Insider’s view. Being in chronic pain can also change the way you see yourself, especially if it curtails your ability to be physically active or participate in activities that are meaningful to you. So if you used to think of yourself as a vibrant, capable person and you’re forced to give up playing tennis or knitting because of your arthri- tis, or a disc problem has ruled out running, you may come to see yourself as broken or damaged. And that view can be disheartening because it represents a loss of physical functioning, meaning, social anchor- ing and identity, experts say. “When people have a pain problem, they often see themselves as somewhat disabled, which can affect their self-esteem,” notes Robert N. Jamison, Ph.D., an associate professor in the departments of anesthesia and psychiatry at Harvard Medical School. And that sets the stage for depres-
sion. If anyone knows this it’s Brad Keller, 54, who ran a marathon, logged 10,000 miles on his bicycle in one year and took Spinning classes regularly be- fore a car ran over his left foot, crushing the nerves, in December 1994. After that, Keller developed chronic nerve pain and electric-shock sensations in his foot, a condition further compound- ed by long-standing back pain. “Mood changes have a way of creeping up on you,” says Keller, a father of two and a
corporate consultant in Charlotte, North Carolina. “I had always tied who I was to how good of shape I was in. And it’s very hard to have a good self-image when you’re turning into something you don’t want to be. I started seeing myself as unworthy because I lost all the activities that allowed me to maintain bal- ance in my life and all the friends that went with them.” Not surprisingly, Keller sank into a depression. If you’re dealing with long-term or poorly con-
trolled pain, Keller’s story may sound familiar. But it doesn’t have to be that way. You can break the pain- depression cycle by taking the right steps to protect your physical and emotional well-being. Here’s how:
Move your body more. It’s no secret that exercise is good for body and mind, but that couldn’t be more true when it comes to chronic pain and depression. “Exercise is probably the single best thing people can do because it has antidepressant, anti-infl ammatory and antipain ef- fects,” Raison says. It also triggers the release of en- dorphins, one of the body’s natural painkillers, and raises levels of the feel-good neurochemical serotonin. Plus, it makes you feel physically capable, which can
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improve your overall sense of well-being, notes Sean O’Mahony, M.D., medical director of the palliative care service at Montefi ore Medical Center, in New York City. Even short bouts of exercise can help: A new study from the Cleveland Clinic Foundation found that when people with chronic pain partici- pated in a daily 10-minute session of walking on a treadmill, they experienced immediate improvement in their depression and anxiety; after just three weeks of walking, the exercise felt easier—meaning they experienced psychological and physical benefi ts in less than a month. The key is to start exercising slowly and build up gradually to prevent injury and more pain, Raison says. A good rule of thumb: Don’t increase the duration or intensity of your workouts by more than 10 percent per week. So if you start with a 20-minute brisk walk, swim or ride on a sta- tionary bike, bump it up to 22 minutes the second week, then 24 minutes the third week and so on. Most important, choose a type of cardiovascular exercise that you’ll enjoy; this dramatically increas- es the odds you’ll stick with it over time.
Discuss meds with your doctor. Nope, we’re not talking about NSAIDs or narcotics or even opioids. In addition to your doctor’s usual arsenal of pain medications, there’s another type that’s surprisingly effective at relieving pain: antide- pressants. SNRIs (serotonin-norepinephrine reuptake inhibitors) like Cymbalta (duloxetine) and Effexor (venlafaxine) are usually tried fi rst, then older tri- cyclic antidepressants such as Elavil (amitriptyline) since the latter tend to have more side effects and a higher risk for overdose, says Raison. “Some of these are known to be effective analgesics [painkillers], independent of their antidepressant effects,” adds Russell Portenoy, M.D., chairman of the department of pain medicine and palliative care at Beth Israel Medical Center, in New York City. When used with pain patients, the goal is pain
relief, but if someone is also depressed, relief from depression becomes the second most important goal, Portenoy explains. Tricyclic antidepressants are used to treat migraines and low back pain, while SNRIs are given for neuropathic (nerve) pain, such as dia- betic neuropathy or fi bromyalgia. (Some of these meds have been approved by the U.S. Food and Drug Administration to treat pain; for others, analgesia is a very common off-label use, Raison says.) So if you have neuropathy, don’t be surprised if the only pain medicine you’re given is an antidepressant—it doesn’t mean your doctor thinks you’re depressed or that your pain is all in your head. Or, you may be given an Rx for an antidepressant along with other pain