Chronic pain is described as any persistent or intermittent pain that lasts more than three months. Depression is described as a psychological state that causes fatigue, appetite changes, sadness, lack of motivation, slowed response times, difficulty sleeping, feelings of helplessness and thoughts of suicide. Studies have revealed that up to 50% of patients suffering from chronic pain are also affected by severe depression.
It can be difficult to assess whether depression has led to chronic pain, or vice versa. Depression can frequently cause unexplained pain, such as back pain and headaches, and people who are experiencing chronic pain can develop increased stress or feelings of guilt and helplessness, often leading to a depressive state. These effects can create a cycle that is difficult to break. Those patients that have chronic pain-induced depression have a poorer prognosis than those suffering from chronic pain without depression. It seems pain and depression create a vicious cycle in which pain worsens the symptoms of depression, and the resulting depression worsens the feelings of pain. Suffering from both conditions tends to promote their own severity.
One of the reasons depression and chronic pain are so intertwined is because of the way stress works on the body. Chronic pain turns on the “fight or flight” stress signals in the brain, preparing the body to fight off whatever is causing the pain. The nervous system is in a high state of alert, and eventually this wears the body down, leaving the person vulnerable to depression. Finding ways to deal with stress and cope with chronic pain can give you an edge in the battle against developing depression.
Chronic pain-induced depression can keep you from enjoying life, such as spending time with your children and grandchildren, engaging in hobbies, exercising and traveling. It can also lead to isolation, exacerbate other health conditions, and can be emotionally draining. It can quickly lead you in a downward spiral, and without treatment and attention, can gravely affect your quality of life.
ASSEMBLING YOUR TEAM
Those patients suffering from chronic pain-induced depression benefit most when a team of professionals is involved in their care. This team may include a:
Physician: Thorough exams and evaluations are of primary importance in the diagnosis and treatment of pain and depression. Physicians may also include psychiatrists to help manage depression, and pain specialists to help manage the pain. When necessary, both pain and psychiatric medications may be prescribed.
Therapist: Anxious and negative thinking patterns can be alleviated during regular sessions with a trained therapist. Coping skills and behavioral therapy skills can be taught to reduce the symptoms of pain and depression. A therapist can also work with the patient’s family to help them understand this complex disease process.
Physical Therapist: A physical therapist can be invaluable in their instruction on exercise and muscle relaxation techniques to help improve mobility and reduce pain. The added benefit is that regular movement can help improve mood.
Other Health Professionals: Occupational therapists, nutritionists and acupuncturists can also help alleviate the symptoms of chronic pain-induced depression.
Catching chronic pain and depression in its early stages can help you get your life back. Early treatment of chronic pain and/or depression can help fight this downward spiral.
Often, when patients present with chronic pain to their physician, they may be prescribed antidepressants, even if the patient’s mood seems fine. While this may seem odd, the use of low dose antidepressants for pain control is well-studied and has been a standard practice for many years. In low doses, antidepressants cause chemical changes in the brain that alter the way pain is perceived. Of course, another reason they are prescribed is that they can stop the cycle that leads to depression prior to it starting.
Standard analgesics are often prescribed to treat chronic pain. For severe chronic pain, opioids are the most effective medications. Several studies have found that opioids may help achieve antidepressant effects by regulating neurotransmitters; however, the use of opioids in chronic pain-induced depression has been controversial due to patients’ dependence and addiction to them. The long-term use of opioids (over 30 days) has actually been shown to increase the risk of depression. Be sure and thoroughly discuss their use and risks with your physician.
Also called psychological counseling or psychotherapy, talk therapy can be very effective in treating both depression and chronic pain by changing patterns of thinking and application of coping skills. Look for a therapist who applies Cognitive Behavioral Therapy, which can provide real-life coping skills that are greatly beneficial to patients.
Many patients suffering from chronic pain and depression find great relief from utilizing stress-reduction techniques. Many of these techniques are taught in therapy sessions, but many more can be learned on your own. Meditation and journaling can both be extremely helpful in coping with chronic pain and depression. Gentle physical activity such as yoga and tai chi are also very healing. Sometimes, just getting out into nature can help those suffering from chronic pain and depression.
Pain Rehabilitation Centers
In these centers, a team approach is provided to treat both the medical and psychiatric aspects of chronic pain-induced depression. These centers offer outpatient or inpatient programs and can provide immediate and long-term support when chronic pain and/or depression is severe. These programs are effective because they involve a combination of treatments. The Comprehensive Pain Rehabilitation Center at the Mayo Clinic is one such program.
Many people suffering from chronic pain and depression find that support groups can be irreplaceable. Peer support groups offer emotional support through caring, encouragement, reassurance and avoidance of criticism. These groups can also offer information support in terms of advice, suggestions, problem-solving and dissemination of facts. The families of patients suffering from chronic pain often have a difficult time relating or understanding, and these groups provide an outlet where the patient is heard without judgment.
The PAINS Project is a great resource for finding more support.
If you are in crisis and need immediate emotional support:
- Call your or your loved one’s health professional
- Call 911 for emergency services
- Go to the nearest hospital emergency room
- 1-800-273-TALK (1-800-273-8255) National Suicide Prevention Hotline
- 1-800-442-HOPE (1-800-442-4673) Kristin Brooks Hope Center National Hotline
- 1-877-Vet2Vet (1-877-838-2838) Veterans peer support line or chat online
- 1-800-SUICIDA (1-800-784-2432) Spanish-speaking suicide hotline
- IMALIVE.org (volunteers are trained and certified in crisis intervention)
If you think you might be suffering from depression in addition to chronic pain, be honest with your health care team and seek the support that will help you regain control over your mind, body and spirit. Nightingale Homecare can serve as an invaluable resource to you as well, with a full range of customized skilled and non-medical in-home care services. Contact us for a free in-home consultation at (602) 504-1555 to discover how we can help enhance joy, comfort, and overall wellbeing and quality of life. You can also learn more about our Phoenix in home care services and the areas we serve.