Depression & Chronic Pain

Pain is real; it is debilitating; and can restrict normal activities leading to anxiety, and if experienced over extended periods of time without relief, can lead to depression.

Symptoms

If you are suffering from chronic low back pain, you could be a prime patient for depression too, if you say 'yes' to most of these symptoms.

• Do you have frequent spells of feeling low, a sense of hopelessness, irritability, and an unexplained desire to cry?
• Are you also experiencing poor appetite, or has there been a marked loss of weight, or, on the other hand, an increased appetite or weight gain?
• Are you sleeping too much or too little?
• Do you get agitated for no specific reason, have low energy, and experience fatigue even when rested?
• Has your desire for sex diminished?
• Are you having problems with concentrating, or experiencing weak memory?
• Do thoughts of suicide cross your mind?

Pain > More Pain

If misery needs company then chronic back pain and depression would be well paired! Research has shown that patients seeking treatment for chronic low back pain invariably show symptoms of depression. However, not many patients are aware that chronic back pain and depression can be co-linked. But the (sad) truth is that depression is an offshoot of chronic back pain. And every patient knows that physical pain is often accompanied by emotional distress that may be manifested as severe depression, anxiety, or feeling of loss of control over one’s physical and emotional self.

The type of depression that often accompanies chronic pain is termed major or clinical depression, and unlike feeling low for a few days, the person could experience this for a longer period of time. In fact, major depression is thought to be four times greater in people with chronic back pain than in patients with pain that is of the acute but short- lived kind.

Depression is compounded by feeling socially isolated as physical limitations can hamper the patient’s ability to do household chores, take care of children, be unable to participate in recreational activities, and his professional work may suffer leading to financial difficulties, that could lead to stress and strain in personal relationships. While any pain can cause the patient to feel low, those whose pain is so severe or constant that it impedes their normal activities, reduces their mobility, forcing them to become dependent on others, are particularly prone to depression. Women and elderly patients are also more likely to report both symptoms of chronic pain and that of major depression.

Types of Chronic Pain

The most commonly reported pain areas reported by depressed patients are:

• Pain in the neck
• Back pain
• Pain in the musculoskeletal system, that is in the muscles and bones
• Stomach pain
• Chest pain
• Headache

Treatment

That major depression can lead to feelings of suicide, and even the act of committing suicide, is a major fallout of depression if not treated on time. Patients suffering from both depression as well as chronic back pain are more likely to commit the act of suicide In fact, depression is very likely to aggravate the physical symptoms of chronic pain. Similarly, untreated chronic pain may lead to distress and depression.

But one of the biggest hurdles in treating major depression in a patient suffering from chronic back pain is that the doctor diagnosing the patient would not be considering the possibility of depression, since the patient himself is not likely to be aware of it himself. Unfortunately, when the doctor misses this important aspect in his treatment of chronic back pain, then any treatment directed specifically at reducing the patient’s pain is likely to be less successful.

So, for treatment to be most effective it should be simultaneously directed towards eliminating or reducing the patient’s physical pain as well as depression. This means the patient should undergo multi-disciplinary treatments that include psychotherapy, counseling, medication for his physical pain, physiotherapy, yoga, as well as anti-depressant medication. Though total elimination of pain might not be possible for many patients, working with a family doctor and a pain management specialty group such as a neurologist, a physiatrist, or an anesthesiologist, along with a supportive family or friend circle, is the recommended way for relief from both physical pain and emotional distress.

A Piece of Advice

Do not allow yourself to be controlled by pain, either mental or physical. Know that chronic pain can be demoralizing and frustrating. When in pain you will be unable to deal intelligently with life’s situations. Chronic pain can set in motion a vicious circle of depression, anxiety and stress, and negatively impacting your interpersonal relationships too. The first step is to accept your problem. The second is to seek help. Let those close to you know that you are depressed. Know that it is a common enough malady with millions across the globe suffering from it. So share and encourage others to open up to you. Share your fears, doubts and anxieties; move out from the shadows of your mind, and the answers and cures will be yours to reach out to. So in helping yourself you will be helping others too.

Many patients, who have benefited from vagus nerve stimulation therapy for depression, have reported a decrease in physical pain as their depression and mood has improved.