Chronic Pain & Depression

Managing Pain When You’re Depressed and Managing Depression When You Are in Pain

by Dr. Michael B. Finkelstein, M.D., F.A.C.P., A.B.H.M.
posted on June 30th 2010

Chronic pain and depression are common problems that often overlap. Depression is one of the most common psychological issues facing people who suffer from chronic pain and it often complicates both the underlying condition causing the pain as well as its treatment. Consider these statistics: According to the American Pain Foundation, about 32 million people in the U.S. report pain lasting longer than one year. From one−quarter to more than half of patients who complain of pain to their physicians are depressed. On average, 65% of depressed people also complain of pain. People whose pain limits their independence are especially likely to get depressed and many are now looking toward alternative approaches to manage their condition. 

Pain and depression are subjective. This means that at any given time, even in the same individual, with the same set of circumstances, symptoms may be more or less severe. Why is this important? The reason: a whole new set of clinical approaches appear when one examines the nature of mind−body interactions. As such, rather than addressing these issues with strictly physical remedies, such as medication, or psychological treatments, such as counseling, there are “integrative” strategies that have impact in both spheres simultaneously and the results can be quite dramatic. As an example, it is often recommended that people who are depressed go outside on a daily basis, particularly into sunlight. It is well documented that a simple walk outdoors will improve mood and lessen the need for medications to treat depression. It may seem too simple to be true, but the effects are real, and this “treatment” is readily available to anyone at no cost! 

We’re not talking about strenuous exercise, which is also known to lead to the release of endorphins in the brain and elevate mood. Instead, we are suggesting something even more basic. And, while not all the mechanisms may be completely understood, the results are not debated. 

Other strategies that can be useful are mind−body techniques such as guided imagery, hypnotherapy and biofeedback to affect the mind’s response to the pain stimulus as well as to direct the mind’s focus to a “lighter," e.g. more pleasant, tone. Practitioners of any of these are readily available to most of us, and there are even tapes, CD’s, and computer programs that one can access on their own. 

Finally, social isolation, as well as physical immobility, can aggravate the symptoms of both chronic pain and depression. While not a perfect solution, community organizations and interaction, including the web, can be important vehicles to help people reconnect to others, a very critical aspect to our overall health.

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