Key Learning Points

• Chronic pain and depression are epidemiological^ linked.

• Individuals with chronic pain and depressive symptoms have altered responses to pain stimuli and opioids.

• Functional neuroimaging techniques demonstrate differences in brain activity among adults with chronic pain and depression.

• Antidepressants have proven efficacy for treatment of chronic pain of diverse etiologies.

• Serotonin syndrome, serotonin withdrawal syndrome, and suicide are associated with use of antidepressants.

INTRODUCTION

Clinicians have long recognized the close association between depression and chronic pain. Findings from epidemiologic and experimental pain studies now provide empirical evidence to support this longstanding clinical observation. Knowledge of the epidemiologic associations and pathophysiological processes that interrelate chronic pain and depression provide a broad framework for understanding the clinical use of antidepressants in the treatment of chronic pain. Advancements in the understanding of drug mechanisms and awareness of adverse effects unique to antidepressant medications could further enhance clinical outcomes and improve patient safety.

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