Chronic pain from a psychiatric perspective: Neurobiology and therapy

Epidemiological studies suggest a high comorbidity of pain disorders and major depression. This has been shown for somatoform disorder, fibromyalgia syndrome, migraine and neck pain. However, a dual diagnosis is still rare as patients predominantly report somatic symptoms during physical examination. Nevertheless, such a comorbidity is reflected on a brain systems level as chronic pain and depressive symptoms are mediated by similar brain structures. Over the past years modern imaging techniques have been able to underline the efficacy of psychotherapeutic and psychopharmacological treatment for chronic pain disorders by demonstrating a normalization of dysfunctional brain circuitries that accompanies a relief of clinical symptoms. Specifically, antidepressants increasing synaptic serotonin and noradrenalin levels as well as cognitive behavioral therapy are currently considered to be most efficient in the treatment of chronic pain from a psychiatric point of view. © 2013 Springer-Verlag Berlin Heidelberg.