heartbeat, breathing or digestion. They also affect mood, sleep, concentration, weight, and can cause adverse symptoms when they are out of balance or not working properly. The neurotransmitters serotonin and norepi- nephrine have been found to influence both pain and mood (to name a few) and research suggests that they play a key role in depres- sion and the mediation of pain. When you prick your finger on a needle,
the nerves of sensation in your skin send signals to your brain in response to the stimulus. The stimulus is moderated in the brain by serotonin and norepinephrine. In some patients with depression, an imbal- ance of serotonin and norepinephrine could affect how they perceive the pain response, possibly making it exacerbated. This is a possible explanation of the connection between pain and depression. In a study done by University of Oxford researcher Dr. Chantal Berna, the findings revealed that inducing a depressed mood disrupted the neurotransmitters that regulate emotion, causing an enhanced perception of pain. “In other words,” as explained by Dr. Berna, “when the healthy people were made sad by negative thoughts and depressing music, we found that their brains processed pain more emotionally, which lead to them finding the pain more unpleasant.”
While it all makes sense to me, as a
doctor you have to try to distinguish if it is the depression causing the heightened pain response, the chronic pain which has lead to depression, or the depression causing symptoms of pain? Further investigation into the latter has postulated that the more severe the physical symptoms, the more severe the depression can be. Statistically, it has been shown that people with depression have three times the risk of incurring chronic pain. Additionally, for many patients who are diag- nosed with depression over a long period of time, many will develop chronic pain problems as well, without any clear injury to explain that pain. A study published in the journal Psychosomatic Medicine found that 2/3 of all people beginning treatment for depression additionally reported being in physical pain, with the most common symptoms being frequent headaches, back pain, joint pain, and abdominal pain. From these studies it might be easy to conclude that the depression induces the pain, but let’s take a look at some research coming from down under. In research done in Australia on depres-
sion and low back pain sufferers; patients with depressive symptoms at the time of consultation had higher back pain scores at the three week follow-up. Patients with back
pain after three weeks in turn were more likely to suffer from depressive symptoms at six weeks. The study, which was in col- laboration with the University of Berne in Switzerland, tested 300 patients who went to their general practitioner with a new episode of back pain. They were followed up over a six-week period. As mentioned above, it has been determined that people with depres- sion are more likely to develop and maintain back pain. The reason given is that due to the imbalance of the brain neurotransmitters, people with depression have a diminished ability to cope with an episode of pain. On the other hand, this research has found that people with back and neck pain suffer from depression more often. Physical symptoms are common in ma- jor depression and may lead to chronic pain. Pain symptoms associated with depression include joint pain, limb pain, back pain, gas- trointestinal problems, fatigue, psychomotor activity changes, and appetite changes.
In regards to chronic pain here are some statistics:
• According to the American Pain Foundation, about 32 million people in the U.S. report having pain lasting longer than one year.
• From one-quarter to more than half of the population that complains of pain to their doctors are depressed. • On average, 65% of depressed people also complain of pain.
• People whose pain limits their independence are especially likely to get depressed.
The treatment of depression needs to
be such that it addresses all the areas of the patient’s life; diet & nutrition, the psycho- logical aspect, stress, and the physical aspect as well. Chiropractic health care is a well suited holistic approach to treating the musculoskeletal pain that may be associ- ated with depression or in fact be the issue that is the root cause of the disease. Simply put, Chiropractors use joint manipulation or “adjustments” to restore joint and muscle mechanics and reduce pain. My doctors like myself, take a total approach to patient treat- ment in an effort to reduce pain but also to prevent it from reoccurring. Addressing nu- trition, sleep habits, workplace ergonomics, stretching and exercise are just a few ways. Coordinating this type of care with that of the counselor, psychologist or psychia- trist could be the solution to reducing the symptoms patients suffering from both pain and depression deal with. Whether or not you choose Chiropractic, massage therapy, acupuncture, or physical therapy, the most important thing is that you choose to deal with any type of chronic pain, especially when associated with depression, rather than ignore it or choose to believe that it is some- thing you have to deal with or might “just go away on its own.”
Dr. Jim Hendricks is a doctor of chiroprac- tic at Freeport Integrated Health Center in Freeport and has been in practice for 15 years. His undergraduate education is in Sports Biology and he is Certified Strength and Conditioning Specialist. His main focus of care is musculoskeletal injuries and pain with a special interest in sports injuries. For more information go to
www.freeporthealth. com. See ad on page 9.
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