NEUROBIOLOGICAL AND CLINICAL RELATIONSHIP BETWEEN PSYCHIATRIC DISORDERS AND CHRONIC PAIN

Other literature type English OPEN
Barš, Marijana ; Đorđević, Veljko ; Gregurek, Rudolf ; Bulajić, Maša (2010)
  • Publisher: Medicinska naklada
  • Journal: Psychiatria Danubina, volume 22, issue 2 (issn: 0353-5053)
  • Subject: pain; drug therapy; comorbidity; psychiatric disorder; psychotherapy; Liaison psychiatrist

Pain is one of the most ubiquitious problems of today's world, its impact being far-reaching. Current conceptualizations of pain medicine adopt a bio-psycho-social perspective. In this model, pain is best described as an interactive, psycho-physiological behaviour pattern that cannot be divided into independet psycho-social and physical components. Neurophysiologic substrates of the pain experience can be broken down into the pain transmission elements emanating from peripheral, spinal, and supra-spinal processes. There are many complex mechanisms involved in pain processing within the central nervous system, being influenced by genetics, interaction of neurotransmitters and their receptors, and pain -augmenting and pain -inhibiting neural circuits. The patient's emotional experiences, beliefs and expectations may determine the outcome of treatment, and are fully emphasized in the focus of treatment interventions. There are several common psychiatric disorders accompanying and complicating the experience of pain and warrant clinical attention and that can be the focus of psychiatric treatment. These include depression, anxiety, sleep disorders, somatoforn disorders, substance-related disorders and ppersonality disorders. Complex and disabling pain conditions often require comprehensive pain treatment of the patients with pain, individually tailored to meet the specific needs of the patient. Rational poly-pharmacy is of a high importance in the treatment of patients with cronic pain, with antidepressants and anticonvulsants contributing as the important adjuvant analgetic agents.
  • References (15)
    15 references, page 1 of 2

    1. Atkinson JH, Meyer JM, Slater MA. Principles of Psychopharmacology in Pain Treatment. U: Dworkin RH, Breitbart WS. Psychosocial Aspects of Pain: A Handbook for Health Care Providers. Seattle: IASP Press, 2004:231-60.

    2. Bouckoms AJ. Chronic Pain: Neuropsychopharmacology and Adjunctive Psychiatric Treatment. In: Rundel J, Wise M. Textbook of Consultation-Liaison Psychiatry. Washington: American Psychiatric Press Inc, 1999; 41:1006-36.

    3. Braš M, Fingler M, Filaković P. Kronična bol. U: Gregurek R. i sur. Suradna i konzultativna psihijatrija. Psihijatrijski i psihološki problemi u somatskoj medicini. Zagreb: Školska knjiga, 2006:101-12.

    4. Braš M. Antidepresivi u liječenju kronične boli, onkologiji i palijativnoj medicini. U: Mihaljević-Peleš A, Šagud M. Antidepresivi u kliničkoj praksi. Zagreb: Medicinska naklada, 2009:41-54.

    5. Diatchenko L, Slade GD, Nackley AG et al. Genetic basis for individual variations in pain perception and the development of a chronic pain condition. Hum Mol Genet 2005; 14:135-43.

    6. Folnegović-Šmalc V. MKB-10 klasifikacija mentalnih poremećaja i poremećaja ponašanja - klinički opisi i dijagnostičke smjernice; Hrvatsko izdanje. Zagreb: Medicinska naklada, 1999.

    7. Keefe FJ, Rumble ME, Scipio CD, Giordano LA, Perri LM. Psychological aspects of persistent pain: current state of the science, invited comentary. J Pain 2004;5:195-211.

    8. Leo RJ, Barkin RL. Antidepressant use in chronic pain management: Is there evidence of a role for duloxetine? Prim Care Companion J Clin Psychiatry 2003;5:118-23.

    9. Leo RJ. Clinical Manual of Pain Management in Psychiatry. Arlington: American Psychiatric Publishing, Inc., 2007.

    10. Nackley AG, Tan KS, Fecho K, Flood P, Diatchenko L, Maixner W. Catechol-O-methyltransferase inhibition increases pain sensitivity through activation of both beta2- and beta3-adrenergic receptors. Pain 2007; 128:199-208.

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