Coexistence of Chronic Pain and Depression: A Short Review with a Focus on the Antidepressant Effect of Tramadol and Buprenorphine

Abstract

It is known that there is a strong relationship between chronic pain and depression, and both of these diseases can intensify each other. In addition to mental illnesses, there are also a number of somatic symptoms, including pain. While pain, especially chronic, is always associated with mental suffering, which can aggravate the symptoms of depression. Proper and timely identification of coexistence of these conditions allows for effective and safe pharmacotherapy.This article reviews the literature on the coexistence of chronic pain and depressive disorders. The common mechanisms of both these diseases and the frequency of their coexistence have been described. The results of studies on the problem of treatment of patients with chronic pain with concomitant depression and patients with depression declaring pain are presented. The role of tramadol and buprenorphine in relieving symptoms of depression, including severe and refractory to traditional treatment, has also been described.

Low-Dose Tramadol as an Off-Label Antidepressant: A Data Mining Analysis from the Patients’ Perspective

“…The use of tramadol as an antidepressant has not received such scrutiny. Nevertheless, its ability to function as an antidepressant has been well-documented. − …”

“…In addition to its use as an analgesic, there is substantial evidence that tramadol is an effective antidepressant. This evidence is presented and/or summarized in over 50 citations in the peer-reviewed biomedical literature in animal models, − in humans, − in the patent literature, − and in reports provided by patients. − The World Health Organization (WHO) Expert Committee on Drug Dependence published a comprehensive review of the chemistry, biochemistry, and biomedical aspects of tramadol in 2018 . Much of the background information and review material presented here concerning this medication is from this reference and references therein.…”

The effect of divided and directed attention on the magnitude of spatial summation of pain

“…The next stage (transmission) is the process of conducting the resulting electrical impulse to the posterior (dorsal) horns of the spinal cord and the higher levels of the CNS. This is possible via two types of nerve fibers, which are protrusions of the I nociceptive neuron located in the posterior medullary ganglion: the Aδ (A-delta) fiber and the C-fiber [14]. Myelinated Aδ fibers form receptive fields with a relatively small surface area, so the patient is usually able to pinpoint a painful spot on the body, such as from a sting or blow.…”

“…The final component of nociceptive pain formation is perception itself, occurring in the quaternary sensory neurons of the cerebral cortex. At this stage, there is a conscious sensation of pain, an evaluation of its intensity of emotional expression, and a possible change in behavior [13,14]. Further information processing involves the structures of the amygdala and hypothalamus, the insula, and the cingulate gyrus, the anterior part of which is involved in the formation of the affective aspect of pain [15,16].…”