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Douleur chronique, dépression et sérotonine

Published online by Cambridge University Press:  28 April 2020

F Boureau ,
C Gay  and
A Combes
F Boureau
Affiliation:
Centre d’évaluation et de traitement de ta douteur, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012Paris
C Gay
Affiliation:
Service hospitalo-universitaire de santé mentale et de thérapeutique (Pr H Loo), hôpital Sainte-Anne, 1, rue Cabanis, 75014Paris, France
A Combes
Affiliation:
Centre d’évaluation et de traitement de ta douteur, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012Paris
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Résumé

Les relations entre douleur chronique et dépression ont été soulignées de longue date, suggérant la possible intervention de variables biologiques ou psychologiques communes. Dans cette revue, trois catégories d’informations nous aideront à étudier ces relations: la prévalence de la dépression chez les malades douloureux chroniques, I’efficacité analgésique des antidépresseurs, I’hypothèse de perturbations neurobiologiques communes à la dépression et à la douleur chronique. Les études cliniques se heurtent à des difficultés d’ordre nosographique. Ainsi, la douleur chronique peut correspondre à des symptomatologies variées où it peut être difficile de faire la part des facteurs organiques (initiaux ou persistants) et des facteurs psychologiques, notamment dépressifs. Divers problèmes méthodologiques peuvent être invoqués pour expliquer la disparité des observations actuellement disponibles. L’efficacité analgésique des antidépresseurs est actuellement démontrée par de nombreux essais cliniques contrôlés, comportant des comparaisons à des molécules de références ou à un placebo. De nombreuses publications aboutissent à la conclusion que l’effet analgésique des antidépresseurs s’observe indépendamment de la présence d’une symptomatologie dépressive associée. Cette notion est importante car elle interdit désormais d’interpréter la réponse positive à un traitement antidépresseur comme un argument en faveur de I’origine dépressive d’une douleur. Diverses études neurobiologiques ont tente de chercher chez les patients douloureux chroniques des perturbations supposées caractériser certains états dépressifs. En particulier, l’hypothèse sérotoninergique a souvent été privilégiée.

Summary

Summary

The relationship between chronic pain and depression have been emphasized since a long time suggesting the possible participation of common biological or psychological mechanisms. Our review focuses on 3 types of information: the prevalence of depression among chronic pain patients, the analgesic efficacy of antidepressants. and the search for common neurobiological perturbations to chronic pain and depression. Nosographical difficulties avose from clinical studies on this topic. Chronic pain may include various symptomatologies and it may often be difficult to distinguish between the respective roles of physical and psychological (ie depressive) factors. Various explanations can be suggested to explain the discrepancy of the available literature. Clinical trials with placebo or reference substance controls have demonstrated the analgesic efficacy of antidepressants. Numerous studies concluded that the analgesic effect is unrelated to a depressive state. This notion is important since it is now impossible to use antidepressant responsiveness as a diagnostic index for depression. Various neurobiological studies have attempted to characterise a common serotoninergic dysfunction to depression and chronic pain.

Keywords

douleur chroniquedépressionsérotoninechronic paindépressionserotonin
Type
Revue
Information
Psychiatry and Psychobiology , Volume 5 , Issue 3 , 1990 , pp. 169 - 178
Copyright
Copyright © European Psychiatric Association

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