title: Depression and pain.
abstract: Depression and pain disorders are often diagnosed in the same patients. Here we summarize the shared pathophysiology between both disorders and the importance of addressing all symptoms in patients with comorbid pain and depression. We describe anatomical structures that are activated and/or altered in response to both depression and pain--examples include the insular cortex, the prefrontal cortex, the anterior cingulate cortex, the amygdala, and the hippocampus. 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. One explanation for the interaction and potentiation of the disease burden experienced by patients affected by both pain and depression is provided by the concept of allostasis. In this model, patients accumulate allostatic load through internal and external stressors, which makes them more susceptible to disease. To break this cycle, it is important to treat all symptoms of a patient. Therapeutic approaches that address symptoms of both depression and pain include psychotherapy, exercise, and pharmacotherapy.
authors.affiliation: Lilly USA, LLC, Indianapolis, IN 46285, USA. Robinson_Michael_J@Lilly.com
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Robinson
authors.forename: Sara E
authors.initials: SE
authors.lastname: Edwards
authors.forename: Smriti
authors.initials: S
authors.lastname: Iyengar
authors.forename: Frank
authors.initials: F
authors.lastname: Bymaster
authors.forename: Michael
authors.initials: M
authors.lastname: Clark
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
mesh_terms: D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D016207:Cytokines / Q000502:physiology; D003863:Depression / Q000150:complications* / Q000503:physiopathology* / Q000628:therapy; D003865:Major Depressive Disorder / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D005081:Exercise Therapy; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008959:Models, Neurological; D008960:Models, Psychological; D009434:Neural Pathways / Q000503:physiopathology; D018377:Neurotransmitter Agents / Q000502:physiology; D014179:Neurotransmitter Uptake Inhibitors / Q000627:therapeutic use; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D011613:Psychotherapy; D013001:Somatoform Disorders / Q000150:complications* / Q000503:physiopathology* / Q000628:therapy
chemical_list: D000929:Antidepressive Agents, Tricyclic; D016207:Cytokines; D018377:Neurotransmitter Agents; D014179:Neurotransmitter Uptake Inhibitors