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Relationship of quinolinic acid and serotonin with depression and pain degree in cancer pain patients: a cross-sectional study

  • Aji Mustika Ningrum ,
  • Prananda Surya Airlangga ,
  • Wiwiek Indriyani Maskoep ,
  • Herdiani Sulistyo Putri ,


Link of Video Abstract:


Introduction: Chronic pain requires a thorough assessment if it persists in patients with cancer. Depressive disorder is one of the psychosocial problems that can occur in cancer patients. Depressive disorders affect up to 34.4% of patients with cancer in Indonesia, causing increased morbidity and complicating the management of patients. Quinolinic acid (QUIN) and serotonin (5-HT) are chemicals that can affect pain perception and depressive disorders. This study aims to analyze the relationship between quinolinic acid and serotonin levels with depression and pain degree in cancer pain patients.

Methods: A cross-sectional study design was conducted at the Palliative Polyclinic of Dr. Soetomo Surabaya General Hospital, Indonesia. Patients were collected with purposive sampling. The patient's quinolinic acid and serotonin plasma were collected through blood samples and assessed using enzyme-linked immunosorbent assay (ELISA) method. Spearman's comparison test determined the correlation between quinolinic acid and serotonin levels with depression and pain degree.

Results: A total of 76 cancer patients were included in this study. The cancer types reported were pelvic cancer (23 patients, 30.3%), head and neck cancer (21 patients, 27.6%), abdominal cancer (ten patients 13.2%), breast cancer (seven patients, 9.2%), lung cancer (five patients, 6.6%), skin cancer (three patients, 3.9%), and other types of cancers (seven patients, 9.2%). As many as 24 patients (31.6%) had mild depression and only three patients (3.9%) experienced major depression. Mild pain was reported by 47 patients (61.8%) and 11 patients (14.5%) suffered from severe pain. Spearman's comparison test was conducted on quinolinic acid and serotonin levels against depression degree and pain degree, resulting in a weak correlation.

Conclusion: Quinolinic acid and serotonin levels are related to depression and pain degree in cancer pain patients (p<0.05), though with a weak correlation. However, further study is needed to confirm the findings of this study.


  1. Bennett MI, Kaasa S, Barke A, Korwisi B, Rief W, Treede R-D, et al. The IASP classification of chronic pain for ICD-11: chronic cancer-related pain. Pain. 2019;160(1):38–44. Available from:
  2. Rahmadi M, Madina U, Sulianto I, Padolo E, Ardianto C, Ratri DMN, et al. Study on dosage range evaluation opioid analgesic for breakthrough pain in cancer patients: a retrospective study. Ann Palliat Med. 2021;10(2):1237–43. Available from:
  3. Klepstad P, Kaasa S, Cherny N, Hanks G, de Conno F. Pain and pain treatments in European palliative care units. A cross sectional survey from the European Association for Palliative Care Research Network. Palliat Med. 2005;19(6):477–84. Available from:
  4. Lawlor PG, Lawlor NA, Reis-Pina P. The Edmonton Classification System for Cancer Pain: a tool with potential for an evolving role in cancer pain assessment and management. Expert Rev Qual Life Cancer Care. 2018;3(2–3):47–64. Available from:
  5. Effendy C, Vissers K, Osse BHP, Tejawinata S, Vernooij-Dassen M, Engels Y. Comparison of Problems and Unmet Needs of Patients with Advanced Cancer in a European Country and an Asian Country. Pain Pract. 2014;15(5):433–40. Available from:
  6. Hermanto A, Sinawang GW, Alfaqih MR, Faizah R. The Impacts of Depression Treatment on Health-Related Quality of Life in Cancer Patients: A Systematic Review. J Ners. 2020;14(3):209–12. Available from:
  7. Kongingan A. Depression in cancer survivors - palliative and pain-free development center Dr. Sutomo Surabaya. Center for Palliative And Pain Free Development. 2008.
  8. Hariyani N, Bramantoro T, Nair R, Singh A, Sengupta K. Depression symptoms and recurrent aphthous stomatitis—Evidence from a population‐based study in Indonesia. Oral Dis. 2020;26(5):948–54. Available from:
  9. Krebber AM, Buffart LM, Kleijn G, Riepma IC, de Bree R, Leemans CR, Becker A, Brug J, van Straten A, Cuijpers P, Verdonck-de Leeuw IM. Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report instruments. Psychooncology. 2014;23(2):121-30. Available from: doi: 10.1002/pon.3409.
  10. Bintari DC, Sudibyo DA, Karimah A. Correlation between depression level and headache severity: A study among medical students during the COVID-19 pandemic. Narra J. 2021;1(3). Available from:
  11. Teodora BA, Ianovici, N. and Bancilla, S. Modifying factors of chronic pain perception in oncology patient. Therapeutics, Pharmacology, and Clinical Technology. 2012; 16(2):226-31.
  12. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and Pain Comorbidity. Arch Intern Med. 2003;163(20):2433. Available from:
  13. Brown SJ, Huang X-F, Newell KA. The kynurenine pathway in major depression: What we know and where to next. Neurosci & Biobehav Rev. 2021;127:917–27. Available from:
  14. Walczak K, Wnorowski A, Turski WA, Plech T. Kynurenic acid and cancer: facts and controversies. Cell Mol Life Sci. 2019/10/28. 2020;77(8):1531–50. Available from:
  15. Amirdelfan K, Pope JE, Gunn J, Hill MM, Cotten BM, Beresh JE, et al. Clinical Validation of a Multi-Biomarker Assay for the Evaluation of Chronic Pain Patients in a Cross-Sectional, Observational Study. Pain Ther. 2020/06/03. 2020;9(2):511–29. Available from:
  16. Moncrieff J, Cooper RE, Stockmann T, Amendola S, Hengartner MP, Horowitz MA. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry. 2022; Available from:
  17. Miller AH, Maletic V, Raison CL. Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biol Psychiatry. 2009/01/15. 2009;65(9):732–41. Available from:
  18. Rahmawati NA, Karimah A, Amin MM. Inflammation in Depression. J Psikiatri Surabaya. 2021;10(2):50. Available from:
  19. Liu H, Ding L, Zhang H, Mellor D, Wu H, Zhao D, et al. The Metabolic Factor Kynurenic Acid of Kynurenine Pathway Predicts Major Depressive Disorder. Front psychiatry. 2018;9:552. Available from:
  20. Gunn J. An Analysis of Biomarkers in Patients with Chronic Pain. Pain Physician. 2020;1;23(1;1):E41–9. Available from:
  21. Ciapała K, Mika J, Rojewska E. The Kynurenine Pathway as a Potential Target for Neuropathic Pain Therapy Design: From Basic Research to Clinical Perspectives. Int J Mol Sci. 2021;22(20):11055. Available from:
  22. Sommer C. Serotonin in Pain and Analgesia: Actions in the Periphery. Mol Neurobiol. 2004;30(2):117–26. Available from:
  23. Marin P, Becamel C, Dumuis A, Bockaert J. 5-HT Receptor-Associated Protein Networks: New Targets for Drug Discovery in Psychiatric Disorders? Curr Drug Targets. 2012;13(1):28–52. Available from:
  24. Ozdemir E, Gursoy S, Bagcivan I. The effects of serotonin/norepinephrine reuptake inhibitors and serotonin receptor agonist on morphine analgesia and tolerance in rats. J Physiol Sci. 2012;62(4):317–23. Available from:

How to Cite

Ningrum, A. M., Airlangga, P. S. ., Maskoep, W. I. ., & Putri, H. S. . (2023). Relationship of quinolinic acid and serotonin with depression and pain degree in cancer pain patients: a cross-sectional study. Bali Medical Journal, 12(3), 2681–2684.




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Aji Mustika Ningrum
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Prananda Surya Airlangga
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Wiwiek Indriyani Maskoep
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Herdiani Sulistyo Putri
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