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KMID : 1007420100080010014
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Mood and Emotion
2010 Volume.8 No. 1 p.14 ~ p.23
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Pain and Depression : What Links do we Know?
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Misra Aayushman
Park Geun-Young
Patkar Ashwin A.
Shim Dong-Suk
Pae Chi-Un
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Abstract
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Pain may be caused by various medical illnesses, for example, fibromyalgia, diabetic neuropathy, herpetic neuralgia,trigeminal neuralgia, and irritable bowel syndrome. It is not uncommon to see such patients simultaneously suffering significant depressive symptoms in clinical practice. In addition, pain and depression commonly share pathophysiologies and clinical manifestations. Patients with depression present with emotional symptoms (depressed mood, sadness, and apathy, etc) and/or physical symptoms (pain, fatigue, and dizziness, etc), since the disorder is multi-faceted. In particular, a reciprocal relationship exists between painful physical symptoms and depression. Data suggest that approximately 65% of depressed patients may have accompanied painful physical symptoms and vice versa. In fact patients showing 2 or more pain symptoms may increase the risk of developing clinical depression than in those without pain symptoms. The co-occurrence of pain and depression may worsen not only clinical outcomes but also occupational, social, and global functioning of such patients. These findings clearly indicate that clinicians must be aware of the common co-occurrence of pain and depression in order to effectively treat and enhance remission for their patients with this comorbidity. Although there have been no clear etiological findings in relation with pain symptoms and depression, possible links between pain and depression may exist in the central and peripheral nervous systems. Both serotonin and norepinephrine are principal neurotransmitters in the ascending and descending pathways as well as in frontal and limbic regions involving in the pathophysiology of both pain and depression.
Other biological markers also have overlapping roles in both conditions. As seen in diagnostic criteria for major depressive disorder (MDD), some depressive symptoms are also commonly seen in patients with pain symptoms such as lack of energy and insomnia. Familial aggregation studies have also suggested higher prevalence of MDD in pain symptoms than in general population. In conclusion, pain and depression may share common neuronal pathways, neurochemical findings, principal neurotransmitters and symptomatologies as well as have reciprocal impacts on each clinical course and treatment outcomes. Better understanding on the relationship between pain and depression may shed a light on the further roadmap for diagnosis and management for both conditions in clinical practice.
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KEYWORD
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Pain, Depression, Pathophysiology, Interface
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