AccScience Publishing / GTM / Volume 2 / Issue 2 / DOI: 10.36922/gtm.312
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ORIGINAL RESEARCH ARTICLE

New insights into chronic pain management based on biopsychosocial model

Ekaterina Fedorovna Turovskaia1* Lyudmila Ivanovna Alekseeva1*
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1 Federal State Budgetary Institution Research Institute of Rheumatology, V. A. Nasonova of R. A. M. S. Moscown Federation, Kashirskoe Shosse 34 A, Russia
Global Translational Medicine 2023, 2(2), 312 https://doi.org/10.36922/gtm.312
Submitted: 23 December 2022 | Accepted: 5 April 2023 | Published: 19 April 2023
© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

The biopsychosocial model of pain dominates the scientific community’s understanding of chronic pain. Chronic pain is considered a different form of depression. In this study, pain relief was explored in chronic pain patients with different neurological disease, accompanied by comorbid symptoms, depression, and insomnia. Twenty-three chronic pain patients aged 26–79 years with comorbid symptoms were included in a prospective 12-week treatment using 10 mg vortioxetine. Different types of chronic pain were represented in this study: low back pain (13 patients), headache (four patients); neuropathic mechanism-induced pain (six patients) – spinal stenosis (two patients), radiculopathy (two patients), and trigeminal neuralgia (two patients). Efficacy of vortioxetine treatment was monitored after 1 week, 3 weeks, and 12 weeks. Visual analog scale (VAS) was used for pain intensity value. Dynamic of pain relief was assessed in accordance with comorbid depression and insomnia. Most patients with chronic pain actively reported depression (65%) and insomnia (74%). Depression was statistically rare in patients with neuropathic pain (33%) compared to patients with nociceptive pain (82%; P < 0.05). Incidence of insomnia was lower, although not statistically, in patients with neuropathic mechanism-induced pain (50%) compared to patients with nociceptive pain (82%, P = 0.129). Patients younger than 65 years reported pain reduction, according to VAS, after 1 week and 3 weeks vortioxetine therapy. The mean pain relief was 1.1 cm in young patients versus 0.16 cm in patients aged >65 years (P < 0.01) after 1-week treatment, and it was 2.35 cm in young patients versus 1.7 cm in patients aged >65 years (P < 0.05) after 3-week treatment. Vortioxetine therapy was effective in different types of chronic pain, accompanied by comorbid depression and insomnia. At early stage of treatment, pain relief was lower in old patients aged >65 years. Regardless of age, all patients had significant pain relief after the 12-week treatment.

Keywords
Chronic pain
Biopsychosocial model
Chronic pain management
Funding
None.
References
  1. Fayaz A, Croft P, Langford R, et al., 2013, Prevalence of chronic pain in the UK: A systematic review and meta-analysis of population studies. BMJ Open, 6: e010364. https://doi.org/10.1136/bmjopen-2015-010364

 

  1. Merskey H, Bogduk N, editors, 1994, IASP task force on taxonomy, Part III: In: Pain Terms, A Current List with Definitions and Notes on Usage. Seattle, WA: IASP Press, p209–214.

 

  1. International Association for the Study of Pain, Subcommittee on Taxonomy, 1986, Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Pain Suppl, 3: S1–226.

 

  1. Tracey I, Bushnell M, 2009, How neuroimaging studies have challenged us to rethink: Is chronic pain a disease? J Pain, 10: 1113–1120. https://doi.org/10.1016/j.jpain.2009.09.001

 

  1. World Health Organization, 2018, ICD-11 International Classification of Diseases for Mortality and Morbidity Statistics. Geneva: World Health Organization. Available from: https://icd.who.int/browse11/l-m/en [Last accessed on 2018 Sep 07]; Available from: https://www.sign.ac.uk/assets/sign136.pdf [Last accessed on 2018 Sep 01].

 

  1. Golubev VL, 2010, Pain Syndroms in Neurological Practice. 3rd ed. Moscow: MED Press-Inform, p.7–12, 44–68.

 

  1. Vein AM, 2001, Pain Syndroms in Neurological Practice. Moscow: Med Press-Inform, p.158.

 

  1. Basbaum AI, Bautista DM, Scherrer G, et al., 2009, Cellular and molecular mechanisms of pain. Cell, 139: 267–284. https://doi.org/10.1016/j.cell.2009.09.028

 

  1. Hucho T, Levine JD, 2007, Signaling pathways in sensitization: Toward a nociceptor cell biology. Neuron, 55: 365–376. https://doi.org/10.1016/j.neuron.2007.07.008

 

  1. Gold MS, Gebhart GF, 2010, Nociceptor sensitization in pain pathogenesis. Nat Med, 16: 1248–1257. https://doi.org/10.1038/nm.2235

 

  1. Ji RR, Kohno T, Moore KA, et al, 2003, Central sensitization and LTP: Do pain and memory share similar mechanisms? Trends Neurosci, 26: 696–705. https://doi.org/10.1016/j.tins.2003.09.017

 

  1. Woolf CJ, 2011, Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152: S2–S15. https://doi.org/10.1016/j.pain.2010.09.030

 

  1. Ossipov MH, Dussor GO, Porreca F, 2010, Central modulation of pain. J Clin Invest, 120: 3779–3787. https://doi.org/10.1172/JCI43766

 

  1. Altman RD, Abramson S, Caplan AI, 2006, Management of Ostearthritis Knee Pain: The State of the Science. United States: Medical Education Resourses. Ins.

 

  1. Rahman W, Bauer CS, Bannister K, et al., 2009, Descending serotonergic facilitation and the antinociceptive effects of pregabalin in a rat model of osteoarthritic pain. Mol Pain, 5: 45. https://doi.org/10.1186/1744-8069-5-45

 

  1. Banks SM, Kerns RD, 1996, Explaning high rates of depression in chronic pain: A diathesis-stress frame-work. Psychol Bull, 119: 95–110.

 

  1. Edwards RR, Cahalan C, Mensing G, et al., 2011, Pain, catastrophizing, and depression in the rheumatic diseases. Nat Rev Rheumatol, 7: 216–224. https://doi.org/10.1038/nrrheum.2011.2

 

  1. Linton SJ, Nicholas MK, Macdonald S, et al., 2010, The role of depression and catastrophizing in musculoskeletal pain. Eur J Pain, 15: 416–422. https://doi.org/10.1016/j.ejpain.2010.08.009

 

  1. Nicholas MK, Linton SJ, Watson PJ, et al., 2011, Early identification and management of psychological risk factors (“yellow flags”) in patients with low back pain: A reappraisal. Phys Ther, 91: 737–753. https://doi.org/10.2522/ptj.20100224

 

  1. Jackson T, Tian P, Wang Y, et al., 2016, Toward identifying moderators of associations between presurgery emotional distress and postoperative pain outcomes: A meta-analysis of longitudinal studies. J Pain, 17: 874–888. https://doi.org/10.1016/j.jpain.2016.04.003

 

  1. Lerman SF, Rudich Z, Brill S, et al., 2015, Longitudinal associations between depression, anxiety, pain, and pain-related disability in chronic pain patients. Psychosom Med, 77: 333–341. https://doi.org/10.1097/PSY.0000000000000158

 

  1. Noyman-Veksler G, Lerman SF, Joiner TE, et al., 2017, Role of pain-based catastrophizing in pain, disability, distress, and suicidal ideation. Psychiatry, 80: 155–170. https://doi.org/10.1080/00332747.2016.1230984

 

  1. Afari N, Ahumada SM, Wright LJ, et al., 2014, Psychological trauma and functional somatic syndromes: A systematic review and meta-analysis. Psychosom Med, 76: 2–11. https://doi.org/10.1097/PSY.0000000000000010

 

  1. Brennstuhl MJ, Tarquinio C, Montel S, 2014, Chronic pain and PTSD: Evolving views on their comorbidity. Perspect Psychiatr Care, 51: 295–304. https://doi.org/10.1111/ppc.12093

 

  1. Crombez G, Eccleston C, Van Damme S, et al., 2012, Fear-avoidance model of chronic pain: the next generation. Clin J Pain, 28: 475–483. https://doi.org/10.1097/AJP.0b013e3182385392

 

  1. Somers TJ, Wren AA, Shelby RA, 2012, The context of pain in arthritis: Self-efficacy for managing pain and other symptoms. Curr Pain Headache Rep, 16: 502–508. https://doi.org/10.1007/s11916-012-0298-3

 

  1. Wright LJ, Zautra AJ, Going S, 2008, Adaptation to early knee osteoarthritis: the role of risk, resilience, and disease severity on pain and physical functioning. Ann Behav Med, 36: 70–80. https://doi.org/10.1007/s12160-008-9048-5

 

  1. Edwards RR, Dworkin RH, Turk DC, et al., 2016, Patient phenotyping in clinical trials of chronic pain treatments: IMMPACT recommendations. Pain, 157: 1851–1871. https://doi.org/10.1097/j.pain.0000000000000602

 

  1. Edwards RR, Dworkin RH, Sullivan MD, et al., 2016, The role of psychosocial processes in the development and maintenance of chronic pain. J Pain, 17: T70–T92. https://doi.org/10.1016/j.jpain.2016.01.001

 

  1. Turk DC, Fillingim RB, Ohrbach R, et al., Assessment of psychosocial and functional impact of chronic pain. J Pain, 17: T21–T49. https://doi.org/10.1016/j.jpain.2016.02.006

 

  1. Burke AL, Mathias JL, Denson LA, 2015, Psychological functioning of people living with chronic pain: A meta-analytic review. Br J Clin Psychol, 54: 345–360. https://doi.org/10.1111/bjc.12078

 

  1. Howe CQ, Robinson JP, Sullivan MD, 2015, Psychiatric and psychological perspectives on chronic pain. Phys Med Rehabil Clin N Am, 26: 283–300. https://doi.org/10.1016/j.pmr.2014.12.003

 

  1. Fillingim RB, Ohrbach R, Greenspan JD, et al., 2013, Psychological factors associated with development of TMD: The OPPERA prospective cohort study. J Pain, 14: T75–T90. https://doi.org/10.1016/j.jpain.2013.06.009

 

  1. Diatchenko L, Fillingim RB, Smith SB, et al., 2013, The phenotypic and genetic signatures of common musculoskeletal pain conditions. Nat Rev Rheumatol, 9: 340–350. https://doi.org/10.1038/nrrheum.2013.43

 

  1. Huijnen IP, Rusu AC, Scholich S, et al., 2015, Subgrouping of low back pain patients for targeting treatments: Evidence from genetic, psychological, and activity-related behavioral approaches. Clin J Pain, 31: 123–132. https://doi.org/10.1097/AJP.0000000000000100

 

  1. Clauw DJ, 2015, Fibromyalgia and related conditions. Mayo Clin Proc, 90: 680–692. https://doi.org/10.1016/j.mayocp.2015.03.014

 

  1. Hauser W, Bernardy K, Uceyler N, et al., 2009, Treatment of fibromyalgia syndrome with antidepressants: A meta-analysis. JAMA, 301: 198–209. https://doi.org/10.1001/jama.2008.944

 

  1. Mørk A, Pehrson A, Brennum LT, et al., 2012, Pharmacological effects of Lu AA21004: A novel multimodal compound for the treatment of major depressive disorder. J Pharmacol Exp Ther, 340: 666–675. https://doi.org/10.1124/jpet.111.189068

 

  1. Bang-Andersen B, Ruhland T, Jorgensen M, et al., 2011, Discovery of 1-[2-(2,4-dimethylphenylsulfanyl)phenyl] piperazine (Lu AA21004): A novel multimodal compound for the treatment of major depressive disorder. J Med Chem, 54: 3206–3221. https://doi.org/10.1021/jm101459g

 

  1. Pehrson AL, Cremers T, Bétry C, et al., 2013, Lu AA21004, a novel multimodal antidepressant, produces regionally selective increases of multiple neurotransmitters-a rat microdialysis and electrophysiology study. Eur Neuropsychopharmacol, 23: 133–145. https://doi.org/10.1016/j.euroneuro.2012.04.006

 

  1. Sanchez C, Asin KE, Artigas F, 2015, Vortioxetine, a novel antidepressant with multimodal activity: Review of preclinical and clinical data. Pharmacol Ther, 145: 43–57. https://doi.org/10.1016/j.pharmthera.2014.07.001

 

  1. Stahl SM, 2015, Modes and nodes explain the mechanism of action of vortioxetine, a multimodal agent (MMA): Enhancing serotonin release by combining serotonin (5HT) transporter inhibition with action at 5HT receptors (5HT1A, 5HT1B, 5HT1D, 5HT7 receptors). CNS Spectr, 20: 93–97. https://doi.org/10.1017/S1092852915000139

 

  1. Cipriani A, Furukawa TA, Salanti G, et al., 2018, Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. Lancet, 391: 1357–1366. https://doi.org/10.1016/S0140-6736(17)32802-7

 

  1. Chen G, Lee R, Højer AM, et al., 2013, Pharmacokinetic drug interactions involving vortioxetine (Lu AA21004), a multimodal antidepressant. Clin Drug Investig, 33: 727–736 https://doi.org/10.1007/s40261-013-0117-6

 

  1. Spina E, Santoro V, D’Arrigo C, 2008, Clinically relevant pharmacokinetic drug interactions with second-generation antidepressants: An update. Clin Ther, 30:1206–1227. https://doi.org/10.1016/s0149-2918(08)80047-1

 

  1. Katona C, Hansen T, Olsen CK, 2012, A randomized, double-blind, placebo-controlled, duloxetine-referenced, fixed-dose study comparing the efficacy and safety of Lu AA21004 in elderly patients with major depressive disorder. Int Clin Psychopharmacol, 27: 215–223. https://doi.org/10.1097/YIC.0b013e3283542457

 

  1. Talmon M, Rossi S Pastore A, et al., 2018, Vortioxetine exerts anti-inflammatory and immunomodulatory effects on human monocytes/macrophages. Br J Pharmacol, 175: 113–124. https://doi.org/10.1111/bph.14074

 

  1. Bouhassira D, Attal N, Alchaar H, et al., 2005, Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4)”. Pain, 114: 29–36. https://doi.org/10.1016/j.pain.2004.12.010

 

  1. Campbell LC, Clauw DJ, Keefe FJ, 2003, Persistent pain and depression: A biopsychosocial perspective. Biol Psychiatry, 54: 399–409. https://doi.org/10.1016/S0006-3223(03)00545-6

 

  1. Baliki M, Schnitzer T, Bauer W, et al., 2011, Brain morphological signatures for chronic pain. PLoS One, 6: e26010. https://doi.org/10.1371/journal.pone.0026010

 

  1. Apkarian A, Sosa Y, Sonty S, et al., 2004, Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. J Neurosci, 24: 10410–1045. https://doi.org/10.1523/JNEUROSCI.2541–04.2004

 

  1. Bennett MI, Attal N, Backonja MM, et al., 2007, Using screening tools to identify neuropathic pain”. Pain, 127: 199–203. https://doi.org/10.1016/j.pain.2006.10.034
Conflict of interest
The authors declared no conflicts of interest.
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Global Translational Medicine, Electronic ISSN: 2811-0021 Published by AccScience Publishing