Benson Curtis, Mifflin Katherine, Kerr Bradley, Jesudasan Sam J B, Dursun Serdar, Baker Glen
Mod Trends Pharmacopsychiatry. 2015;30:67-79. doi: 10.1159/000435933. Epub 2015 Sep 18.
Although it is well known that there is a high degree of comorbidity between chronic pain and mood and anxiety disorders, the mechanisms involved in these co-occurrences are not clear. It appears that numerous neurotransmitters and neuromodulators are involved, and this chapter focuses on the monoamine neurotransmitters noradrenaline, 5-hydroxytryptamine (5-HT, serotonin), and dopamine and the amino acid neurotransmitters GABA (γ-aminobutyric acid) and glutamate in chronic pain and depression. Numerous preclinical and clinical neurochemical, neuroanatomical, pharmacological and molecular biological studies as well as clinical pharmacological treatment investigations implicate noradrenaline, 5-HT and, to a lesser extent, dopamine in the etiology of pain and depression. Similarly, preclinical and clinical studies on GABAergic and glutamatergic mechanisms as well as reports on the actions of neuroactive steroids suggest that GABA and glutamate play an important role in the etiology of pain and depression and may contribute to comorbidity.
尽管众所周知慢性疼痛与情绪和焦虑症之间存在高度共病现象，但这些共病所涉及的机制尚不清楚。似乎有多种神经递质和神经调质参与其中，本章重点关注单胺神经递质去甲肾上腺素、5-羟色胺（5-HT，血清素）、多巴胺以及氨基酸神经递质γ-氨基丁酸（GABA）和谷氨酸在慢性疼痛和抑郁症中的作用。大量临床前和临床神经化学、神经解剖学、药理学和分子生物学研究以及临床药物治疗研究表明，去甲肾上腺素、5-HT以及在较小程度上的多巴胺与疼痛和抑郁症的病因有关。同样，关于GABA能和谷氨酸能机制的临床前和临床研究以及关于神经活性类固醇作用的报告表明，GABA和谷氨酸在疼痛和抑郁症的病因中起重要作用，可能导致共病。
