The interface of pain and mood disturbances in the rheumatic diseases

Objectives: To review the overlap of pain and depression in the rheumatic diseases, focusing on fibromyalgia (FM) and rheumatoid arthritis, and to provide treatment recommendations based on an understanding of this interface.

Methods: A literature search was performed through PubMed and Medline, for the years 1978 to 2008 and using the keywords: depression, mood disorders, pain, arthritis, fibromyalgia, rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus, scleroderma, antidepressants, exercise, and cognitive behavioral therapy.

Results: This review focuses on the pain/depression interface in common rheumatic disorders. FM is an excellent model to study the proposed mechanisms of such interactions. The potential genetic, inflammatory/immune, morphologic, and neurohormonal mechanisms that have been reported in FM are reviewed and compared with similar studies in depression. The importance of the interface of pain and depression has been noted in rheumatoid arthritis and other rheumatic illnesses, although there are very few studies to investigate their pathophysiologic underpinnings. General therapeutic recommendations can be made based on these overlapping models of the interface of pain and depression.

Conclusions: Clinical and pathophysiologic studies in FM demonstrate the striking overlap of pain and depression. These studies pertain to a better understanding of the pain/depression interface in all chronic rheumatic illnesses.