Seminars in Arthritis and Rheumatism
Volume 40, Issue 1 , Pages 15-31, August 2010

The Interface of Pain and Mood Disturbances in the Rheumatic Diseases

  • Don L. Goldenberg, MD

      Affiliations

    • Corresponding Author InformationAddress reprint requests to Don L. Goldenberg, MD, 2000 Washington St., Newton, MA 02468

Chief, Rheumatology, Newton-Wellesley Hospital, Professor of Medicine, Tufts University School of Medicine, Newton, MA

published online 17 February 2009.

Objectives

To review the overlap of pain and depression in the rheumatic diseases, focusing on fibromyalgia (FM) and rheumatoid arthritis, and to provide treatment recommendations based on an understanding of this interface.

Methods

A literature search was performed through PubMed and Medline, for the years 1978 to 2008 and using the keywords: depression, mood disorders, pain, arthritis, fibromyalgia, rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus, scleroderma, antidepressants, exercise, and cognitive behavioral therapy.

Results

This review focuses on the pain/depression interface in common rheumatic disorders. FM is an excellent model to study the proposed mechanisms of such interactions. The potential genetic, inflammatory/immune, morphologic, and neurohormonal mechanisms that have been reported in FM are reviewed and compared with similar studies in depression. The importance of the interface of pain and depression has been noted in rheumatoid arthritis and other rheumatic illnesses, although there are very few studies to investigate their pathophysiologic underpinnings. General therapeutic recommendations can be made based on these overlapping models of the interface of pain and depression.

Conclusions

Clinical and pathophysiologic studies in FM demonstrate the striking overlap of pain and depression. These studies pertain to a better understanding of the pain/depression interface in all chronic rheumatic illnesses.

Keywords: depression, fibromyalgia, rheumatoid arthritis, osteoarthritis

Abbreviations: BDNF, Brain-derived neurotrophic factor, CBT, Cognitive behavioral therapy, CNS, Central nervous system, COMT, Catechol-O-methyltransferase, CRH, Corticotropin-releasing hormone, CRP, C-reactive protein, CSF, Cerebrospinal fluid, CWP, Chronic widespread pain, FM, Fibromyalgia, GABA, Gamma-aminobutyric acid, HPA, Hypothalamic-pituitary-adrenal, IBS, Irritable bowel syndrome, IL, Interleukin, MRI, Magnetic resonance imaging, NMDA, N-methyl-d-aspartate, OA, Osteoarthritis, PET, Positron emission tomography, RA, Rheumatoid arthritis, SNRI, Serotonin-norepinephrine reuptake inhibitor (dual reuptake inhibitor), SSRI, Selective serotonin reuptake inhibitor, TNF, Tumor necrosis factor

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 Dr. Goldenberg is a consultant and on the Advisory Board for Pfizer, Lilly, and Forest Pharmaceuticals.

PII: S0049-0172(08)00213-8

doi:10.1016/j.semarthrit.2008.11.005

Seminars in Arthritis and Rheumatism
Volume 40, Issue 1 , Pages 15-31, August 2010

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