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Chronic Pain Pharmacological Treatment in Patients with Depressive Disorders

Aurilio C, Pace MC, Passavanti MB, Pota V, Sansone P, Barbarisi M, Rossi A, Coaccioli S, Chieffi S, Messina G and Marcellino Monda

Background and Objective: Frequently patients with chronic pain show depressive disorders. The co-morbidity of pain and depressive disorders has a negative impact on the patient’s outcome, with an increase of the costs relating to health expenses, a reduction of productivity and a reduction of a probable remission of depressive symptoms. Following the evidences till now examined and reported, the study group elaborated recommendations for the pain and depressive disorder treatment.
Databases and Data Treatment: We searched all potentially relevant publications in Medline database from 1990 to 2014. A quality assessment was conducted categorizing following a power of evidence criteria. Results: Forty-six relevant publications were identified: 34 randomized and controlled studies (RCT), 11 metaanalyses or reviews of literature and 1 observational open-label.
Conclusions: In a condition of co-morbidity of chronic pain and depressive disorder there is poor evidence for the tricyclic antidepressant efficacy. Among the inhibitors of the serotonin-noradrenalin reuptake, duloxetine proved to be efficient in the short-long term treatment of the pain and depressive disorder states. There is poor evidence for the inhibitor use of serotonin re-uptake in the co-morbidity states of arthritis pain and depressive disorder, against their higher efficacy in the irritable bowel syndrome