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As mentioned earlier, there is substantial evidence for a pain-depression dyad and probably a pain–depression–anxiety triad (see "Psychiatric Comorbidity"). The comorbidity among these disorders ranges from 30% to 60%, and they have reciprocal adverse effects on quality of life, disability, health care use, and treatment response. In particular, the presence of pain negatively affects depression outcomes, while depression in turn makes pain treatments less effective. Anxiety may have a similar effect, although the research in this area is less substantial than for depression.

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FIGURE 66–2. Pain numeric rating scale (NRS).Interviewer-administered (verbal) and self-administered (visual) versions of the single-item NRS for pain, also referred to "the fifth vital sign."

FIGURE 66–3. PEG three-item pain scale.The PEG three-item pain scale—an ultrabrief measure for assessing and monitoring pain—is based on three items from the Brief Pain Inventory: average Pain severity, interference with Enjoyment of life, and interference with General activities.Source. Krebs EE, Bair MJ, Damush TM, Sutherland JM. Used with the authors' permission.

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