The link between pain and depression is well-known, but that doesn’t mean it’s inevitable. Here’s how to stop the downward spiral.
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The link between pain and depression is well-known, but that doesn’t mean it’s inevitable. Here’s how to stop the downward spiral.
The link between pain and depression is well known, but that doesn’t mean it’s inevitable. Here’s how to stop the downward spiral.
STORY BY STACEY COLINO
when you hurt it’s hard to feel like much is right with the world. So it’s hardly surprising that ongoing pain often takes a toll on your mood and can even lead to depression. Meanwhile, for some people, pain is a symptom of their depression, just as for others it shows up as extreme fatigue or appetite changes. Wheth- er one condition causes the other or they simply coexist, any way you slice it, the relationship between chronic pain and depression is a long and winding two-way street, experts say. “Sixty to 70 percent of people who are depressed complain of pain, even if there’s no obvious source of the pain, because depression amplifi es the feeling of pain in the body,” says Charles L. Raison, M.D., clinical director of the mind-body program in the department of psychiatry and behavioral sciences at the Emory University School of Medicine, in Atlanta. “Meanwhile, people with chronic pain have high rates of being depressed or becoming depressed.” A study from Wayne State University, in Detroit, found that 35 percent of people with chronic pain also suffer from major depression. How is this possible? For one thing, “chronic pain and depres- sion ride on the same circuitry in the central nervous system, and the wires can get crossed up,” explains Raison. “The neurochemicals norepinephrine and serotonin play a central role in the antipain pathway in the brain, and they’re involved in depression.” Plus, some of the areas of the brain that regulate pain are also involved in the processing of emotions and the regulation of mood. As a result, ex- periencing chronic pain can trigger changes in these brain regions— especially the prefrontal cortex and these shifts can knock you off balance emotionally or alter your thinking abilities. “I tell people that in treating chronic pain, we do just as much brain management as pain management,” says Rex Schmidt, Psy.D., a clinical psychol- ogist at the Nebraska Medical Center Pain Management Program, in Omaha. “If we’re not doing a good job of managing a person’s depression, we’re not going to do a good job of managing their pain.”