"Not only is there pathophysiological correlation between anxiety disorders and depressive disorders, there is also clinical correlation. One of the first meta-analyses to be carried out looking for comorbidity between anxiety and depression5 found that 58% of depressed patients had some type of anxiety, and that concomitant depression and anxiety had occurred in 52.2% of cases in the previous year. Conversely, 56% of patients with anxiety had depression. There is evidence that depression and anxiety are associated with chronic pain and not only that they can be clinically concomitant, but also that chronic pain is considered a predictor of major depression or worsening of anxiety symptoms6–10; a relationship has been found between the magnitude of the...pain and the intensity of the depressive and anxiety symptoms.9
An analysis of a two-dimensional model of anxiety and depression found that the scores for each of the syndromes correlated significantly with the intensity and severity of the pain.11,12 An epidemiological study showed that painful physical symptoms are a common feature in patients suffering from generalised anxiety disorder and even more so in patients with comorbid depressive disorder".
"It has been suggested that fibromyalgia is related to a deficit in the internal modulation of pain, especially of the inhibitory mechanisms.100,101 The neurobiology of pain involves the regulation of endogenous processes of inhibition and excitation that include inhibitory conditioned pain modulation; it is postulated that...nociceptive stimulation cancels out other nociceptive stimulus if they occur at a body site distant from the painful surface. This system involves serotonergic, noradrenergic and opioidergic inhibitory pathways and causes a reduction in diffuse pain throughout the body with the associated emotional effect. Some experimental studies have shown that inhibitory conditioned pain modulation is deficient in fibromyalgia.101–103 Fibromyalgia is thought to be related to central and peripheral hyperexcitability of the nociceptor system that manifests as multiple painful tender points, hyperalgesia and allodynia.
In depressed patients, imaging alterations are described in the sector of the dorsal anterior insula where changes usually occur in patients with chronic pain; this may have a role in what is known as “emotional allodynia”, a concept related to the pain experienced by people with major depression in response to stimuli which would not normally be painful.104 It should be noted that people with bipolar disorder have also been found to have comorbidity with fibromyalgia105–109 and migraine.110–112 Functional imaging studies reveal structural changes in the amygdala and the prefrontal cortex and support the fact that bipolar depression [and] suffering from pain...share the same biological circuits.113,114"
In depressed patients, imaging alterations are described in the sector of the dorsal anterior insula where changes usually occur in patients with chronic pain; this may have a role in what is known as “emotional allodynia”, a concept related to the pain experienced by people with major depression in response to stimuli which would not normally be painful.104 It should be noted that people with bipolar disorder have also been found to have comorbidity with fibromyalgia105–109 and migraine.110–112 Functional imaging studies reveal structural changes in the amygdala and the prefrontal cortex and support the fact that bipolar depression [and] suffering from pain...share the same biological circuits.113,114"
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