Pain and Depression：What Links do we Know?

다국어 초록 (Multilingual Abstract)

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.

참고문헌 (Reference)

• 1 Dohrenwend BP, "Why is depression comorbid with chronic myofascial face pain? A family study test of alternative hypotheses" 83 : 183-192, 1999
• 2 Zimmerman M, "Why don’t psychiatrists use scales to measure outcome when treating depressed patients?" 69 : 1916-1919, 2008
• 3 Bigal ME, "What predicts the change from episodic to chronic migraine?" 22 : 269-276, 2009
• 4 Ohayon MM, "Using chronic pain to predict depressive morbidity in the general population" 60 : 39-47, 2003
• 5 David M. Marks, "Triple Reuptake Inhibitors: A Premise and Promise" 대한신경정신의학회 5 (5): 142-147, 2008
• 6 Scott DJ, "Time-course of change in [11C]carfentanil and [11C]raclopride binding potential after a nonpharmacological challenge" 61 : 707-714, 2007
• 7 McIsaac SA, "The role of hypothalamic pituitary-adrenal axis dysfunction in the etiology of depressive disorders" 45 : 127-133, 2009
• 8 Von Korff M, "The relationship between pain and depression"
• 9 Melikoglu MA, "The relationship between disease activity and depression in patients with Behcet disease and rheumatoid arthritis"
• 10 Fishbain DA, "The relationship between antidepressant and analgesic responses: findings from six placebo-controlled trials assessing the efficacy of duloxetine in patients with major depressive disorder"
• 11 Gureje O, "The relation between multiple pains and mental disorders:results from the World Mental Health Surveys" 135 : 82-91, 2008
• 12 Obata H, "The monoaminemediated antiallodynic effects of intrathecally administered milnacipran, a serotonin noradrenaline reuptake inhibitor, in a rat model of neuropathic pain" 100 : 1406-1410, 2005
• 13 Lepine JP, "The epidemiology of pain in depression" 19 (19): S3-S7, 2004
• 14 Kessler RC, "The epidemiology of major depressive disorder:results from the National Comorbidity Survey Replication(NCS-R)" 289 : 3095-3105, 2003
• 15 Jain R, "The epidemiology and recognition of pain and physical symptoms in depression" 70 : e04-, 2009
• 16 Fava M, "The effect of duloxetine on painful physical symptoms in depressed patients:do improvements in these symptoms result in higher remission rates?" 65 : 521-530, 2004
• 17 Pine DS, "The association between major depression and headache:results of a longitudinal epidemiologic study in youth" 6 : 153-164, 1996
• 18 Magni G, "Suicidality in chronic abdominal pain:an analysis of the Hispanic Health and Nutrition Examination Survey(HHANES)" 76 : 137-144, 1998
• 19 Suarez-Roca H, "Stressinduced muscle and cutaneous hyperalgesia:differential effect of milnacipran" 88 : 82-87, 2006
• 20 Roozendaal B, "Stress, memory and the amygdala"
• 21 Ohayon MM, "Specific characteristics of the pain/depression association in the general population" 65 (65): 5-9, 2004
• 22 Kirmayer LJ, "Somatization and the recognition of depression and anxiety in primary care" 150 : 734-741, 1993
• 23 Roehrs T, "Sleep loss and REM sleep loss are hyperalgesic" 29 : 145-151, 2006
• 24 Offenbaecher M, "Self-reported depression,familial history of depression and fibromyalgia(FM),and psychological distress in patients with FM" 57 (57): 94-96, 1998
• 25 Simpson DA, "Selective inhibition from the anterior hypothalamus of C-versus A-fibre mediated spinal nociception" 136 : 305-312, 2008
• 26 Tan-No K, "S-(+)-fenfluramine-induced nociceptive behavior in mice:Involvement of interactions between spinal serotonin and substance P systems" 41 : 33-38, 2007
• 27 Wood PB, "Role of central dopamine in pain and analgesia" 8 : 781-797, 2008
• 28 Rao U, "Risk markers for depression in adolescents:sleep and HPA measures" 34 : 1936-1945, 2009
• 29 Means-Christensen AJ, "Relationships among pain,anxiety,and depression in primary care" 25 : 593-600, 2008
• 30 Burton AK, "Psychosocial predictors of outcome in acute and subchronic low back trouble" 20 : 722-728, 1995
• 31 Wasan AD, "Psychopathology predicts the outcome of medial branch blocks with corticosteroid for chronic axial low back or cervical pain:a prospective cohort study" 10 : 22-, 2009
• 32 Gilbody SM, "Psychiatrists in the UK do not use outcomes measures.National survey" 180 : 101-103, 2002
• 33 Magni G, "Prospective study on the relationship between depressive symptoms and chronic musculoskeletal pain" 56 : 289-297, 1994
• 34 Kurland JE, "Prevalence of irritable bowel syndrome and depression in fibromyalgia" 51 : 454-460, 2006
• 35 Celestin J, "Pretreatment psychosocial variables as predictors of outcomes following lumbar surgery and spinal cord stimulation:a systematic review and literature synthesis" 10 : 639-653, 2009
• 36 Kroenke K, "Physical symptoms in primary care.Predictors of psychiatric disorders and functional impairment" 3 : 774-779, 1994
• 37 Cui M, "Periaqueductal gray stimulation-induced inhibition of nociceptive dorsal horn neurons in rats is associated with the release of norepinephrine,serotonin,and amino acids" 289 : 868-876, 1999
• 38 Leuchter AF, "Painful physical symptoms and treatment outcome in major depressive disorder: a STAR*D (Sequenced Treatment Alternatives to Relieve Depression) report"
• 39 Karp JF, "Pain predicts longer time to remission during treatment of recurrent depression" 66 : 591-597, 2005
• 40 Fields HL, "Pain modulation:expectation,opioid analgesia and virtual pain" 122 : 245-253, 2000
• 41 Corruble E, "Pain complaints in depressed inpatients" 33 : 307-309, 2000
• 42 Ilgen MA, "Pain and suicidal thoughts,plans and attempts in the United States" 30 : 521-527, 2008
• 43 Ignelzi RJ, "Pain and its modulation.Part 2.efferent mechanisms" 6 : 584-590, 1980
• 44 Ignelzi RJ, "Pain and its modulation.Part 1.Afferent mechanisms" 6 : 577-583, 1980
• 45 Dafny N, "Pain Modulation and Mechanisms In Section 2: Sensory Systems"
• 46 Dworkin SF, "Multiple pains and psychiatric disturbance.An epidemiologic investigation" 47 : 239-244, 1990
• 47 McBeth J, "Moderation of psychosocial risk factors through dysfunction of the hypothalamic-pituitary-adrenal stress axis in the onset of chronic widespread musculoskeletal pain:findings of a population-based prospective cohort study" 56 : 360-371, 2007
• 48 Onal A, "Milnacipran attenuates hyperalgesia and potentiates antihyperalgesic effect of tramadol in rats with mononeuropathic pain" 88 : 171-178, 2007
• 49 Demyttenaere K, "Mental disorders among persons with chronic back or neck pain:results from the World Mental Health Surveys" 129 : 332-342, 2007
• 50 Geerlings SW, "Longitudinal relationship between pain and depression in older adults:sex,age and physical disability" 37 : 23-30, 2002
• 51 Patten SB, "Long-term medical conditions and major depression in a Canadian population study at waves 1 and 2" 63 : 35-41, 2001
• 52 Oslund S, "Long-term effectiveness of a comprehensive pain management program:strengthening the case for interdisciplinary care" 22 : 211-214, 2009
• 53 Boulanger L, "Impact of comorbid depression or anxiety on patterns of treatment and economic outcomes among patients with diabetic peripheral neuropathic pain" 25 : 1763-1773, 2009
• 54 Potvin S, "Human evidence of a supra-spinal modulating role of dopamine on pain perception" 63 : 390-402, 2009
• 55 Pae CU, "History of early abuse as a predictor of treatment response in patients with fibromyalgia: A post-hoc analysis of a 12-week, randomized, double- blind, placebo-controlled trial of paroxetine controlled release"
• 56 Marks DM, "History of depressive and anxiety disorders and paroxetine response in patients with irritable bowel syndrome:post hoc analysis from a placebo-controlled study" 10 : 368-375, 2008
• 57 Munce SE, "Gender differences in depression and chronic pain conditions in a national epidemiologic survey" 48 : 394-399, 2007
• 58 Lee P, "Frequency of painful physical symptoms with major depressive disorder in asia:relationship with disease severity and quality of life" 70 : 83-91, 2009
• 59 Von Korff M, "First onset of common pain symptoms:a prospective study of depression as a risk factor" 55 : 251-258, 1993
• 60 Ercolani M, "Fibromyalgic syndrome:depression and abnormal illness behavior.Multicenter investigation" 61 : 178-186, 1994
• 61 Raphael KG, "Familial aggregation of depression in fibromyalgia:a community-based test of alternate hypotheses" 110 : 449-460, 2004
• 62 Jelinski SE, "Factors associated with depression in patients referred to headache specialists" 68 : 489-495, 2007
• 63 Semenchuk MR, "Efficacy of sustained-release bupropion in neuropathic pain:an open-label study" 16 : 6-11, 2000
• 64 Iyengar S, "Efficacy of duloxetine,a potent and balanced serotonin-norepinephrine reuptake inhibitor in persistent pain models in rats" 311 : 576-584, 2004
• 65 Semenchuk MR, "Double-blind,randomized trial of bupropion SR for the treatment of neuropathic pain" 57 : 1583-1588, 2001
• 66 Kojima M, "Depression,inflammation,and pain in patients with rheumatoid arthritis" 61 : 1018-1024, 2009
• 67 Dufton BD, "Depression and the mediation of chronic pain" 51 : 248-250, 1990
• 68 Bair MJ, "Depression and pain comorbidity:a literature review" 163 : 2433-2445, 2003
• 69 Henry JL, "Concepts of pain sensation and its modulation" 19 : 104-112, 1989
• 70 Arnold LM, "Comorbidity of fibromyalgia and psychiatric disorders" 67 : 1219-1225, 2006
• 71 Demyttenaere K, "Comorbid painful physical symptoms and depression:prevalence,work loss,and help seeking" 92 : 185-193, 2006
• 72 Arnow BA, "Comorbid depression,chronic pain,and disability in primary care" 68 : 262-268, 2006
• 73 Baune BT, "Combined effects of major depression,pain and somatic disorders on general functioning in the general adult population" 138 : 310-317, 2008
• 74 Creavin ST, "Co-occurrence and associations of pain and fatigue in a community sample of Dutch adults"
• 75 Katon WJ, "Clinical and health services relationships between major depression,depressive symptoms,and general medical illness" 54 : 216-226, 2003
• 76 Ratcliffe GE, "Chronic pain conditions and suicidal ideation and suicide attempts:an epidemiologic perspective" 24 : 204-210, 2008
• 77 Von Korff M, "Chronic pain and use of ambulatory health care" 53 : 61-79, 1991
• 78 Magni G, "Chronic musculoskeletal pain and depressive symptoms in the general population.An analysis of the 1st National Health and Nutrition Examination Survey data" 43 : 299-307, 1990
• 79 Magni G, "Chronic abdominal pain and depression.Epidemiologic findings in the United States.Hispanic Health and Nutrition Examination Survey" 49 : 77-85, 1992
• 80 Whooley MA, "Case-finding instruments for depression.Two questions are as good as many" 12 : 439-445, 1997
• 81 Zubieta JK, "COMT val158met genotype affects mu-opioid neurotransmitter responses to a pain stressor" 299 : 1240-1243, 2003
• 82 Blumer D, "Biological markers for depression in chronic pain" 170 : 425-428, 1982
• 83 Bair MJ, "Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients" 70 : 890-897, 2008
• 84 Ang QQ, "Association between painful physical symptoms and clinical outcomes in East Asian patients with major depressive disorder:a 3-month prospective observational study" 63 : 1041-1049, 2009
• 85 Burckhardt CS, "Assessing depression in fibromyalgia patients" 7 : 35-39, 1994
• 86 Lin Q, "Antinociception and inhibition from the periaqueductal gray are mediated in part by spinal 5-hydroxytryptamine(1A)receptors" 276 : 958-967, 1996
• 87 Simon GE, "An international study of the relation between somatic symptoms and depression" 341 : 1329-1335, 1999
• 88 Wells KB, "Affective,substance use,and anxiety disorders in persons with arthritis,diabetes,heart disease,high blood pressure,or chronic lung conditions" 11 : 320-327, 1989
• 89 Behan PO, "A pilot study of sertraline for the treatment of chronic fatigue syndrome" 18 : S111-, 1994