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Global Translational Medicine New insights into chronic pain management

Complaints on emotional disorders and presence Nevertheless, our study successfully demonstrated the
of insomnia did not correlate with pain relief. It can be effectiveness of vortioxetine in different types of chronic
explained that chronic pain is considered a different form pain (e.g., headache, musculoskeletal disorder, trigeminal
of depression. Depression and chronic pain have common neuralgia, radiculopathy, and spinal stenosis). In this
pathogenic mechanism. Depression plays a leading role in study, we divided the study participants into two groups
pain chronicity, so patients with chronic pain should also – nociceptive and neuropathic pain origins. The efficacy
be tested by additional emotional scales that can detect of vortioxetine in pain relief was demonstrated in young
latent depression. and elderly patients. It is the first study where vortioxetine
Duration of chronic pain (less or more than 1 year) was examined as a substance for possible chronic pain
had no statistical influence on pain relief (Table 1). After treatment. Vortioxetine is more tolerable compared with
3 months of persistent pain, reorganization develops in other antidepressants and has proven immunomodulatory
the antipain system at the neurochemical level. Plasticity and anti-inflammatory effects. Besides, it is also reasonable
changes of the nervous system in chronic pain include to examine the efficacy of vortioxetine in rheumatological
neurochemical modulations and gray matter restriction in pain in future.
main antinociceptive brain centers [50,51] . 5. Conclusions

In early stage of vortioxetine treatment (1 week and Our findings demonstrated the efficacy of vortioxetine
st
3 week of treatment), pain reduction was statistically treatment in chronic pain patient, accompanied by
rd
more effective in patient younger than 65 years old. comorbid symptoms, with different pain origins, that
However, patients of all age had significant pain relief is, nociceptive and neuropathic. Most patients with
on 12 week of treatment (Figure 9). Low efficacy of chronic pain have depression and insomnia. Depression
th
early-stage vortioxetine treatment in old patients can be was statistically rare in patients with neuropathic pain
explained by delayed neuron metabolism and changes in origin. Pain relief did not correlate with pain origin,
receptor sensitivity in patients aged more than 65 years. presence of comorbid symptoms, duration of chronic
Comparative analyses between groups, based on pain pain (less or more than 1 year) and gender. In early
origin, demonstrated significant pain relief in all groups. stages of vortioxetine therapy, pain relief was statistically
Pain relief was not correlated with duration of disease, lower in patients aged >65 years. Regardless of age, all
presence of comorbid symptoms, and gender (Table 1). patients experienced significant pain relief on 12 week
th
of treatment.
The present study demonstrated no influence of
peripheral structural and inflammatory processes on Acknowledgments
vortioxetine effectivity. The development of chronic pain
is associated with alteration of the neurochemical level in We would like to thank Armine Avetisian, representative of
antinociceptive system. Emotional disorder and insomnia Lundbeck Russia, for providing vortioxetine information,
occur in most patients with chronic pain. However, and Rafael Danielyan for providing helpful discussion.
in patients with nociceptive pain, central sensitization Funding
plays a predominant role in pathogenesis of chronic pain
syndrome. Therefore, one of the main ways of controlling None.
chronic pain is targeting CNS mechanisms that influence
its neuroplastic changes accompanied by dysfunctioning Conflict of interest
of the descending noradrenergic and serotoninergic The authors declared no conflicts of interest.
system. Successful treatment should also consider the
role of biological, psychological and social factors in the Author contributions
treatment of chronic pain, and multidisciplinary approach Conceptualization: Ekaterina Fedorovna Turovskaia,
in chronic pain management should be encouraged in Lyudmila Ivanovna Alekseeva
specialized centers . Data curation: Ekaterina Fedorovna Turovskaia
[52]
The limitation of the study was the small sample size. Formal analysis: Ekaterina Fedorovna Turovskaia
We included five subgroups of patients with nociceptive Investigation: Ekaterina Fedorovna Turovskaia
and neuropathic pain origin, which can also influence Writing – original draft: Ekaterina Fedorovna Turovskaia,
the statistics. Moreover, there are also gender differences Lyudmila Ivanovna Alekseeva
in incidence of headache, musculoskeletal disorder, Writing – review & drafting: Ekaterina Fedorovna
trigeminal neuralgia, radiculopathy, and spinal stenosis. Turovskaia, Lyudmila Ivanovna Alekseeva

Volume 2 Issue 2 (2023) 8 https://doi.org/10.36922/gtm.312