Abstract

Chronic pain is a serious public health problem with a strong affective-motivational component that makes it difficult to treat. Most patients with chronic pain suffer from severe depression; hence, both conditions coexist and exacerbate one another. Brain inflammatory mediators are critical for maintaining depression-pain syndrome and could be substrates for it. The goal of our paper was to review clinical and preclinical findings to identify the neuroinflammatory profile associated with the cooccurrence of pain and depression. In addition, we aimed to explore the regulatory effect of neuronal reorganization on the inflammatory response in pain and depression. We conducted a quantitative review supplemented by manual screening. Our results revealed inflammatory signatures in different preclinical models and clinical articles regarding depression-pain syndrome. We also identified that improvements in depressive symptoms and amelioration of pain can be modulated through direct targeting of inflammatory mediators, such as cytokines and molecular inhibitors of the inflammatory cascade. Additionally, therapeutic targets that improve and regulate the synaptic environment and its neurotransmitters may act as anti-inflammatory compounds, reducing local damage-associated molecular patterns and inhibiting the activation of immune and glial cells. Taken together, our data will help to better elucidate the neuroinflammatory profile in pain and depression and may help to identify pharmacological targets for effective management of depression-pain syndrome.

Highlights

  • Chronic pain is a complex disorder that significantly impacts society and is the leading cause of disability and financial burden worldwide (Global Burden of Disease Study 2016)

  • The structures that play an important role in pain and depression states listed in the selected papers included the cerebral cortex and its subdivisions, the prefrontal cortex (PFC), the anterior cingulate cortex (ACC), the amygdala, the hippocampus, and the raphe nuclei, as alterations in plasma were observed in human subjects

  • Regarding treatment for depression-pain syndrome, we found that therapies with different mechanisms may attenuate central and peripheral inflammation, raising a discussion about the relationship between the neuronal network and inflammation modulation

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Summary

Introduction

Chronic pain is a complex disorder that significantly impacts society and is the leading cause of disability and financial burden worldwide (Global Burden of Disease Study 2016) It is considered a public health problem and affects approximately 20% of the general population (Breivik et al, 2006). It has been estimated that 85% of people affected with chronic pain suffer from severe depression (Bair et al, 2003; Williams et al, 2003), supporting the concept that both conditions coexist and exacerbate one another (Gallagher and Verma, 1999; Blier and Abbott, 2001; Leo, 2005) This association has been labeled depression-pain syndrome or the depressionpain dyad (Lindsay and Wyckoff, 1981; Beckman, 2004; Cox et al, 2017)

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