Presence Of Pain Symptoms Research Articles

USO DA TERAPIA FOTODINÂMICA E DA CRIOTERAPIA NO CONTROLE DA DOR APÓS O TRATAMENTO ENDODÔNTICO: RELATO DE CASO CLÍNICO

Patients may undergo endodontic treatment for many reasons, including the presence of extensive decay that exposes pulp tissue and tooth fractures. The treatment, in turn, can generate, in some cases, the presence of painful symptoms, due to numerous reasons, such as incorrect removal of the smear layer and chemical injuries from the irrigating material. To reduce patient discomfort, alternative technical applications can be used to control post-operative pain, such as cryotherapy and laser therapy. The objective of this work, in the form of a case report, was to show the importance of controlling postoperative pain after endodontic treatment using laser therapy and cryotherapy techniques. Searches were carried out in electronic databases: Virtual Health Library (VHL), Scientifc Electronic Library Online (Scielo) and PubMed for the last 7 years (2017 to 2024), in addition to patient care where cryotherapy was used using serum physiological cold and laser therapy was performed. The results presented were satisfactory, as after 4 sessions, pain was assessed through telephone contact with the patient over periods of 24h, 72h and 7 days, where the patient’s pain-free response was verified and without need of analgesic use. The present study can conclude that performing cryotherapy concomitantly with the use of laser therapy presents a significant reduction in the postoperative pain response.

Correlation Between Proinflammatory Cytokine Expression and Clinical Data in Apical Granuloma

IntroductionThis study was intended to evaluate the expression of inflammatory cytokines commonly secreted by CD4+ T cells (IL-2, IL-5, IL-17, TGF-β, TNF-α, and IFN-γ) in apical granulomas and correlate with the clinical conditions and time elapsed since root canal treatment. MethodsEighteen biopsy specimens obtained by periradicular surgery of teeth with post-treatment apical periodontitis and diagnosed as apical granuloma were available from the oral pathology laboratory. Silanized slides containing paraffin sections were used for immunohistochemical reactions. Images were analyzed by using an optical microscopy and each slide was subdivided into 5 fields at high magnification. ResultsIFN-γ and TGF-β were the cytokines with the highest expression levels. There were statistically significant differences when comparing IL-2 and IFN-γ (P < .05), and IL-2 and TGF-β (P < .05). Comparison between the detected cytokines and clinical data and time of treatment demonstrated significant correlation (P < .05) between lower expression of IL-2 and the presence of painful symptoms, absence of sinus tract, and treatments performed more than 4 years before. It was also possible to observe a significant correlation between lower expression of IL-5 and treatments performed less than 4 years before (P < .05). ConclusionIFN-γ and TGF-β were highly expressed in apical granulomas. However, only IL-2 and IL-5 levels were associated with clinical data and time since previous root canal treatment.

Management of Pain Symptoms and Contractures in Patients with Chronic Temporomandibular Disorders and Psychosocial Comorbidities Using Gaalas Phototherapy

Abstract The most important clinical indicators of temporomandibular disorders (TMD) are pain in the temporomandibular joints, masticatory and cervical muscles, as well as a reduction in the opening capacity of the mouth. Psychosocial factors have a significant impact in the persistence of the disease and should be taken in consideration in the treatment plan. The aim of the present study was to perform clinical and statistical evaluation on the management of pain symptoms and overcome of pronounced arthro- and myogenic mandibular contractures in GAD 7 positive patients with chronic temporomandibular disorders using combined irradiation with infrared gallium-aluminum-arsenide laser (785 nm), superluminescent visible red (633 nm) and infrared (880 nm) light emitting devices. Materials and methods. The study included 62 individuals with various types of temporomandibular disorders, which were established using the latest diagnostic criteria – DC/TMD, 2014, revision 2020. Fifteen out of 62 patients responded positively to the GAD 7 questionnaire, which indicates depression and/or anxiety. In 8 out of these 15 cases, the presence of pain symptoms, mandibular contractures and psychosocial comorbidities exceeded 6 months. According to DC/TMD standards, these are patients with chronic temporomandibular disorders and they were the target group for our study. The average interincisal distance from this eight-member group was 27.62 mm (SD – 8.17). Results. The Student t-test for the dependent samples showed a significant reduction in VAS pain scores and an increased interincisal distance after phototherapy procedures. Conclusions. Combined phototherapy has proven to be an effective treatment of mandibular contractures, joint and muscle pain in TMD patients with psychosocial comorbid conditions.

Prevalence and risk factors of significant persistent pain symptoms after critical care illness: a prospective multicentric study

BackgroundPrevalence, risk factors and medical management of persistent pain symptoms after critical care illness have not been thoroughly investigated.MethodsWe performed a prospective multicentric study in patients with an intensive care unit (ICU) length of stay ≥ 48 h. The primary outcome was the prevalence of significant persistent pain, defined as a numeric rating scale (NRS) ≥ 3, 3 months after admission. Secondary outcomes were the prevalence of symptoms compatible with neuropathic pain (ID-pain score > 3) and the risk factors of persistent pain.ResultsEight hundred fourteen patients were included over a 10-month period in 26 centers. Patients had a mean age of 57 (± 17) years with a SAPS 2 score of 32 (± 16) (mean ± SD). The median ICU length of stay was 6 [4–12] days (median [interquartile]). At 3 months, the median intensity of pain symptoms was 2 [1–5] in the entire population, and 388 (47.7%) patients had significant pain. In this group, 34 (8.7%) patients had symptoms compatible with neuropathic pain. Female (Odds Ratio 1.5 95% CI [1.1–2.1]), prior use of anti-depressive agents (OR 2.2 95% CI [1.3–4]), prone positioning (OR 3 95% CI [1.4–6.4]) and the presence of pain symptoms on ICU discharge (NRS ≥ 3) (OR 2.4 95% CI [1.7–3.4]) were risk factors of persistent pain. Compared with sepsis, patients admitted for trauma (non neuro) (OR 3.5 95% CI [2.1–6]) were particularly at risk of persistent pain. Only 35 (11.3%) patients had specialist pain management by 3 months.ConclusionsPersistent pain symptoms were frequent in critical illness survivors and specialized management remained infrequent. Innovative approaches must be developed in the ICU to minimize the consequences of pain.Trial registration. NCT04817696. Registered March 26, 2021.

Perception of risk factors at work associated with musculoskeletal symptoms in dental students of Melaka, Malaysia: A cross-sectional study.

Dental professionals have been reported to be constantly exposed to work-related musculoskeletal disorders with symptoms often started as early as the student phase. Risk perception may play an important role in modifying risk at work. To assess the influence of gender, academic level, and the presence of painful symptoms on the perception of risk factors at work contributing to musculoskeletal symptoms among dental students of Melaka, Malaysia. A cross-sectional survey of 183 clinical year dental students based on a convenience sample. The data were collected using the Nordic Musculoskeletal Questionnaire and Job Factor Questionnaire for assessment of musculoskeletal symptoms and risk factors at work respectively. Study data were evaluated using percentage, median, Cochran's Q test, Bonferroni correction, multiple linear regression analysis and Mann-Whitney U Test. The analysis was interpreted considering a 95 % confidence interval and significant level at P < 0.05. Dental students reported a high prevalence (86.9 %) of musculoskeletal symptoms mostly affected the neck, shoulder, lower and upper back body regions. No significant difference in perception was found with the gender. A significant (P < 0.05) higher perception was observed in fourth-year students. The presence of painful symptoms was significantly (P < 0.05) associated with working in the same position, prolonged duration of work and use of tools. Priority in implementing ergonomic education throughout the training in the dental schools should be considered to improve perception and reduce musculoskeletal disorders associated with the dental profession.

Insight into pain syndromes in acute phase of mild-to-moderate COVID-19: Frequency, clinical characteristics, and associated factors.

BackgroundPain has been frequently described as a clinical feature of COVID‐19, and the main pain syndromes that have been associated with the acute phase of this disease so far are headache, myalgia, arthralgia, and neuropathic pain. Understanding the characteristics of pain symptoms is crucial for a better clinical approach.MethodsPatients who were diagnosed as having COVID‐19 using reverse transcription‐polymerase chain reaction were included in the study. Patients were asked to complete a 51‐item questionnaire via a phone interview, which included questions on demographics, acute COVID‐19 symptoms, the presence of pain symptoms, and their characteristics in the acute phase of COVID‐19.ResultsA total of 222 out of 266 patients with COVID‐19 participated in the study, yielding a response rate of 83.5%. A total of 159 patients reported at least one kind of pain syndrome with a prevalence of 71.6%. Myalgia was reported in 110 (49.6%) patients, headache in 109 (49.1%), neuropathic pain symptoms in 55 (24.8%), and polyarthralgia in 30 (13.5%) patients. A total of 66 patients reported only one type of pain, 46 reported two types, 42 reported three types, and five patients reported all four types of pain. Logistic regression analysis showed that there were significant associations between these pain syndromes and a strong association was found between neuropathic pain and headache.ConclusionPain is a frequently observed symptom of mild‐to‐moderate COVID‐19. There are significant relationships between pain syndromes in COVID‐19, which may be due to a sequence of common etiologic factors.SignificanceThis study described the main pain syndromes associated acute phase of mild‐to‐moderate COVID‐19 and its associated features. Headaches and pain of neuropathic characteristics were prevalent in this sample.

ДИНАМИКА ИМПУЛЬСНОЙ АКТИВНОСТИ НЕЙРОНОВ ВЕНТРАЛЬНОГО ПОСТЕРОЛАТЕРАЛЬНОГО ЯДРА (VPL) ТАЛАМУСА КРЫС В ОТВЕТ НА СТИМУЛЯЦИЮ СОМАТОСЕНСОРНОЙ КОРЫ НА МОДЕЛИ БОЛЕЗНИ ПАРКИНСОНА

Neurodegenerative diseases are going to increase as the life expectancy is getting longer. Most patients with neurodegenerative diseases (ND) complain of pain, the origin of which remains largely unknown and requires further research. One of the reasons why the topic of pain and PD is difficult to address is that it is sometimes tough to discern whether a particular pain is due to PD or not. Chronic pain is such a common symptom among the general population, and people with PD are not immune to common problems as well. However, there are aspects of PD that may exacerbate the pain experienced from a common problem. In addition, there are particular types of pain that may be unique to people with PD. There is a frequent and more intense onset of pain in Parkinson’s disease, as the most important non-motor symptom, with a violation of both the emotional measurement of pain and the subjective perception of its intensity. In addition, various types of pain have been described in PD, mainly neuropathic or nociceptive. The presence of pain symptoms is often not taken into account in the recommendations for treatment, leaving their management at the discretion of only doctors. Studies focusing on pain frequency in such disorders suggest a high prevalence of pain in selected populations from 40% to 86% in Parkinson’s disease (PD). The methods of pain assessment vary between studies so the type of pain has been rarely reported. However, a prevalent nonneuropathic origin of pain emerged for PD. The electrophysiological investigations on 8 rats Albino lines (230±30g.) has been conducted: intacts (5 animals) and on the rotenone model of Parkinson’s disease (PD) (3 animals) has been conducted. The extracellular recording of impulse activity 229 single neurons of ventral-posterolateral nucleus (nVPL) of thalamus on high frequency stimulation of second somatosensory cortex of the brain has been produced. Analyses of relative degree frequency intensity of depressor and excitatory effects, on the bases of diagrams of average frequency of impulses, presented as disk graphs in mentioned conditions following changes of tetanic depressor and excitatory reactions, accompanied by posttetanic depressor and potentiation has been revealed. On the model of PD in both sequences, in comparison with norm, reduction in the number of neurons, responded by inhibitory poststimulus reactions has been revealed. The prestimulus frequency of nVPL neurons impulse activity, preceding to both inhibitory and excitatory sequences, in comparison with, dramatically increased turned out to be. The poststimulus frequency of impulse activity on the model of PD, accompanied by inhibitory and excitatory sequences also significantly increased turned out to be. A significant shift of frequency of pre- and poststimulus activity in pathology is a consequence of the development of excitotoxicity, that is fraught with apoptosis and dead. In conclusion, on the model of PD the excitotoxicity revealed in neurons of nVPL, leading to neurodegenerative defeat of these important antinociceptive structures of thalamus, with origin of resistant chronic pain. Marked indicates the need of protective conservation of inhibitory effects and reduced of excessive excitatory.

The Usefulness of CD34, PCNA Immunoreactivity, and Histopathological Findings for Prediction of Pain Persistence After the Removal of Endometrioma.

Endometriosis is an estrogen-dependent inflammatory disease that causes infertility and chronic pelvic pain. Ovarian endometrioma is the most common form of endometriosis, and conservative surgery is the main preferred therapeutic approach for endometrioma-associated symptoms. The aim of this study was to investigate the persistence of cyclic and noncyclic pelvic pain (NCPP) after endometrioma excision and their relationship to clinical and histopathological findings. In this prospective observational study, 41 symptomatic patients were evaluated for the presence of pain symptoms 3 to 6 months after endometrioma excision. Tissue specimens of endometrioma were collected during the operation and embedded in paraffin. The persistence of pain was 41.4%. Surgical excision of endometrioma significantly decreased NCPP and dysmenorrhea, but not dyspareunia ( P < .0001, P = .0001, and P = .25, respectively). Histopathological changes, including depth of endometriosis penetration into the cyst wall, the presence of macrophage infiltration, and vascularity of endometrioma cyst walls were significantly higher in patients with pain persistence than in patients without pain persistence ( P = .0034, P = .0042, and P = .0007, respectively). Moreover, proliferating cell nuclear antigen (PCNA) and CD34 immunoreactivity in both glandular and stromal cells and vascular endothelium were significantly higher in patients with pain persistence ( P = .0079 and P = .0025, respectively). Additionally, these histopathological changes and PCNA and CD34 immunoreactivity were significantly correlated with the persistence of NCPP and dysmenorrhea. The discovered differences in patients with endometrioma with or without pain persistence may indicate a possible relationship between endometrioma-associated pain and histopathological variability of endometrioma.

Self-Reported Pain in Male and Female Iraq/Afghanistan-Era Veterans: Associations with Psychiatric Symptoms and Functioning.

To examine pain symptoms and co-occurring psychiatric and functional indices in male and female Iraq/Afghanistan-era veterans. Self-reported data collection and interviews of Iraq/Afghanistan-era veterans who participated in a multisite study of postdeployment mental health. Veterans were enrolled at one of four participating VA sites. Two thousand five hundred eighty-seven male and 662 female Iraq/Afghanistan-era veterans. Nonparametric Wilcoxon rank tests examined differences in pain scores between male and female veterans. Chi-square tests assessed differences between male and female veterans in the proportion of respondents endorsing moderate to high levels of pain vs no pain. Multilevel regression analyses evaluated the effect of pain on a variety of psychiatric and functional measures. Compared with males, female veterans reported significantly higher mean levels of headache ( P < 0.0001), muscle soreness ( P < 0.008), and total pain ( P < 0.0001), and were more likely to report the highest levels of headache ( P < 0.0001) and muscle soreness ( P < 0.0039). The presence of pain symptoms in Iraq/Afghanistan-era veterans was positively associated with psychiatric comorbidity and negatively associated with psychosocial functioning. There were no observed gender differences in psychiatric and functional indices when levels of pain were equated. Although female Iraq/Afghanistan-era veterans reported higher levels of pain than male veterans overall, male and female veterans experienced similar levels of psychiatric and functional problems at equivalent levels of reported pain. These findings suggest that pain-associated psychological and functional impacts are comparable and consequential for both male and female veterans.

Impact of anxiety symptoms on outcomes of depression: an observational study in Asian patients.

ObjectiveTo investigate the impact of anxiety symptoms on depression outcomes in Asian patients with major depressive disorder (MDD) (n=714).MethodsThe 17-item Hamilton Depression Scale (HAMD-17), overall severity, somatic symptoms, and quality of life (QOL) (EuroQOL Questionnaire-5 Dimensions [EQ-5D]) were assessed at baseline and 3 months. Anxiety was measured using items 10 and 11 from the HAMD-17. Linear, tobit, and logistic multiple regression models analyzed the impact of anxiety symptoms on outcomes. Baseline anxiety was related to age and the presence of pain symptoms at baseline.ResultsRegression models showed that a higher level of anxiety was associated with a lower frequency of remission and lower QOL at 3 months. Patients with lower baseline anxiety symptoms had higher remission rates (odds ratio for each point of anxiety symptoms, 0.829 [95% confidence interval [CI]: 0.723–0.951]). Patients with higher levels of baseline anxiety had a lower QOL at 3 months (a decrease in EQ-5D tariff score for each point of anxiety symptoms, 0.023 [95% CI: 0.045–0.001]).ConclusionIn conclusion, the presence of anxiety symptoms negatively impacts the outcomes of depression.

The Incidence and Severity of Physical Pain Symptoms in Marfan Syndrome: A Survey of 993 Patients.

To characterize the incidence, severity, quality, and treatment of pain in a large cohort of Marfan patients. A web-based survey was distributed to all individuals on the Marfan Foundation listserv. Respondents who endorsed a diagnosis of Marfan syndrome were queried as to the presence, frequency, severity, location, and quality of their pain and were asked to describe the specific treatments used to manage pain. The primary outcome was the presence of pain symptoms in respondents during the 7-day period preceding completion of the survey. Of the 993 patients with a verified diagnosis of Marfan syndrome, 67% (95% confidence interval, 64%-69%) reported pain in the preceding 7 days. Median (interquartile range) "average daily pain" was 4 (3 to 5) on the numeric rating scale; "worst pain" was 7 (5 to 8). "Worst pain experienced" was ≥4 in 93% of respondents. Analgesic use to control pain related to Marfan syndrome was reported in 56% of respondents with 55% reporting <50% pain relief with this modality. Few patients underwent interventional procedures for pain control, despite intractable back and joint pain being common. A majority (52%) of respondents rated "chronic pain care" from their physicians as either "poor" or "fair." Our findings suggest that pain symptoms in Marfan patients are underestimated and likely undertreated. We propose a need for improved patient and medical provider awareness of pain management options in this population, including the development of effective algorithms to treat pain in Marfan patients.

Comparison of the effects of escitalopram and nortriptyline on painful symptoms in patients with major depression

ObjectiveUnexplained painful physical symptoms are commonly reported by depressed patients. The evidence suggests that dual-action antidepressants are potent in relieving pain in depression. However, a direct comparison of the effects of selective serotonergic and selective noradrenergic antidepressants on painful symptoms has not been investigated so far. MethodSixty patients who participated in the Genome-based Therapeutic Drugs for Depression study with a diagnosis of moderate or severe episodes of depression according to the International Classification of Diseases, 10th Revision, and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria were involved. All the participants were randomly allocated to receive nortriptyline or escitalopram. The severity of depression was measured using the Montgomery–Åsberg Depression Rating Scale, the Hamilton Depression Rating Scale and the Beck Depression Inventory at weeks 0, 2, 4, 6 and 8. The intensity of pain was measured on the Visual Analog Scale at the same points of the study. ResultsAt “week 0,” 83.3% of the patients later randomized to treatment with escitalopram and 86.7% of those treated with nortriptyline reported at least one painful symptom. A significant decrease of pain intensity was observed after 2 weeks of treatment. The two groups did not differ in degree of pain reduction at weeks 2, 4, 6 and 8 in comparison to baseline values. A 50% reduction in pain intensity preceded the 50% reduction of depression severity. The intensity of pain at “week 0” did not differ in remitted or nonremitted patients at week 8. ConclusionBoth selective serotonergic and selective noradrenergic antidepressants are equally effective in alleviations of painful physical symptoms of depression. The presence of painful symptoms before the onset of treatment did not determine the final response.

Relationship Between Dry Eye Symptoms and Pain Sensitivity

Dry eye disease (DED) is common, but little is known about factors contributing to symptoms of dry eye, given the poor correlation between these symptoms and objective signs at the ocular surface. To explore whether pain sensitivity plays a role in patients' experience of DED symptoms. A population-based cross-sectional study of 1635 female twin volunteers, aged 20 to 83 years, from the TwinsUK adult registry. Dry eye disease was diagnosed if participants had at least 1 of the following: (1) a diagnosis of DED by a clinician, (2) the prescription of artificial tears, and/or (3) symptoms of dry eyes for at least 3 months. A subset of 689 women completed the Ocular Surface Disease Index (OSDI) questionnaire. Quantitative sensory testing using heat stimulus on the forearm was used to assess pain sensitivity (heat pain threshold [HPT]) and pain tolerance (heat pain suprathreshold [HPST]). Of the 1622 participants included, 438 (27.0%) were categorized as having DED. Women with DED showed a significantly lower HPT (P = .03) and HPST (P = .003)--and hence had higher pain sensitivity--than those without DED. A strong significant association between the presence of pain symptoms on the OSDI and the HPT and HPST was found (P = .008 for the HPT and P = .003 for the HPST). In addition, participants with an HPT below the median had DED pain symptoms almost twice as often as those with an HPT above the median (31.2% vs 20.5%; odds ratio, 1.76; 95% CI, 1.15-2.71; P = .01). High pain sensitivity and low pain tolerance are associated with symptoms of DED, adding to previous associations of the severity of tear insufficiency, cell damage, and psychological factors. Management of DED symptoms is complex, and physicians need to consider the holistic picture, rather than simply treating ocular signs.

1370 URINE ANALYSIS OF CONFIRMED UTI PATIENTS REVEAL HIGHER LEVELS OF CXC CHEMOKINES COMPARED TO PATIENTS WITH LUTS WITHOUT UTI

INTRODUCTION AND OBJECTIVES: Reliable prediction of UTI is hindered by the lack of non-invasive predictive urine biomarkers. Past studies have focused on IL-8 (CXCL-8) with the recruitment of neutrophils after bacterial invasion of uroepithelial cells. In the present study, we investigated whether other members of IL-8 family of chemokines i.e. CXC chemokines are also elevated following UTI and whether they can together form a specific multi-marker panel that is more useful as a surrogate marker for rapid laboratory diagnosis of UTI and prevention of urosepsis. METHODS: Single time point urine specimens were collected from 42 patients with confirmed UTI ( ve bacterial culture report) prior to initiation of antibiotic treatment and compared them with 4 other cohorts of either sex without any infection ( ruled out by urine dipstick test) in the age range of (25–90 yrs). There were Overactive bladder (n 115), interstitial cystitis/painful bladder syndrome ( IC/PBS); n 59 and asymptomatic controls (n 44). Differentiation between IC/ PBS, OAB-wet and OAB-dry was based on absence or presence of pain symptoms and a 3-day voiding diary. Ten chemokines in urine were measured by MILLIPLEXTM MAP Human Cytokine/Chemokine multiplex immunoassay and ELISA. Multivariate logistic regression was used to determine association and Kruskal-wallis ANOVA was used to check for significance. RESULTS: The multivariate regression analysis highlighted that existence of UTI was associated with elevated CXCL-10 levels (odds ratio [OR]:1.05; 95% CI, (1.0187, 1.0930), p 0.002). Levels of CXCL-10, CXCL1 and IL-8 in confirmed UTI urine were also higher than in OAB; (1203 537.2 vs 39.31 17.51pg/ml), (96.16 28.19 vs 11.15 7.50pg/ml) and (113 29.45 vs 29.1 13.54pg/ml), respectively. Urine levels of non-CXC chemokines like MCP-1, IL-1ra and PDGF were higher in population without underlying urinary tract infection such as IC/PBS and control subjects, and higher urinary NGF were noted in OAB wet patients. CONCLUSIONS: Discriminatory multivariate modeling of 10 urinary chemokines identified UTI associated CXC chemokines in urine and thereby demonstrated the utility of mathematical modeling for identifying disease-associated urine biomarkers. Although a single marker such as urinary IL-8 may be a sensitive for UTI, but it is poorly specific as it is also elevated in a variety of other diseases. A mutimarker panel that also includes CXCL-10 and CXCL-1 can be used as a urinary finger print for UTI with increased specificity.

Painful physical symptoms and treatment outcome in major depressive disorder: a STAR*D (Sequenced Treatment Alternatives to Relieve Depression) report

Painful physical symptoms (PPS) are both common and reduce the likelihood of remission in major depressive disorder (MDD), based upon results of clinical trials in selected populations. Whether PPS significantly contribute to poorer treatment outcome overall in primary or specialty psychiatric care settings remains unclear. Out-patients (n=2876) with MDD were treated in the first step of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial with citalopram up to 60 mg/day for up to 14 weeks. Presence of painful symptoms, as well as severity of depression, physical illness, and demographic and treatment factors were examined. Time to and overall rates of remission were analysed in relation to the presence of PPS. Of the participants, 80% complained of PPS. These patients, both in primary and specialty psychiatric settings, had significantly lower remission rates and took longer to remit. Increasing severity of PPS was associated with greater physical illness burden, lower socio-economic status, absence of private insurance and being female, African-American or Hispanic. After adjustment for these factors, patients with PPS no longer had significantly poorer treatment outcomes. Presence and severity of PPS is an indicator of MDD that may have poorer treatment outcome with an initial selective serotonin reuptake inhibitor. These poorer treatment outcomes are multifactorial, however, and are not explained by the presence and severity of pain per se.