Specialists understand that both chronic pain and depression can lead to one another, which complicates treatment but in no way precludes getting effective help.
A friend from Santa Fe, New Mexico writes:
“There was a period about seven years ago when I described myself—tellingly, I said no such thing to others—as 'wild with pain'. Anyone looking at me would have thought I was lazing in bed. I was only too aware that the pain, all of it, was what you could call subcutaneous, though it filled the unhappy sac of my body from the roots of my hair to the acupressure points on the soles of my feet.
“Nor was I unaware that passing my days in bed could only be increasing the overall soreness. When I got word, on my mobile phone of course, that a dear friend was coming to town, it took me less than a minute to connect her arrival with the fact that she had been, in a life she had consciously turned away from for reasons of personal growth, one of the top sports masseurs in the U.S. Surely for me she would come out of retirement.
“She’s the kind of friend who has keys to your place, and when she let herself in and took one look at me, she skipped the greeting in favor of saying, ‘We’re taking you to the hospital now.’ Before I could make my well-rehearsed plea for ‘just one more of your special massages,’ she pre-empted me with, ‘Get dressed. You’re depressed again, and you need help.’
“The writer Anne Lamott is fond of saying, ‘Everybody does better with the truth.’ Sometimes we hate her for it, at least until the pain stops.
“I’d been around the block with depression enough times to know that people often somaticize clinical depression. They feel it as a physical problem, often a distressing one that in only a few days of depressed imagining is focused on a medical syndrome that is immediately life-threatening. But surely that didn’t include back pain so severe it was difficult to change positions in bed and impossible to sleep.
“At the hospital, the doctor, who knows both me and my friend well, matter-of-factly diagnosed me, from the door, as ‘depressed. Again.’ Then he put me on the maddening starter dose of an SSRI and ordered daily twenty minute walks until I could up them to daily half-hour aerobic walks. It felt like Jesus telling Lazarus to jump rope. I, on the other hand, felt better in a week of following doctor’s orders (and my friend’s “coaching”).
Scott Berry | Life Coach and Counsellor
When you 'bottom-out' in the cycle of depression there's very little you can do but reach out for medical help. But once you get it, and you begin to emerge from that horrible place, that's when you can actively work too improve your life and create resilience strategies that help should you start 'falling' again.Learn More
Is there a link between pain, especially chronic pain, and depression?
As august a source as America’s Mayo Clinic has on its single-page (yet for all that comprehensive) discussion of depression and pain and their likely if mysterious links and interactions, thus: “In many people, depression causes unexplained physical symptoms such as back pain or headaches. This kind of pain may be the first or the only sign of depression.” Extreme muscle tension itself can be acutely painful.
Turning to the other vector of the pain-depression link, the Mayo Clinic notes that depression resulting from pain goes beyond the discouragement that physical injury can cause to people who are normally active or for whom physical activity underlies work, remunerative or otherwise.
Chronic pain, it notes, “causes a number of problems that can lead to depression, such as trouble sleeping and stress.” Depression also frequently accompanies health conditions such a diabetes and heart problems that are in themselves painful. It confirms the “vicious cycle” by which pain can lead to depression in a way similar to the way depression can “cause” pain.
The authors of a website Spine-health put it another way: “For some people, the stress and depression resulting from chronic pain can become consuming, and have the potential to significantly worsen and prolong the pain. Increased pain can, in turn, lead to increased stress and depression, creating a cycle of depression and pain that can be difficult to break.”
Chronic pain is defined as pain that lasts more that three to six months, or beyond the predictable duration of an injury or ailment. Beyond that, it can resist categorization as readily as it does understanding. Pain directly attributable to a condition such as spinal stenosis or degenerative disc disease is, relatively, easily diagnosable and demonstrable, if less easily treated or even reduced.
By contrast, many forms of pain, often severe pain, are difficult to locate, diagnose, and treat. Examples are syndromes commonly called “phantom pain,” wherein the pain sufferer “feels” pain in a limb that has been amputated, or “referred pain,” in which pain whose source is one part of the body (often hard to identify) is felt in another.
And then there is the physiological syndrome well described by the Spine-health team as this: “Prolonged pain appears to set up a pathway in the nervous system that sends pain signals to the brain, even in the absence of an underlying anatomical problem in the spine. In such cases, the pain is itself the disease.”
For the person dealing with such kinds of pain—particularly, pain that has no readily visible source and/or for which medical experts are unable to locate a specific one—the specific physical pain is compounded by various forms of personal isolation that get added to the experience of the pain itself, which leads to depression.
Even caretakers, including close family members and friends, who “believe” the complainant's pain but become increasingly aware of their helplessness in the face of it, weary of hearing about it. Soon, or eventually, the person with the pain stops talking about it to eliminate the stress it causes others.
Similarly, sufferers of chronic pain find themselves having to find a way to relate to the people who, seeing no cause of the pain, don’t believe it, even if they do not say so. In the same vein, there is the suspicion on the part of some others that the pain complainant is merely seeking the relief of strong, or stronger, drugs.
It can become a real Catch-22. Onlookers may not want to admit, at least into full consciousness, the very idea of invisible, undiagnosable chronic pain because it’s like not wanting to think about nuclear war: it could happen to you. So, even though it would not be your fault, it would be your problem. There is such a thing as denial about the problems of others.
The Anxiety and Depression Association of America states clearly, “Many chronic pain disorders are common in people with anxiety disorders.” Arthritis, which the ADAA notes is “a wide-ranging term that describes a group of more than 100 medical conditions,” often leads to accompanying anxiety, depression and mood disorders.
Of late there has been increasing focus on a medical condition called fibromyalgia, which similarly is used to label a range of conditions that manifest as widespread muscle pain and profound fatigue. The ADAA provides a more detailed consideration of fibromyalgia here.
How is pain associated with chronic pain best treated?
It warrants noting that the combination of these conditions greatly complicates treatment of either, say nothing of both together. In the estimation of the ADAA (verbatim here):
“An anxiety disorder along with chronic pain can be difficult to treat. Those who suffer from chronic pain and have an anxiety disorder may have a lower tolerance for pain. People with an anxiety disorder may be more sensitive to medication side effects or more fearful of side effects than, and they may also be more fearful of pain than someone who experiences pain without anxiety.”
But that in no way means that there are no good treatment options, medically and by the individual with chronic pain.
Unsurprisingly, medication is a front-line therapy. In most cases it entails treatment with both pain-reducing medications and anti-depressants. Treatment with medication is a complicated matter and should only be administered by licensed medical and psychiatric professionals, ideally specialists in the matter.
In addition to medication, the Mayo Clinic advocates:
The ADAA also recommends “life-style” adjustments that will be familiar to people accustomed to dealing with depression, such as (in addition to the Mayo Clinic’s):
Sleep, in sufficient amounts and of the right kind
Nutrition, particularly the avoidance of foods that aggravate muscular-skeleton conditions, such as
Avoidance of alcohol, caffeine, and tobacco
A website called blurtitout.org, whose team of contributors write about these matters as people who understand them from the inside, recommend the following forms of self-treatment, further elaborated here:
Depression - A Survival Guide
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