REVIEW – November 2006

Depression in pain, pain in depression


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The paper deals with coexistence of chronic pain and depression as well as their partly common biological mechanism. Modulation of chronic pain involves the action of the neurotransmitters serotonin and noradrenalin, whose concentration decreases in depression. Owing to the deficit of these neurotransmitters, the pain modulating system in the midbrain is impaired as a result of which pain impulses not possessing the capacity for biological defence enter the central nervous system. In pain treatment new generation antidepressants, i.e. inhibitors of reuptake of noradrenalin and serotonin are emerging. Several clinical trials addressing neuropathic pain and fibromyalgia as well as other chronic pain syndromes have been completed with a positive treatment outcome.
As before, treatment schemes of chronic pain include active rehabilitation, or exercise therapy, and cognitive behavioural therapy. At the same time, such treatment schemes are also accepted in the case of depression. Thus, the paper conveys the idea that chronic pain and depression have many common components.