Depression, Anxiety, and Pain: precision tools to measure behavior and improve treatment

Principal Investigator: Daniel S. Barron

Authors: Daniel S. Barron, David Ahern, David Silbersweig
Lay Abstract

Chronic pain affects almost a third of U.S. adults, costing ~$560 billion each year. Depression and anxiety are markedly frequent experiences among people with chronic pain: a third of patients with pain have either depression or anxiety while about half had both depression and anxiety. Critically, when a patient reports depression and anxiety in relation to their pain, interventional pain physicians often struggle to correlate that narrative with a pathophysiology that they can treat. We present preliminary results for two tools to quantify individual differences in pain experience: a depression-anxiety phenotype based on symptom scores and a digitized emotional state assessment based on unstructured conversation. As part of a larger behavioral assay, we will deploy these tools in BWH’s new Pain Intervention & Digital Research Program (Pain-IDR). Our overarching goal is to define a brain-behavior profiles that can be further tested and applied as treatment targets for patients experiencing depression, anxiety, and pain.

Scientific Abstract

Chronic pain affects up to 28% of U.S. adults, costing ~$560 billion each year. Depression and anxiety are markedly frequent experiences among people with chronic pain: an analysis of 5,381 pain patients showed that a third had either depression or anxiety and that about half had both depression and anxiety. Critically, when a patient reports depression and anxiety in relation to their pain, interventional pain physicians often struggle to correlate that narrative with a pathophysiology that they can treat. We present preliminary results for two tools to quantify individual differences in pain experience: a depression-anxiety phenotype (based on canonical correlation analysis of 1,029,903 non-imputed questionnaire responses in the UK Biobank, that defines a quantitative relationship between depression and anxiety symptoms) and a digitized emotional state (based on unstructured clinical conversation recorded with inexpensive, consumer-grade equipment and open-source, automated software tools that extract facial, acoustic, and linguistic features and tracks clinical symptoms). As part of a larger behavioral assay, we will deploy these approaches in BWH’s new Pain Intervention & Digital Research Program (Pain-IDR). Our overarching goal is to define a brain-behavior profiles that can be further tested and applied as treatment targets for patients experiencing depression, anxiety, and pain.

Clinical Implications
Chronic pain affects almost a third of U.S. adults, costing ~$560 billion each year. Depression and anxiety are markedly frequent experiences among people with chronic pain: a third of patients with pain have either depression or anxiety while about half had both depression and anxiety. Critically, when a patient reports depression and anxiety in relation to their pain, interventional pain physicians often struggle to correlate that narrative with a pathophysiology that they can treat. We present preliminary results for two tools to quantify individual differences in pain experience: a depression-anxiety phenotype based on symptom scores and a digitized emotional state assessment based on unstructured conversation. As part of a larger behavioral assay, we will deploy these tools in BWH’s new Pain Intervention & Digital Research Program (Pain-IDR). Our overarching goal is to define a brain-behavior profiles that can be further tested and applied as treatment targets for patients experiencing depression, anxiety, and pain.

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