The Neurobiological and Therapeutic Intersection of Pain and Affective Disorders

Moskowitz, Michael H.; Fishman, Scott M.

doi:10.1176/foc.4.4.465

Cited by 5 publications

(2 citation statements)

References 13 publications

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“…The experience of pain and emotion are intertwined [1] .Clinically, disorders involving the latter are often accompanied by reports of pain [2] . Equally, patients with chronic pain often suffer from affective disorders although the chain of causality linking the two remains to be established [3] .…”

Section: Introductionmentioning

confidence: 99%

Perception of Thermal Pain and the Thermal Grill Illusion Is Associated with Polymorphisms in the Serotonin Transporter Gene

et al. 2011

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AimThe main aim of this study was to assess if the perception of thermal pain thresholds is associated with genetically inferred levels of expression of the 5-HT transporter (5-HTT). Additionally, the perception of the so-called thermal grill illusion (TGI) was assessed. Forty-four healthy individuals (27 females, 17 males) were selected a-priori based on their 5-HTTLPR/rs25531 (‘tri-allelic 5-HTTLPR’) genotype, with inferred high or low 5-HTT expression. Thresholds for heat- and cold-pain were determined along with the sensory and affective dimensions of the TGI.ResultsThresholds to heat- and cold-pain correlated strongly (rho = −0.58, p<0.001). Individuals in the low 5-HTT-expressing group were significantly less sensitive to heat-pain (p = 0.02) and cold-pain (p = 0.03), compared to the high-expressing group. A significant gender-by-genotype interaction also emerged for cold-pain perception (p = 0.02); low 5-HTT-expressing females were less sensitive. The TGI was rated as significantly more unpleasant (affective-motivational dimension) than painful (sensory-discriminatory dimension), (p<0.001). Females in the low 5-HTT expressing group rated the TGI as significantly less unpleasant than high 5-HTT expressing females (p<0.05), with no such differences among men.Conclusion/SignificanceWe demonstrate an association between inferred low 5-HTT expression and elevated thresholds to thermal pain in healthy non-depressed individuals. Despite the fact that reduced 5-HTT expression is a risk factor for chronic pain we found it to be related to hypoalgesia for threshold thermal pain. Low 5-HTT expression is, however, also a risk factor for depression where thermal insensitivity is often seen. Our results may thus contribute to a better understanding of the molecular underpinnings of such paradoxical hypoalgesia. The results point to a differential regulation of thermoafferent-information along the neuraxis on the basis of 5-HTT expression and gender. The TGI, suggested to rely on the central integration of thermoafferent-information, may prove a valuable tool in probing the affective-motivational dimension of these putative mechanisms.

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Section: Introductionmentioning

confidence: 99%

Perception of Thermal Pain and the Thermal Grill Illusion Is Associated with Polymorphisms in the Serotonin Transporter Gene

et al. 2011

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“…In late life, these conditions increase the risk of suicide [9,10], polypharmacy [11], physical deconditioning and disability [12,13], cognitive impairment [14,15], and worsened caregiver burden [16]. A shared biology (e.g., similar neurotransmitter perturbation [17]) and psychology (learned helplessness, low self‐efficacy [18]) support a unified approach to treatment. Rationally developed and tested age‐specific interventions targeting these linked conditions are sorely needed.…”

Section: Introductionmentioning

confidence: 99%

Addressing Both Depression and Pain in Late Life: The Methodology of the ADAPT Study

Karp¹,

Rollman²,

Reynolds³

et al. 2012

Pain Med

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Objective To describe the methodology of the first NIH-funded clinical trial for seniors with comorbid depression and chronic low back pain. Methods Randomized controlled effectiveness trial using stepped care methodology. Participants are ≥ 60 years old. Phase 1 (6 weeks) is open treatment with venlafaxine xr 150 mg/day and supportive management (SM). Response is two weeks of PHQ-9 ≤ 5 and at least 30% improvement in the average numeric rating scale for pain. Non-responders progress to phase 2 (14 weeks) in which they are randomized to high-dose venlafaxine xr (up to 300 mg/day) with Problem Solving Therapy for Depression and Pain (PST-DP) or high-dose venlafaxine xr and continued SM. Primary outcomes are the univariate pain and depression response and both observed and self-report disability. Survival analytic techniques will be used, and the clinical effect size will be estimated with NNT. We hypothesize that self-efficacy for pain management will mediate response for subjects randomized to venlafaxine xr and PST-DP. Results Not applicable. Conclusions The results of this trial will inform the care of these complex patients and further understanding of comorbid pain and depression in late-life.

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Effect of Problem-Solving Therapy Versus Supportive Management in Older Adults with Low Back Pain and Depression While on Antidepressant Pharmacotherapy

Karp

Gao

Wahed

et al. 2018

The American Journal of Geriatric Psychiatry

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The Neurobiological and Therapeutic Intersection of Pain and Affective Disorders

Cited by 5 publications

References 13 publications

Perception of Thermal Pain and the Thermal Grill Illusion Is Associated with Polymorphisms in the Serotonin Transporter Gene

Perception of Thermal Pain and the Thermal Grill Illusion Is Associated with Polymorphisms in the Serotonin Transporter Gene

Addressing Both Depression and Pain in Late Life: The Methodology of the ADAPT Study

Effect of Problem-Solving Therapy Versus Supportive Management in Older Adults with Low Back Pain and Depression While on Antidepressant Pharmacotherapy

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