Pain is a subjective experience that is influenced by genetics, gender, social, cultural and personal parameters. Opposed to chronic pain, which by definition has to last for at least 3 months, acute pain is mostly because of trauma, acute medical conditions or treatment. The link between mood disorders and acute pain has proven to be increasingly significant since the link is bi-directional, and both act as risk factors for each other. Depression and anxiety are associated with increased perception of pain severity, whereas prolonged duration of acute pain leads to increased mood dysregulation. (Michaelides & Zis, 2019).
Accumulating evidence suggests than neuroinflammation plays a critical role in the pathogenesis of both depression and chronic pain. (Zis et al, 2017)
Psychological pain is a prominent dimension of depressive disorder and has been associated with higher risk of suicidal ideation and suicidal behavior. Sensitivity to psychological and physical pain is increased in depression. (Conejero et al, 2018)
Depression and pain share biological pathways and neurotransmitters, which has implications for the treatment of both concurrently. (Bair et al, 2003) Treating both the conditions together is essential for an effective treatment outcome. Central serotonin (5-hydroxytryptamine; 5-HT) neurotransmission has long been known to participate in the processing of signals related to pain. It also plays a key role in the pathogenesis and treatment of depression. (Haleem, 2019) Both disorders activate common neurocircuitries (e.g. the hypothalamic-pituitary-adrenal axis, limbic and paralimbic structures, ascending and descending pain tracks), common neurochemicals (e.g. monoamines, cytokines, and neurotrophic factors), and are associated with common psychological alterations. (Robinson et al, 2009)
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Zis P, Daskalaki A, Bountouni I, Sykioti P, Varrassi G, Paladini A. Depression and chronic pain in the elderly: links and management challenges. Clin Interv Aging. 2017 Apr 21;12:709-720. doi: 10.2147/CIA.S113576. PMID: 28461745; PMCID: PMC5407450.
Conejero I, Olié E, Calati R, Ducasse D, Courtet P. Psychological Pain, Depression, and Suicide: Recent Evidences and Future Directions. Curr Psychiatry Rep. 2018 Apr 5;20(5):33. doi: 10.1007/s11920-018-0893-z. PMID: 29623441.
Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003 Nov 10;163(20):2433-45. doi: 10.1001/archinte.163.20.2433. PMID: 14609780.
Haleem DJ. Targeting Serotonin1A Receptors for Treating Chronic Pain and Depression. Curr Neuropharmacol. 2019;17(12):1098-1108. doi: 10.2174/1570159X17666190811161807. PMID: 31418663; PMCID: PMC7057205.
Robinson MJ, Edwards SE, Iyengar S, Bymaster F, Clark M, Katon W. Depression and pain. Front Biosci (Landmark Ed). 2009 Jun 1;14(13):5031-51. doi: 10.2741/3585. PMID: 19482603.