Often times a patient will come in complaining of a recurrent stiff neck, or back ache, or aching leg muscles that seem to have no physical cause. When I ask them if they’re depressed, they look at me as if I just told them they were imagining their pain. Their aches are real all right, but they’re usually surprised to find out that depression can cause a lot of vague aches and pains.
Researchers now know that pain and depression share the same center of the brain that controls mood and its chemical messengers serotonin and norepinephrine. The upshot of that is that depression can cause physical pain when these two chemicals do not regulate themselves.
Similarly, if you injure yourself, or have an illness that creates physical pain, it can cause depression. Statistics show that people with chronic pain have 3 times the risk of developing psychiatric problems, namely mood disorders and people who are chronically depressed have 3 times the risk of developing chronic pain. The combination of the two can be overwhelming for the affected person.
What To Do About Pain/Depression Syndrome
When a patient comes to me complaining of pain somewhere, of course my first reaction is to exhaust any clinical reasons for it. It might stem from injury to nerves or muscles, strain from exercise, other illnesses such as kidney disease or arthritis which can cause back and leg pains, or dehydration which can cause both joints and muscles to cramp and hurt. Just plain lack of sleep can also cause muscles and joints to ache.
Pain from illness or injury usually has an acute, or sudden, onset and may progress to chronic pain over time. However, pain that comes on gradually as little aches and pains that grow into chronic pain may actually be caused by depression. Symptoms of chronic pain are:
- Pain that lasts longer than 6 months after an injury
- Pain that occurs from something that is not normally painful
- Hypersensation – being overly sensitive to pain.
When I cannot determine a physical cause for a patient’s chronic pain, I then start to look at a depression connection. If a patient is depressed, often they will say that they’ve been feeling down lately, but there are other tell tale signs that can help reveal it. These are:
- Lack of interest in usual things
- Inability to sleep
- Inability to concentrate
- Sadness or excessive crying
- Weight changes
- Low energy levels
Although a direct cause has not been determined yet, fibromyalgia is likely an example of how depression can manifest in physical pain. Tests usually do not show any physical injury to tissues but examination reveals real and specific tenderness points throughout the body.
Treatment usually consists of both treating the physical pain with analgesics, muscle relaxants, magnesium, and trying a course of antidepressants as well. How we treat fibromyalgia may become the template of how we need to treat other pain/depression disorders as well, that is treat both the physical pain as well as the emotional pain, i.e. depression, individually.
In Part II, I’ll talk to you more about some different types of treatment for pain/depression syndromes, but in the meantime here are a few things you can do to help yourself feel better:
- Sleep. Try to get enough sleep every night. As I said earlier, lack of sleep can cause a lot of stiffness and pain in joints and muscles, especially in over-40 people. If you’re having trouble sleeping, try some warm milk with a little cinnamon in it, Rooibos tea, or you may even want to try an over-the-counter temporary sleep aid to break the sleeplessness pattern.
- Nutrition. Make sure you’re getting enough potassium, magnesium, and calcium as depletions in these nutrients can make your muscles cramp and ache. They are nature’s muscle relaxants. Too low carbohydrate diets can rob these minerals out of your system as well. Menopausal women may suffer more from loss of these minerals as well.
- Dehydration. Fluids lubricate your muscles, bones and joints. If you are deficient in them from not drinking enough water daily this can lead to all kinds of aches and pains and bad cramps in the middle of the night.
- Exercise. Even though your legs neck and back may be paining you, movement will help loosen up tight muscles. Swimming is an excellent exercise that helps unkink tight muscles and allow you to move your body without impact stress and strain. Exercise also produces more of the very neurotransmitters responsible for turning off/on depression and regulating pain response, serotonin and norepinephrine. Regular exercise can also help you fall asleep more easily.
Mark Rosenberg, M.D.