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motivation, which leaves you more susceptible to stress from trivial matters and makes it harder to follow through with active coping skills that will help improve depression and pain,” adds Schmidt. For some people, the best approach to treating sleep disturbances is to combine drug therapy with good sleep habits. “Sleep remedies like Ambien [zol- pidem], Lunesta [eszopiclone] and Sonata [zaleplon] are very effective, safe and the least likely to cause rebound insomnia,” Portenoy explains. “Second-line approaches include using tricyclic antidepressants or antidepressants like trazodone [Desyrel] and Re- meron [mirtazapine]. Often people with signifi cant sleep problems and pain or depression will be on more than one of these drugs.” It’s also crucial to practice stellar sleep hygiene—by going to bed and waking up at the same times each day (this keeps your body’s internal clock ticking effi ciently); avoid- ing caffeine after early afternoon; and not exercising within four hours of bedtime. Meanwhile, introduce a soothing evening routine—taking a warm bath, listening to calming music or reading a pleasant (but not too stimulating) book—to help you downshift into sleep mode. “Sleep needs to be an invited condi- tion; people need to wear themselves out or set them- selves up for sleep in a way that doesn’t force it,” suggests Robert Jamison. “If you can’t sleep within 15 minutes, get out of bed and do something relaxing until you’re in the mood to sleep.”


Try mindfulness meditation. Since none of us can eliminate stress completely, it’s wise to control what we can—namely, how we re- spond to things that bring on tension. To that end, it helps to practice relaxation techniques regularly to “quiet the limbic system in your brain, which will help with both depression and pain,” explains Schmidt. One approach that seems to be especially effective is mindfulness meditation: In a study involv- ing 91 women with fi bromyalgia, researchers at the University of Louisville found that those who par- ticipated in eight weekly 2½-hour sessions of a mind- fulness meditation program experienced a signifi cant improvement in depressive symptoms. Meanwhile, research at the University of Pittsburgh found that when older adults with chronic backaches partici- pated in an eight-session mindfulness meditation program, they had signifi cant improvements in their acceptance of pain and their physical function. With mindfulness meditation, the goal is to sit in


a quiet, comfortable spot, clear your mind of thoughts and focus on your breathing: When thoughts do come to mind, observe them as if they were clouds fl oating across the sky, without judging what you’re thinking.


Then simply return your attention to your breathing. For guidance on how to do mindfulness meditation, check out CDs from Sharon Salzberg (sharonsalzberg. com), Jon Kabat-Zinn (mindfulnesstapes.com) and Sounds True (shop.soundstrue.com). And if medita- tion isn’t your cup of tea, fi nd another stress-relieving technique, such as biofeedback, visualization, self- hypnosis or progressive muscle relaxation.


Get yourself connected. When you’re in pain or depressed or both, it can be hard to muster the energy to socialize. Sometimes just showing up to a dinner or family get-together takes so much out of you that it’s hard to be at your best. After his foot injury, Brad Keller says “it was basically impossible to engage in social activities— beyond simply being there—because I was either in too much pain or I was so medicated that it was diffi cult to participate.” After trying a spinal cord stimulator to treat his foot pain, he began feeling better physically and emotionally—a difference that quickly became apparent to others. “I started notic- ing I had the actual desire to go to parties and try new things like working with the youth choir at church, learning to play the saxophone and rafting with my son. None of that was part of the picture when I was in constant pain,” Keller says. Help family members and friends understand how they can help you manage your pain, adapt to what you’re going through and encourage you to participate in meaningful activities. But resist the temptation to dwell on the topic: “Don’t develop a habit of talk- ing excessively about the pain; focus your energy on the gratifying parts of your life; and talk to family members about how they can help you engage in activities that would help you become more functional,” Schmidt notes. Dis- traction is very important for coping with both chronic pain and depression so you might tell loved ones how they can help take your mind off the hurt—perhaps by accompanying you on a walk in the park on a sunny day, joining you to see a comedy on a rainy afternoon or playing an engrossing game together (backgam- mon, anyone?). “There’s no question that how fam- ilies and friends react to a person’s pain will affect that person’s ability to adapt and function,” Portenoy adds. If you have a hard time discussing these issues on your own, family therapy can help. It’s worth the extra effort—for the sake of body and mind. PR stacey colino is a health writer based in Chevy Chase, Maryland.


If you don’t


manage depression,


you can’t manage


your pain; the two go


hand-in-hand.


PAIN RESOURCE FALL 2012 55


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