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The comprehensive review by Bair and colleagues¹ gives further credibility to the depression-pain dyad long observed by primary care physicians. Although I agree with the observation by Bair et al that physicians often evaluate a patient's physical symptoms without exploring the biopsychosocial context of a patient's pain, perhaps a greater issue is the challenge of communicating to such patients the dynamic relationship between pain and mood disorders.

Physicians in our practice of consultative general internal medicine evaluate many patients with chronic pain and unexplained symptoms. Based on my experience in this practice, I've developed 3 tips that are useful when communicating with patients suffering from coexisting depression and unexplained pain. First, I reassure the patient that I understand his or her pain to be real and not "in the head." Indeed, Bair et al¹ remind us of a theory that depression and pain symptoms share a common descending pathway in . . . [Full Text of this Article]

Thomas J. Beckman, MD
Rochester, Minn

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