The Relationship Between Pain and Depression in a Trial Using Paroxetine in Sufferers of Chronic Low Back Pain

Dickens, Chris; Jayson, M. I. V.; Sutton, Chris; Creed, Francis

doi:10.1176/appi.psy.41.6.490

Cited by 86 publications

(65 citation statements)

References 18 publications

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“…Only 4 studies 6,132,137,141 were conducted in a primary care setting, with the remainder situated in pain, psychiatric, and specialty clinics. The intervention arm of each selected study usually involved tricyclic antidepressants, and only 4 studies involved selective serotonin reuptake inhibitors (SSRIs) 135,138,143,145 to assess pain and depression. While most of the studies demonstrated improvement in both pain and depression symptoms, a few of the studies 132,142,147 failed to show symptom relief.…”

Section: Is Antidepressant Treatment For Painful Symptoms and Comorbimentioning

confidence: 99%

Depression and Pain Comorbidity

Bair¹,

Robinson²,

Katon³

et al. 2003

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Because depression and painful symptoms commonly occur together, we conducted a literature review to determine the prevalence of both conditions and the effects of comorbidity on diagnosis, clinical outcomes, and treatment. The prevalences of pain in depressed cohorts and depression in pain cohorts are higher than when these conditions are individually examined. The presence of pain negatively affects the recognition and treatment of depression. When pain is moderate to severe, impairs function, and/or is refractory to treatment, it is associated with more depressive symptoms and worse depression outcomes (eg, lower quality of life, decreased work function, and increased health care utilization). Similarly, depression in patients with pain is associated with more pain complaints and greater impairment. Depression and pain share biological pathways and neurotransmitters, which has implications for the treatment of both concurrently. A model that incorporates assessment and treatment of depression and pain simultaneously is necessary for improved outcomes.

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Section: Is Antidepressant Treatment For Painful Symptoms and Comorbimentioning

confidence: 99%

Depression and Pain Comorbidity

Bair¹,

Robinson²,

Katon³

et al. 2003

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“…Several studies have documented relationships between neuroticism and depression and reports of pain in patients with chronic pain [19][20][21][22][23][24][25][26]. Neuroticism has been found to be related to pain unpleasantness (an affective dimension of pain) but not to pain intensity [19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

The association of depression and neuroticism with pain reports: A comparison of momentary and recalled pain assessment

Raselli¹,

Broderick²

2007

Journal of Psychosomatic Research

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“…They also contrast with findings from an extension study (n ¼ 181), in which the effect of duloxetine on pain reduction was maintained (and reduced further) during the 41-week follow-up period 96 . In a placebo-controlled trial of patients with chronic LBP and depressive symptoms (n ¼ 92), 56 days' treatment with the selective serotonin reuptake inhibitor paroxetine 20 mg did not significantly improve depression, pain or disability compared with placebo 97 . In addition, no direct relationship between pain and depression was observed in this study; associations were entirely mediated by disability and illness attitudes and were lost when these factors were controlled 97 .…”

Section: Antidepressantsmentioning

confidence: 94%

“…In a placebo-controlled trial of patients with chronic LBP and depressive symptoms (n ¼ 92), 56 days' treatment with the selective serotonin reuptake inhibitor paroxetine 20 mg did not significantly improve depression, pain or disability compared with placebo 97 . In addition, no direct relationship between pain and depression was observed in this study; associations were entirely mediated by disability and illness attitudes and were lost when these factors were controlled 97 . It should be noted that SSRI use is limited by ADRs, including sexual dysfunction, weight gain and sleep disturbance as reviewed by Ferguson 98 .…”

Section: Antidepressantsmentioning

confidence: 94%

Pharmacotherapy of low back pain: targeting nociceptive and neuropathic pain components

Morlion¹

2010

Current Medical Research and Opinion

114

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Vol. 27, No. 1, 2011, 11-33 To review pharmacological management of chronic low back pain (LBP), with respect to management of nociceptive and neuropathic components. Methods:Studies were identified by a PubMed search of English-language papers from the last 10 years, with additional hand searches of relevant reviews. Discussion:Paracetamol, non-steroidal anti-inflammatory drugs and cyclo-oxygenase-2 inhibitors target the nociceptive component of chronic LBP, and do not affect neuropathic pain mechanisms. Antidepressants target the neuropathic component of chronic LBP; however, conflicting efficacy results have been reported. Opioids target both nociceptive and to a lesser extent neuropathic pain. They are effective in chronic LBP, but many patients require higher doses or combination treatment. The long-term efficacy of opioids in chronic LBP has been questioned because of the absence of high-quality data and concerns regarding tolerability and dependence. The topical preparation lidocaine 5% plaster, indicated in post-herpetic neuralgia, is effective in localized neuropathic pain in patients with chronic LBP. Pregabalin is ineffective as monotherapy for chronic LBP but is effective when combined with celecoxib or opioids. Muscle relaxant monotherapy is ineffective in chronic LBP. Combination therapy is often necessary in patients with chronic LBP, in order to manage both nociceptive and neuropathic pain components. Conclusion:Chronic LBP often comprises both nociceptive and neuropathic components, therefore a multimodal and individualized treatment approach is necessary. Combining drugs with different mechanisms of action (e.g. an agent with m-receptor activity plus an agent of a different class) represents a rational approach to management of chronic LBP with both nociceptive and neuropathic components.

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The Relationship Between Pain and Depression in a Trial Using Paroxetine in Sufferers of Chronic Low Back Pain

Cited by 86 publications

References 18 publications

Depression and Pain Comorbidity

Depression and Pain Comorbidity

The association of depression and neuroticism with pain reports: A comparison of momentary and recalled pain assessment

Pharmacotherapy of low back pain: targeting nociceptive and neuropathic pain components

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