Pain and the Brain

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Chronic pain is difficult to diagnose and treat, and is often comorbid with psychiatric conditions. Pain and mood disorders may share neurologic pathways and a neurochemical base. For example, depression is associated with abnormalities in serotonin and norepinephrine, neurotransmitters that also modulate the endogenous analgesic system. Further, co-occurring depression and pain may obscure a diagnosis of the other, secondary condition. Agents that inhibit pain signals and boost serotonin and norepinephrine levels, such as serotonin-norepinephrine reuptake inhibitors (SNRIs), may provide pain relief as well as alleviate psychiatric symptom. Psychotherapies and education should also be considered to help patients achieve optimal functioning. The pathophysiology, diagnosis, and treatment of pain and mood disorders are discussed in this video, which features case studies of and expert commentary on patients with diabetic neuropathy, lower back pain, and chronic widespread pain.

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J Clin Psychiatry 2008;69(9):e25