You Don’t Have to Live With Chronic Pain and Depression
By James Hendricks, D.C. I
f you Googled the word “depression”, you find over 61 million search results, if you did the same for pain you find over 210 million. When you link the 2 together you will get over 73 mil- lion links. The over whelming thought in the medical research com- munity is that there is a definite link between the two. As a prac- titioner, the vital part is being able to recognize the symptoms of each, determine if the symptoms are linked in an effort to diagnose and treat your patient correctly. Not all patients with chronic pain are depressed, but studies have shown that approximately one out of three people with chronic pain have significant depression. Clinical depression is the form of depression that is most often seen with pain and it is characterized and diagnosed with the list of symptoms below. Doctors give a diagnosis of clinical depression to patients that suffer from at least five of these daily, for a minimum of two weeks.
• Depressed mood for most of the day, nearly every day • Poor appetite or significant weight loss or increased appetite or weight gain
• Loss of interest or pleasure in usual activities • Disrupted sleep: too much or too little • Agitation or restlessness • Low energy or fatigue • Feelings of worthlessness and/or guilt • Lessened ability to think, concentrate, or make decisions • Frequent thoughts of death, suicide, or wishing to be dead
Researchers have determined that while depression is strongly linked to pain, “there is little understanding of how this link works or how it might be utilized in clinical settings.” There is not a clear link that one precedes the other; however when both pain and depression are present in a patient the overall prognosis is signifi- cantly affected. As a doctor that treats musculoskeletal conditions, injuries and pain, while I have been trained to recognize the symp- toms of depression, it is not my main clinical focus. I would expect the same to be true with a Psychiatrist or Psychologist, while they are able to recognize musculoskeletal pain or injuries, it is not their clinical focus, but depression would be. In the investigation of the treatment of depression and pain, it is noted in the research literature that clinicians in some cases are fail- ing to assess both issues, resulting in a probable “under treatment
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of one or both of them.” Clinical evidence has suggested that while treating the pain will not totally alleviate the symptoms of depres- sion when both are present; it does result in significant early im- provements in the depression as the musculoskeletal pain improves. This would suggest that a course of action would be to combine both the treatment of the pain with the treatment of depression to achieve the maximum amount of success.
Researchers do agree on these four facts about pain and depression:
• Pain occurs with depression as often as it occurs with anxiety. • The number of painful areas in the body, and how much pain interferes with daily life, can predict the risk of developing depression.
• Some symptoms of depression, like low energy, sleep problems, and worry, are common among pain patients, but other depression symptoms, like guilt and loneliness, are not. • Depression often appears soon after a chronic pain condition starts.
As a doctor that treats musculoskeletal pain every day, it makes perfect sense that depression is linked to ongoing chronic pain. Pain in general limits what we in the medical world call the “Activities of Daily Living:” sleep, dressing, using the bathroom, sexual activity, driving the car, household chores and social activities to name a few. Loss of even just one of these activities over time can lead to stress in family relationships, loss of pleasurable activities, fatigue, etc. As a person who deals with chronic arthritis pain daily, on a personal level I can relate to how loss of physical activity or physi- cal strength can lead to a diminished level of self esteem and self worth. As a poster I have seen frequently says,” Growing Old Is Not for Wimps,” I find as with all things one must always find happiness in things that we do have and retain an optimistic attitude; however it may be hard to find the optimism when suffering from clinical depression. Many researchers believe that neurotransmitters of the human
brain form a link between chronic pain and depression. Neurotrans- mitters are used to relay, amplify and modulate electrical signals be- tween the brain, through its nerves and other cells of the body. The brain uses neurotransmitters to control everyday bodily activity: like
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