Can depression exist without pain? Review article
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Abstract
The relationship between pain and depression seems to be two-way: depression is accompanied by an increased experience of pain, and pain syndromes are accompanied by depressive symptoms. We can talk at least about the coexistence of these two phenomena, and most likely also about a common etiopathogenesis and therapy.
The definition of depressive syndrome, proposed by the basic diagnostic systems (ICD-10, DSM-5), does not take into account the symptoms often found in depressed patients, including pain, but also anxiety or sexual disorders. This is explained by striving for greater specificity in the diagnosis of depression, but paradoxically, it may just make the correct diagnosis difficult. For example, depression may proceed solely in the form of a “pain mask” without the manifestation of symptoms considered typical in classification systems. Similarly, difficulties in clinical practice may arise when a properly diagnosed somatic disease is treated as drug-resistant due to hidden depression manifested by increased pain expression. Chronic stress and chronic somatic diseases ultimately contribute to the development of chronic depressive disorders and chronic pain disorders. Low self-esteem and a sense of disability – through a system of biochemical and biophysiological feedback loops – lead to the intensification of somatic symptoms, including pain, which in turn deepens even more low self-esteem and lowers mood.
Therapy in such states must be comprehensive, including appropriate pharmacotherapy, psychological counseling, relaxation and meditation techniques, stress reduction therapy, properly programmed physical activity, assertiveness training and other strategies. Antidepressants in general, and in particular some of their groups or specific representatives – especially SNRI (venlafaxine, duloxetine) – significantly reduce pain. Moreover, the analgesic potential of these drugs is so high that they are used in the treatment of pain states of somatic diseases even without depressive symptoms.
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