conduct a psychological assessment, diagnosis "depression" Oral mediton 30 mg (1 time/d), drosciin60 mg (1 time/d), amitillin 25 mg (1 time/d), 3 d patients gradually alleviated pain, about 20 d pain symptoms disappeared, the patient's mental state improved Follow-up for six months, pain is no repetition 2 Discussion generally speaking, pain symptoms are the corresponding organs or system of damage or lesions clinical , but some patients do not have physical lesions This chronic pain, which cannot be explained by instrumental impairment or related diseases, may be a stressful state of mind, a behavioral habit for the attention of others, or an accompanying symptom of a mental illness such as depression and anxiety, or a clinical manifestation of a functional disorder (such as irritable bowel syndrome) in the past, some scholars have this medically unexplained pain collectively referred to as non-instrumental pain, including heart-caused pain and various chronic pain syndrome, and pain departments often focus on uncertainty syndrome, chronic headache syndrome, heart-caused pain and other diagnoses According to the U.S Mental Illness Diagnostic and Statistical Manual, 5th edition or The 10th edition of the International Classification of Diseases, more of these mental-related pain diagnosis is SPD The common diagnosis of chronic pain associated with mental factors in clinical practice is SPD, DDPS, or anxiety disorder SPD also known as cardio-causal pain, mainly manifested in all parts of the body persistent pain, and patients feel abnormal pain, but medical examination can not find the corresponding site or system of instrumental lesions, can not use the pathophysiological process to explain this long-term persistent, severe pain symptoms Psychosocial factors are the main cause of their onset, and these patients often have emotional conflicts in their past or present lives In the case of case 1, previous cerebral infarction leads to physical activity disorders, pyeongse family care is less, may cause a psychological disorder or subconscious pain and get family attention Long-term pain in turn triggers anxiety in patients, which leads to this vicious cycle of psychological,pain anxiety , genetic factors may be one of the causes Studies have shown that some SPD patients have neuroelectrophysiological changes in the brain region, or that there may be structural changes in specific brain regions in imaging that may contribute to their diagnosis A study of single photon emission computertomized tomography in SPD patients showed that there was a low perfusion signal in the brain region in some patients, suggesting that changes in cerebral blood flow may also be associated with it Therefore, the improvement in pain symptoms in patients in case 1 may also be associated with improved cerebral ischemia with the use of nemodiflat depression disorder or depression is a kind of emotional disorder characterized by depression and mood, mainly manifested in mood changes, but some patients with reduced cognitive function or even feel physical pain, this pain is not accompanied by instrumental lesions The incidence of DDPS is 65% Statistics show that more than two-thirds of patients with depression with physical pain, accompanied by pain symptoms in 92% of patients with at least 1 pain, 76% of the multiple pain Some DDPS patients highlight the physical pain, and mood changes are not obvious, some scholars think that this chronic pain is a variant of depression disorder, for hidden depression, more common in middle-aged and elderly people Hidden depression can also have fatigue, sleep quality decline and autonomic nervous system functional symptoms and other physical discomfort, this condition on the correct diagnosis of clinical help, such as case 2 patients, because of its abnormal mental state and sleep disorders, better for clinicians to provide a diagnosis of ideas, but still need to be carefully identified There are obvious overlapping symptoms between SPD and DDPS, which can make clinical diagnosis difficult and prone to misdiagnosis In particular, the main clinical manifestations of somatic pain depression disorder is difficult to diagnose, and easy to be confused with SPD Studies have shown that 60% to 100% of SPD patients are associated with depression, 25% to 50% are accompanied by severe depression, which in turn causes difficulties in identifying with DDPS In addition, long-term pain can lead to anxiety, which can also manifest as pain or accompanying pain symptoms SPD and DDPS are mainly related to mental factors, and their occurrence mechanism is closely related to the pathological mechanisms of depression and anxiety Nonsteroidal anti-inflammatory drugs and opioids are generally ineffective, while tricyclic antidepressants, serotonin and/or norepinephrine reuptake inhibitors have good therapeutic effects on SPD and DDPS, but the dosage and effectiveness time of the drug may vary for patients with anxiety conditions, the choice of benzodiazepines and other anti-anxiety drugs can improve sleep and anxiety Studies have shown that doloxistin has a significant therapeutic effect on the pain symptoms of patients with a wide range of anxiety disorders with pain, and is more effective and safe in short, for patients with non-related instrumental lesions who are mainly complained about by chronic pain, their medical history should be followed in detail, and their physiological, psychological and social functions should be evaluated in many ways Patients with depression and anxiety should understand and judge whether it is an abnormal state caused by chronic pain or a mental illness of its own For patients with difficulty in diagnosis, they may seek psychological outpatient or psychiatric assistance