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The interface of pain and mood disturbances in the rheumatic diseases
Seminars in Arthritis and Rheumatism, 06/30/09

Goldenberg DL et al. – This review provides a basis for understanding the importance of the pain/depression interface in the rheumatic illnesses. Clinical and pathophysiologic studies in fibromyalgia (FM) demonstrate the striking overlap of pain and depression.

Methods

Aim was to review:
- Overlap of pain and depression in the rheumatic diseases, focusing on FM and RA, and
- To provide treatment recommendations based on an understanding of this interface
A literature search was performed through PubMed and Medline, for the yrs 1978 to 2008
Keywords used: depression, mood disorders, pain, arthritis, fibromyalgia, rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus, scleroderma, antidepressants, exercise, and cognitive behavioral therapy

Results

Review focuses on the pain/depression interface in common rheumatic disorders; treatment principles are outlined as:
- Pain and depression are inseparable, bidirectional
- Explain to patients the shared neurobiology of pain and depression
- Always evaluate and treat sleep disturbances
- “Bundle” the treatment of mood disturbances with physical symptoms carefully
- Use diagnostic labels cautiously; avoid causation
- Avoid inactivity, fear-avoidance
- Neural pain dysregulation is prominent in all rheumatic diseases (FM model)
General therapeutic recommendations can be made based on these overlapping models of the interface of pain and depression