Chronic pain syndrome and depression

Akutna bol ima zaštitnu funkciju, služi kao upozorenje te nas uči izbjegavati štetne događaje u budućnosti. Kronična bol nema zaštitnu ulogu te uzrokuje patnju i tjeskobu. Od kronične boli pati 20 % europske populacije i čak 30 % populacije SAD-a. Kronična bol može biti rezultat specifične somatske bolesti, može se javiti u sklopu psihosomatske bolesti ili kao rezultat somatizacije. Kronični bolni sindromi i depresija su isprepleteni te kod oba sindroma nalazimo iste promjene središnjega živčanog sustava. Depresija je najčešći poremećaj raspoloženja koji se javlja u komorbiditetu s kroničnom boli. Čak 40-60 % bolesnika s kroničnom boli pati i od depresije. Ako se ne prepoznaju kao komorbiditet dolazi do pogoršanja oba sindroma. Postoje različiti modeli koji objašnjavaju povezanost depresije i kronične boli, u ovom radu prikazani su patofiziološki, kognitivno-bihevioralni i psihodinamski modeli. Postoje razne pretpostavke o vremenskom odnosu kronične boli i depresije. Ne očekuje se da će isti model moći objasniti taj odnos u svim slučajevima. No, sigurnim se čini da uvijek postoji psihopatološka vulnerabilnost koju bol pogoršava, a recipročno psihopatologija pojačava bolno iskustvo. Liječenje bolesnika s kroničnim bolnim sindromom je multidisciplinarno. Uz farmakološku terapiju, poželjno je koristiti i nefarmakološke metode, kako bi se povećala djelotvornost ukupne terapije te kako bi se zaobišle nuspojave, zloupotreba i ovisnost o lijekovima.Acute pain has a protective function, it serves as a warning and teaches us to avoid harmful events in the future. Chronic pain does not have a protective role and it causes suffering and anxiety. Chronic pain affects 20% of European populations and 30% of the US population. Chronic pain can be a result of specific somatic illness, it may occur as part of a psychosomatic disease or as a result of somatization. Chronic pain syndromes and depression are interwoven and in both syndromes we find same changes in the central nervous system. Depression is the most common mood disorder that occurs as a comorbidity of chronic pain. Up to 40 to 60% of patients with chronic pain suffer from depression. If they are not recognized as comorbidity, deterioration of both syndromes occurs. There are several models trying to explain the connection between depression and chronic pain, in this paper pathophysiological, cognitive-behavioral and psychodynamic models are explained. There are various assumptions about the temporal relationship of chronic pain and depression. It is not expected that the same model will be able to explain this relationship in all cases. But there seems to be a psychopathological vulnerability that is aggravated by pain, and reciprocally psychopathology increases the painful experience. Treatment of patients with chronic pain syndrome is multidisciplinary. With pharmacological therapy, it is also advisable to use non-pharmacological methods to increase the effectiveness of the overall therapy and to overcome side effects, abuse, and drug dependence