Paliatívna medicína a liečba bolesti 1-2e/2021

Antidepressants in the indication of pain treatment in a palliative medicine

Depression is considered to be one of the most common and serious conditions in palliative medicine. It is generally reported in the literature that the prevalence of depressive syndrome in palliative patients is about 9%-38%. In the palliative care, there is a dangerous confusion between the meaning of the words “depressed” and “feeling sad.” Depression, as a disease, can go unnoticed, undiagnosed

• therefore untreated. In addition, to all its adverse effects on the patient’s life, the untreated depressive syndrome also contributes to the inadequate treatment of pain (pain control) and even exacerbates the pain. Depression and pain are very closely related. Depression leads to increased pain and pain, reciprocally, potentiates depression. Neuroplastic changes in the nervous system, which involve pathology in molecular, cellular and synaptic processes that modify connectivity between neurons and neural circuits, are thought to occur, so that said neuroplastic changes in the nervous system during depression and chronic pain are very similarly. The positive effect of antidepressants in the treatment of pain in a palliative patient is clear. It leads to the relief of pain, the alleviation of symptoms and, ultimately, the improvement of the quality of life and the suffering of the patient in palliative medicine. The administration of AD in the treatment of chronic pain is not primarily a psychiatric indication, as their primary is not their antidepressant and anxiolytic effect, but antinociceptive, mediated by stimulation of central (and descending) pain inhibitory mechanisms.

Keywords: depression, chronic pain, palliative medicine, antidepressants