Perceived Control Important in Treating Pain, Depression in Older Patients

The Role of Perceived Control

In their study, the researchers used data from the Netherlands Study of Depression in Old Age and included 342 people aged 60-93 years with depressive disorders and 125 controls without depression.

Perceived control, which was measured using the Pearlin Mastery Scale, was considered the extent a person perceives himself or herself to be in control of events and ongoing situations and reflects the perception of the ability to manage them. A higher rating meant more feelings of perceived control.

Those in the depression group reported more pain than the control group in the last 6 months and more chronic pain lasting 90 days or longer. Those in the depression group with pain reported that their pain was more intense and disabling compared to the control group.

In this study, for each 10-point increase in the pain disability score, the chance of having a depressive disorder was 1.21 higher as a consequence of changes in perceived control.

Dr de Waal found that when perceived control was added to the model, the direct effects of pain on the presence of depressive disorder declined, including for pain intensity (OR from 1.27 to 1.10) and for pain-related disability (OR from 1.31 to 1.14). The indirect effects through perceived control on depression were greater than the direct effects of the pain itself.

However, in those with depression, the severity of depression was more directly related to pain intensity and pain-related disability than the indirect effects through perceived control, the authors wrote.

The Role of Pain Treatment in Preventing Depression

“This suggests that the role for pain and pain treatment is different in preventing depression than in diminishing severity of depression,” Dr de Waal and her co-authors wrote. Future studies need to look at whether psychological interventions to increase perceived control will work in practice.

Dr David Buxton, MD, a member of the American Psychiatric Association’s Council on Psychosomatic Medicine, director of Palliative Care at CJW Medical Center and a clinical assistant professor at Virginia Commonwealth University in Richmond, Virginia, who was not an author of the current paper, told Clinical Pain Advisor that doctors need to treat both the mind and body together rather than separately. If a patient has depression, they should be evaluated for pain, and if a patient is in pain, they should be evaluated for depression, Dr Buxton said. Clinicians need to better understand how patients also interpret their pain and how patients can be put back in control of their pain. 

“What they have shown is that how people understand pain without a doubt can influence how they feel pain,” Dr Buxton said. “The data we are getting from this kind of study will hopefully be supported by more core data that understands why this is happening. How we can use it as a therapeutic tool is still being fleshed out.”


De Waal MWM, Hegeman JM, Gussekloo J, Verhaak PFM, Van der Mast RC, Comijs HC. The effect of pain on presence and severeity of depressive disorders in older persons: The role of perceived control as mediator. J Affective Disorders. 2016;197: 239-244.