Ruoff G E
J Fam Pract. 1996 Dec;43(6 Suppl):S25-33; discussion S34.
The management of patients with chronic pain is a challenging clinical problem that frequently requires a multi-disciplinary approach. Depression is a common comorbidity associated with chronic pain, occurring in as many as 50% of chronic pain patients. Depression may develop secondarily or independently of the chronic pain syndrome, or it may occur as the primary cause of chronic pain. Regardless of their etiology, evidence exists to suggest that depression and chronic pain share common biologic pathways, namely, the serotonergic (5-HT) and noradrenergic systems. Chronic pain patients who are depressed require aggressive, full-dose treatment with antidepressants. Treatment should be selected based on a prior clinical response, the side-effect profile, the dosing schedule, and the potential for drug interactions. The newer antidepressants, including the selective serotonin reuptake inhibitors venlafaxine and nefazodone, are therapeutic options for the treatment of depression in the patient with chronic pain.
慢性疼痛患者的管理是一个具有挑战性的临床问题，通常需要多学科方法。抑郁症是与慢性疼痛相关的常见共病，在多达50%的慢性疼痛患者中出现。抑郁症可能继发于慢性疼痛综合征，也可能独立于慢性疼痛综合征发生，或者它可能是慢性疼痛的主要原因。无论其病因如何，有证据表明抑郁症和慢性疼痛共享共同的生物学途径，即血清素能（5-HT）和去甲肾上腺素能系统。患有抑郁症的慢性疼痛患者需要积极的全剂量抗抑郁药治疗。应根据先前的临床反应、副作用情况、给药方案和药物相互作用的可能性来选择治疗方法。新型抗抑郁药，包括选择性5-羟色胺再摄取抑制剂文拉法辛和奈法唑酮，是治疗慢性疼痛患者抑郁症的治疗选择。
