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The Neurobiological and Therapeutic Intersection of Pain and Affective Disorders

Correspondence: Address correspondence to Michael Moskowitz, M.D., M.P.H., Division of Pain Medicine, University of California, Davis, Ellison Ambulatory Care Center, 4860 Y St., Suite 3020, Sacramento, CA; e-mail: smfishman{at}ucdavis.edu.

The majority of patients suffering from chronic pain have comorbid mood or anxiety disorders. This is not surprising as there is an affective component to all pain, and the chronic stress and social disruption caused by unrelenting pain erodes the individual’s ability to maintain a sense of identity, social context, and physical and emotional stability. Conversely, patients with chronic affective disorders develop an alarmingly high incidence of chronic pain. Regardless of primacy, when each disorder is present, both should be identified and treated. Anatomical, neurochemical, and neurophysiological commonalities between chronic pain and chronic affective disorders lead to striking overlap of medication treatments used with each group of disorders. Moreover, in treating both types of disorders, sophisticated polypharmacology is often the rule not the exception. With so much biopsychosocial complexity and overlap in mechanisms and treatments, the well-trained psychiatrist is ideally positioned to provide care for patients with chronic pain disorders.

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