Duloxetine for chronic pain

Chronic pain is still a critical medical issue in modern society that results in severe deadaptation and reduces the quality of life in 15–40% of people in developed countries. Neuropathic pain is an essential issue characterized by recurrent course and the presence of comorbidities, e.g., depression. Duloxetine is particularly important among drugs with established efficacy prescribed for neuropathic pain. This agent significantly affects serotoninergic and noradrenergic systems and significant pathogenic mechanisms of the development of chronic pain, i.e., processes of disinhibition, thereby increasing the functional activity of the descending system of pain inhibition. The analgesic effect of duloxetine occurs much earlier and is independent of its antidepressant effect. Duloxetine is prescribed for many conditions that are often challenging for practitioners and associated with chronic pain. In addition, duloxetine has a significant effect on comorbid anxiety, depression, and sleep disorders. KEYWORDS: chronic pain, neuropathic pain, chronic pain syndrome, duloxetine. FOR CITATION: Ekusheva E.V. Duloxetine for chronic pain. Russian Medical Inquiry. 2021;5(10):687–693 (in Russ.). DOI: 10.32364/2587- 6821-2021-5-10-687-693.

Fibromyalgia and Depression

Fibromyalgia and depression might represent two manifestations of affective spectrum disorder. They share similar pathophysiology and are largely targeted by the same drugs with dual action on serotoninergic and noradrenergic systems. Here, we review evidence for genetic and environmental factors that predispose, precipitate, and perpetuate fibromyalgia and depression and include laboratory findings on the role of depression in fibromyalgia. Further, we comment on several aspects of fibromyalgia which support the development of reactive depression, substantially more so than in other chronic pain syndromes. However, while sharing many features with depression, fibromyalgia is associated with somatic comorbidities and absolutely defined by fluctuating spontaneous widespread pain. Fibromyalgia may, therefore, be more appropriately grouped together with other functional pain disorders, while psychologically distressed subgroups grouped additionally or solely with affective spectrum disorders.