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Chronic Pain

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Pain and depression

Living with chronic pain is linked with depression for many people. Research shows that depression is more prevalent in people that live with chronic pain than those who live with other illnesses [1]. There is evidence that the intensity of your pain predicts how disabled and how depressed you are when you have chronic pain [2] and that gender is important. Research shows that women are more likely to be depressed related to their level of pain, whereas for men depression is more strongly related to how pain interferes with activity [3]. It is also more likely that as you age with chronic pain you are more likely to be depressed [4]. Inflammation and depression are linked too. Research shows that there is an increased activation of pro-inflammatory pathways in people living with depression [5].

Signs and symptoms of depression

  • Ongoing sad, anxious, or empty feelings
  • Feeling hopeless, guilty, worthless, helpless, irritable or restless
  • Loss of interest in activities or hobbies once enjoyable, including sex
  • Feeling tired all the time
  • Difficulty concentrating, remembering details, or making decisions
  • Difficulty falling asleep or staying asleep, a condition called insomnia, or sleeping all the time
  • Overeating or loss of appetite
  • Thoughts of death and suicide or suicide attempts
  • Ongoing aches and pains, headaches, cramps, or digestive problems that do not ease with treatment [6].

Lifestyle approaches to depression

The lifestyle approach is anti-inflammatory in nature. This approach firstly aims to limit all inputs to your nervous system to those that are anti- rather than pro-inflammatory. Anti-inflammatory inputs include diet, moderate exercise, laughter, pleasure, social connection and de-stressed environment. and can be found in the “Anti-inflammatory lifestyle” fact sheet.

Medical treatments for depression

The National Institute of Mental Health says:

“Depression is diagnosed and treated by a health care provider. Treating depression can help you manage your chronic pain and improve your overall health. Recovery from depression takes time but treatments are effective. At present, the most common treatments for depression include:

Cognitive behavioral therapy (CBT), a type of psychotherapy, or talk therapy, that helps people change negative thinking styles and behaviors that may contribute to their depressionSelective serotonin reuptake inhibitor (SSRI), a type of antidepressant medication that includes citalopram (Celexa), sertraline (Zoloft), and fluoxetine (Prozac)Serotonin and norepinephrine reuptake inhibitor (SNRI), a type of antidepressant medication similar to SSRI that includes venlafaxine (Effexor) and duloxetine (Cymbalta).

While currently available depression treatments are generally well tolerated and safe, talk with your health care provider about side effects, possible drug interactions, and other treatment options. For the latest information on medications, visit the U.S. Food and Drug Administration website . Not everyone responds to treatment the same way. Medications can take several weeks to work, may need to be combined with ongoing talk therapy, or may need to be changed or adjusted to minimize side effects and achieve the best results [6]”.

Last word:

If you live with pain it may be a really confusing situation. Among a number of factors, your medicines may be having an impact too. The medical approaches to depression and pain need to be prescribed by your doctor. You may consider getting a referral to a pain specialist for an expert review of best practice use of medicines for your pain and depression. However there are lifestyle approaches too which you can find in the "anti-inflammatory lifestyle for pain" fact sheet.

References

1. Banks, S.M. and R.D. Kerns, Explaining high rates of depression in chronic pain: A diathesis-stress framework. Psychological Bulletin, 1996. 119(1): p. 95.

2. Arnstein, P., et al., Self efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain patients. Pain, 1999. 80(3): p. 483-491.

3. Haley, W.E., J.A. Turner, and J.M. Romano, Depression in chronic pain patients: relation to pain, activity, and sex differences. Pain, 1985. 23(4): p. 337-343.

4. Turk, D.C., A. Okifuji, and L. Scharff, Chronic pain and depression: role of perceived impact and perceived control in different age cohorts. Pain, 1995. 61(1): p. 93-101.

5. Raison, C.L., L. Capuron, and A.H. Miller, Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends in immunology, 2006. 27(1): p. 24-31.

6. National Institute of Mental Health. Depression and chronic pain. undated [cited 2014 25.6.14]; Available from:http://www.nimh.nih.gov/health/publications/depression-and-chronic-pain/index.shtml.

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