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MENTAL HEALTH
CHALLENGES
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The effectiveness of opioid use in chronic pain is under scrutiny Significant reduction in pain and depression was evident even at the
because of the current opioid epidemic. Comorbid depression has end of 1 year. MBSR was as effective as CBT in reducing pain but
a higher incidence of abuse. Concomitant use of benzodiazepines CBT was more effective in reducing comorbid depression.
significantly increases deaths from opioid overdose during the first Brain stimulation with implanted electrodes has effectively re-
90 days. duced pain and depression. Noninvasive transcranial magnetic stim-
Inflammation: Cytokines released secondary to peripheral or ulation reduces depressive symptoms and has the potential to reduce
CNS inflammation are known to produce pain and depression. De- comorbid pain.
pression and pain secondary to the cytokines in patients receiving
interferon for the treatment of Hepatitis C and multiple myeloma Recommended reading:
could be reduced by treatment or pretreatment with anti-depres- 1. Pain and Depression: A Systematic Review: W.W.IsHak et al
sants especially duloxetine. www.harvardreviewofpsychiatry.org Volume 26 • Number 6 • No-
Ketamine a potent NMDA (glutamate) antagonist is also likely to vember/December 2018
reduce glutamate related inflammation in the central nervous system 2. Chronic pain and mental disorders: Shared neural mechanisms,
of patients with pain and depression. Ketamine, an old anesthetic epidemiology and treatment. W.M.Hooten, 2003Mayo clin
is shown to be effective in reducing post-operative and chronic pain. proc.2016;91(7):955-970
It also regulates the connectivity between brain centers involved in 3. Depression and Pain Comorbidity. Matthew J. Bair et al ARCH
both depression and pain. There is increasing evidence that keta- INTERN MED/VOL 163, NOV 10, 3. 3.
mine is effective in rapidly reducing both pain and depression. Oral 4. Effect of Mindfulness-Based Stress Reduction vs Cognitive
nasal and intravenous ketamine preparations are used. Behavioral Therapy for Usual Care on Back Pain and Functional
Dysregulation of the endocannabinoid system is present in pa- Limitations in Adults With Chronic Low Back Pain A Randomized
tients with pain and depression. The cannabinoids were effective in Clinical Trial
reducing depression and especially comorbid pain. Cherkin et al JAMA; 2016 315(12) 1240—1249
Mindfulness-based stress reduction (MBSR) is an eight-week ev-
idence-based program that offers secular, intensive mindfulness Somayaji Ramamurthy, MD, is a retired professor of anesthesiology and former
training to assist people with stress, anxiety, depression and pain. director of the Pain Medicine Fellowship program at UT Health San Antonio.

28 San Antonio Medicine • May 2019