In my last article, I spoke to you about the association between chronic pain and depression; how one can cause/aggravate the other because the part of the brain that controls mood also controls pain. I suggested several things that you can do on your own to try and alleviate, or reduce, your pain and/or help brighten your mood.
Today, I’d like to address a few clinical treatments available for chronic pain and depression syndrome. Since chronic pain and depression are so enmeshed with each other, treatment ideally should try and target both at once. If this is not possible an individual approach is used – one treatment for the pain and one for the depression. In addition, a “holistic” approach of looking at the patient’s entire lifestyle in treating pain and depression can be helpful.
Your doctor may draw up a treatment plan for you using a multi-dimensional approach, i.e., using several therapies at once. If your pain is moderate to severe and prescription drugs are required, you may be referred to a Pain Clinic in your area.
The following are several therapies used in the treatment of chronic pain and depression:
Because pain and depression share the same part of the brain that controls mood, and its chemical messengers of serotonin and norepinephrine, a certain class of antidepressants, called SNRI’s (serotonin and norepineprine reuptake inhibitor), is prescribed. This type of antidepressant helps the center of the brain that is shared by pain/depression to utilize its chemical messengers more efficiently. The drugs allow the messengers to flow longer, thereby reducing depression and pain.
As I mentioned in Part I, exercise plays an important part both in reducing pain and depression. It helps naturally release more serotonin and norepinephrine into your blood stream. Plus, it can alleviate stiffness that often occurs in patients who have chronic pain. People seem to give up exercise because of their pain, but in actuality, movement can help relieve it. Exercise also helps you sleep.
Figuring out the best exercise for you will allow you to get some movement, decrease stiffness, increase the pain/depression fighting chemicals and keep your muscles and stamina strong. Bicycle riding, which takes impact off of joints, is a good choice for many people with chronic pain. Swimming is another excellent activity as the buoyancy of the water helps people move without stress on joints. Immersion in water itself helps relax stiff muscles and alleviate water retention, which causes additional pressure on tissues and joints causing discomfort.
Cognitive therapies are “mental training” therapies that I recommend to my patients with chronic pain and depression. These aim at controlling the negative, often self-defeating, thought patterns that can accompany chronic pain and depression. These therapies can help you adhere to your pain treatment program. They teach you how to turn these thoughts off and set progressive goals in your treatment program. These types of therapies can also help you relax thereby reducing anxiety and tension that helps reduce pain significantly.
Neurofeedback is a fairly recent therapy that actually aims at resetting brain waves in people. It is effective for persons who have complex regional pain to return their perception of pain to a more normal level. Pain Clinics are available for patients to go and be hooked up to electrodes that stimulate the brain. This type of stimulation can have a significant reduction in pain for several hours, allowing people to add more quality time to their lives. These units are also available for at home use.
Activities of Daily Living Management
One of the most depression-inducing problems associated with chronic pain, especially if it is moderate to severe, is the loss of independence – having to depend on others to help you live your life every day. Coupled with this may be a loss of a job and social connections as a by-product of constant pain. Working with a pain specialist can put you in contact with social workers and community resources. Together they can assess your home environment for whatever equipment and set ups you may need to assist you in getting around more easily. Taking control of your life often helps ease anxiety that can aggravate pain and depression.
When pain is severe, long-term prescription pain medication may be needed. These are drugs such as oxycodone, Oxy-Contin, Lortab, Vicodin, and Norco. In some cases morphine may be administered in small incremental doses. Since these drugs can be habit-forming, they are generally used only in severe, otherwise unmanageable types of pain scenarios. Drug therapy is often used in combination with other therapies, such as cognitive or exercise therapy, to help keep the patient’s pain level on an even keel. Drug therapy should be managed and followed by a pain specialist.
Chronic Pain Resources
For further information regarding Pain Management practitioners in your area, you may want to contact any of the following:
- American Chronic Pain Association
- American Pain Foundation
- Academy of Cognitive Therapy
Close to 32 million Americans suffer with chronic pain and in turn go through depression. I advise my patients with chronic pain/depression syndrome that it can be a challenge combination to treat but it is not impossible.
As you can see, there are several modalities of treatment that are available. Often times using a mix of approaches can give you more relief than one approach alone.
If you have the symptoms of chronic pain and/or depression, make sure to tell your doctor about them as chronic pain and concomitantly depression, often go undiagnosed until it has become much worse and harder to treat.
Mark Rosenberg, M.D.