Chronic Pain and Depression: A Vicious Cycle continued...
In people who are biologically vulnerable to clinical depression, losses (such as a job, or sense of respect as a functional person, or of sexual relations) can contribute to the development of depression.
Once depression sets in, it magnifies the pain that is already there. "Depression adds a double whammy to chronic pain by reducing the ability to cope," says Beverly E. Thorn, professor of psychology at the University of Alabama and author of the book, Cognitive Therapy for Chronic Pain.
Research has compared people with chronic pain and depression to those who only suffer chronic pain. Those with chronic pain and depression:
- report more intense pain
- feel less control of their lives
- use more unhealthy coping strategies
Because chronic pain and depression are so intertwined, depression and chronic pain are often treated together. In fact, some treatments can improve both chronic pain and depression.
Treating Chronic Pain and Depression: A "Whole-Life" Approach
Chronic pain and depression can affect a person's entire life. Consequently, an ideal treatment approach addresses all the areas of one's life affected by chronic pain and depression.
Because of the connection between chronic pain and depression, it makes sense that their treatments overlap.
The fact that chronic pain and depression may involve the same nerves and neurotransmitters means that antidepressants can be used to improve both chronic pain and depression.
"People hate to hear, 'it's all in your head.' But the reality is, the experience of pain is in your head," says Feinberg. "Antidepressants work on the brain to reduce the perception of pain."
Tricyclic antidepressants have abundant evidence of effectiveness for certain kinds of neurologically-based pain (such as pinched nerves or migraine headaches). However, because of side effects, their use is often limited. Some newer antidepressants are prescribed by doctors to treat certain painful chronic syndromes and seem to work well, with fewer side effects.
Many people with chronic pain avoid exercise. "They can't differentiate chronic pain from the 'good hurt' of exercise," says Feinberg. But, the less you do, the more out of shape you become. That means you have a higher risk of injury and worsened pain.