Depression

How Chronic Pain Leads to Depression

Thu, 21 Feb 2008 13:54:58 -0800

February 21, 2008
by: Sylvia Marten

[url:138,type=|term|,content=|Depression|]
[url:161,type=|term|,content=|Sleep disorders|]
[url:1079,type=|node|,content=|Anxiety|]

In the study, the researchers demonstrated that the wiring in the brain of someone dealing with chronic pain is different than that of pain-free individuals. In a the brain of a pain-free individual, all the regions of the brain exist in a complementary state, meaning that if one region of the brain is active the other regions are at rest. But in people with chronic pain, a front region of the cortex mostly associated with emotion is constantly active.

“The areas that are affected fail to deactivate when they should.” said Dante Chialvo, lead author and associate research professor of physiology at the Feinberg School. “They are stuck on full throttle, wearing out neurons and altering their connections to each other. “

‘If you are a chronic pain patient, you have pain 24 hours a day, seven days a week, every minute of your life,” Chialvo said. “That permanent perception of pain in your brain makes these areas in your brain continuously active. This continuous dysfunction in the equilibrium of the brain can change the wiring forever and could hurt the brain.”

Chialvo hypothesized: “It could be that pain produces depression and the other reported abnormalities because it disturbs the balance of the brain as a whole.”

Importantly, Chialvo notes that the research findings “show it is essential to study new approaches to treat chronic patients not just to control their pain but also to evaluate and prevent the dysfunction that may be generated in the brain by the chronic pain.” The research results are being published in the Journal of Neuroscience.

Source: http://www.chialvo.net/

More resources:

Pain Message Boards
[url:137,type=|term|]
[url:138,type=|term|]

Back Pain and Holiday Blues: 18 Tips to Reduce Your Holiday Stress

spine-health — Fri, 07 Dec 2007 13:00:24 -0800

December 7, 2007
by: Sylvia Marten

Ah yes, the holidays are upon us once again, and with them the holiday blues. Not everyone is in festive spirits, especially those of us with chronic pain. Often, chronic back pain leads to [url:138,type=|term|,content=|depression|], and alternately depression can worsen physical pain. The added anxiety and stress of all the holiday planning and expectations can intensify feelings of sadness. Travel blues may factor into the equation too - vacation blues catch us off guard as we're taken away from our normal routines and pain management support like special [url:158,type=|term|,content=|ergonomic chairs|] and [url:161,type=|term|,content=|mattresses|]. Even if it's just a temporary bout of the holiday blues, that doesn't mean you have to simply accept it. Here are some things you can do to reduce your holiday stress.

Talk with friends on the phone, or over coffee.
Talk with other people who suffer from back pain or chronic pain on the Spine-Health.com forums:

See your family doctor or psychiatrist - you may have a physiological disorder that requires antidepressants.
Improve your diet and exercise regularly, at least on non-party days. Don't stress about weight gain at the big family gathering or work holiday party. Having food you enjoy and chatting with friends releases endorphines. Live a little! On other days, make sure that you eat in moderation and get at least a half hour of cardiovascular exercise, even if that means nothing more than taking a walk. If you have difficulty with certain types of exercises due to back or neck pain, try these [url:1183,type=|node|,content=|exercise tips for people with back pain|].
Seek sunshine - the real thing is best, but if it's dark and dreary outside, spend a few extra dollars and get yourself some full spectrum lighting.
Set realistic goals and don't be the ultimate people-pleaser. Decide what's important and don't overextend yourself.
Plan a small gathering of friends or neighbors such as a dinner or wine party.
Read these Spine-Health.com articles:

[url:1079,type=|node|]
[url:6615,type=|node|]
[url:1081,type=|node|]

Make sure your plans move you toward your goal, and celebrate even minor achievements.
Cook, buy yourself some new music and/or new books to have on hand. (no depressing music!)
Go to a museum or concert.
Plan a short trip to a place you enjoy, either by yourself or with a good friend, and don't forget to take along these [url:1107,type=|node|,content=|pain-free travel tips|].
Rent movies from your local movie store or an online DVD rental company.
Hug somebody! This is no joke, hugging has positive and real physical benefits. The BBC even published the results of a study stating that hugs increase oxytocin and reduce blood pressure in women.
Meditate. According to researchers at James Cook University in North Queensland, Australia, meditation offers similar mood benefits to running or other physical exercise. If your pain restricts you from strenuous exercise, consider meditation. Don't know how? You can learn to meditate.
Go ergonomic. If you're at home, it makes sense to have [url:158,type=|term|,content=|ergonomic seating|] available. If you're going to sit and watch TV, eat dinner or pay bills, do everything you can to reduce your pain by giving your back the proper support. [url:170,type=|term|,content=|Pain management|] is a key component in managing depression during the holidays as well as throughout the year.
[url:1927,type=|node|,content=|Get enough sleep|]. Yes, you have to get to the store, wrap those gifts, bake that cake, etc...but sleep deprivation is a big contributor to depression. Be disciplined - go to bed and get 6 to 8 hours of sleep! If you have difficulty sleeping due to chronic pain, you might want to check out our articles on the [url:1315,type=|node|,content=|best mattresses for back pain|].
Clean up the house and get organized. A clean space can make you feel better about any other holiday projects you have going on.

BONUS "BEAT THE HOLIDAY BLUES" TIP:

Honor your own feelings. While nobody wants to feel depressed, recognizing your sadness can mean that something isn't working in your life the way that you would like it to. If it's something you want to change, hey, it's almost time for those New Year's resolutions, right? Pay attention to what your body is telling you, and if necessary, seek the help you need.

Chronic Pain = Clinical Depression

Mon, 12 Nov 2007 16:54:50 -0800

November 12, 2007
by: Sylvia Marten

When pain becomes chronic and does not respond to pain medication and other treatments, the normal response is a combination of fear, anxiety, irritability, anger, and eventually [url:830,type=|node|,content=|depression|]. People suffering from chronic pain are four times more likely to suffer from clinical depression than healthy individuals. And the greater the pain, the more likely it is that the person will develop depression.

How does depression develop in people with chronic pain? The cycle is described by Dr. William Deardorff as follows:

"[The development of depression] can be understood by looking at the host of symptoms often experienced by the person with chronic back pain or other spine-related pain."

The pain often makes it difficult to sleep, leading to fatigue and irritability during the day.
Then, during the day, because patients with back pain have difficulty with most movement they often move slowly and carefully, spending most of their time at home away from others. This leads to social isolation and a lack of enjoyable activities.
Due to the inability to work, there may also be financial difficulties that begin to impact the entire family.
Beyond the pain itself, there may be gastrointestinal distress caused by anti-inflammatory medication and a general feeling of mental dullness from the pain medications.
The pain is distracting, leading to memory and concentration difficulties.
Sexual activity is often the last thing on the person’s mind and this causes more stress in the patient’s relationships.

Understandably, these symptoms accompanying chronic back pain or neck pain may lead to feelings of despair, hopelessness and other symptoms of a major depression or clinical depression.

A recent study by Strunin and Boden (2004) investigated the family consequences of chronic back pain. Patients reported a wide range of limitations on family and social roles including: physical limitation that hampered patients’ ability to do household chores, take care of the children, and engage in leisure activities with their spouses. Spouses and children often took over family responsibilities once carried out by the individual with back pain. These changes in the family often led to depression and anger among the back pain patients and to stress and strain in family relationships." (Source: [url:819,type=|node|,content=|Chronic Pain and Depression|]).

Helpful Resources:

[url:830,type=|node|]
Living with Pain that just won't go away
Chronic Pain Message Board
[url:819,type=|node|,content=|Depression and Chronic Back Pain|]

Question: Are You Depressed or Just Feeling Down?

spine-health — Wed, 22 Aug 2007 18:42:59 -0700

Everyone feels down once in awhile, and for many of us enduring stressful times in our lives, it can truly feel overwhelming. But how do you know if you’re clinically depressed and should see a professional for help? Clinical depression goes beyond what would be considered normal sadness or feeling bleak.

Take this questionnaire and put a check next to each statement that is true for you:

___ I have a predominant mood that is depressed, sad, blue, hopeless, low, or irritable, which may include periodic crying spells
___ I have a lack of appetite, even for my favorite foods, or significant weight loss, or conversely increased appetite or weight gain
___ I have a sleep problem of either too much sleep (hypersomnia), or too little sleep (hyposomnia)
___ I feel agitated (restless) or sluggish (low energy or fatigue)
___ I have lost interest or pleasure in usual activities
___ I have decreased sex drive
___ I feel worthless and/or very guilty
___ I have problems with concentration or remembering things
___ I have thoughts of death, suicide, or wishing to be dead

If you put checks next to at least 5 of the above statements and the symptoms have occurred daily for two weeks or more, you are considered clinically depressed.

Based on what we’ve learned from Spine-health.com’s [url:2192,type=|node|,content=|back pain community|], I would add that chronic back pain and any type of chronic pain that seems unresponsive to treatments is also a cause (and/or a symptom) of depression.

If this is the case for you, please find professional help promptly. There are a wide range of anti-depressant medications available that have helped a lot of people and many types of therapy that can also help. Visit the National Alliance on Mental Illness to learn more about treatment options.

Posted by: Stephanie

Sources:

[url:819,type=|node|]
American Psychiatric Association. In: Diagnostic and Statistical Manual of Mental Disorders. 4th Ed. Washington, DC.1994

Also see:

[url:830,type=|node|]

Cyber Hugs: How Online Support Groups Help with Chronic Pain

Wed, 18 Jul 2007 19:29:21 -0700

July 18, 2007
by: Stephanie

If you're dealing with [url:137,type=|term|,content=|chronic pain|], you probably already know what a devastatingly lonely experience it can be. Even with the most supportive family and friends, you still feel alone, because they don't know – they can't know – what it's like to endure chronic pain each and every day of your life. And just so sick and tired of explaining yourself and having it affect all the most important relationships in your life.

This is where online support groups come in – an online discussion forum where people with the same kinds of pain are dealing with the same things your are. These groups provide you with a circle of friendship, support and camaraderie to help you through the worst and celebrate the good times as well. These people won't tell you its all in your head, they won't keep asking if you think you feel better yet, and they won't mind when you just need to vent.

Contrary to how many people view online chronic pain support forums, the people in these groups are not whiners and attention seekers. At least on Spine-health.com's back pain forums and chat rooms – we find people are almost universally constructive, supportive and at times downright hilarious.

So what are the main benefits of an participating in an online support community?

They validate your feelings – no, you're not crazy or imagining it!
They give you hope even in your deepest times of need
They spur you on to keep coping and looking for pain relief even after you're exhausted and want to give up
They help you with daily living problems. Should I get a shower seat? How do you arrange the pillows at night to get back support? What are recipes that are easy to prepare and nutritious?
They are available day or night. Up with intense pain at 2:00 am and feeling all alone? Log on and you'll have company – your online friends can help you get through the night.
And sometimes best of all, you get the satisfaction of helping others. You can reach out to others when they post questions, need an emotional lift, or just need to talk.

A good pain management program and other approaches can hopefully help you from a medical perspective. And if you're really depressed, take care to get help from a professional right away. (You can use this [url:819,type=|node|,content=|Symptoms of Depression|] checklist as a guide to see if you - or someone you care about - needs help.) And by all means don't forget to take good care of your emotional, spiritual and psychological health too by finding a good support group. You may have to visit a number of discussion boards and chat rooms to find one that suits you best, but I guarantee you it will be well worth it. If you prefer to meet in person, contact your local hospital or your pain management physician and they should be able to give you a list of local chronic pain support groups in your area.

You will be amazed at how many people suffer from the same pain and related challenges as you do, and how refreshing it is to meet others in such similar situations. Cyber hugs to all!

Posted by: Stephanie

Additional Resources:

American Pain Foundation Pain Resource Locator
Back Pain and Chronic Pain Discussion Forum
[url:830,type=|node|]

Pain is Inevitable. Suffering is Optional.

spine-health — Tue, 26 Jun 2007 18:19:08 -0700

June 26, 2007
by: Stephanie

That sentiment, from The Dalai Lama, sums up the gist of a lot of our message board posts. Contrary to what many people think (at least from what surgeons tell me), message boards aren’t just for people hopped up on pain meds or whining. At least on our board, positive thinking is rampant – exactly the kind of support that helps people with back pain deal better and heal better…

Extracts from Spine-health’s discussion forum (minus the epidemic smilies):

Get educated, then keep pushing and don’t give up

Joe: “…My advice is to learn as much as you can about what is going on with you. The challenge can be when you’re loaded up with drugs it is hard to know what you need! But keep pushing and don't give up. There are answers, they might not come right away, but they will come."

Joe: “…The stages we are all in. bewilderment, denial, depression, anger, and finally acceptance. And when we reach the acceptance part we realize we need to educate ourselves and make the best out of what we have.”

When the pain is bad, focus on other things

Cleoscreations: "… My best coping mechanism is ignoring it! In other words, finding other things to do and think about. If it is so bad that I can't ignore it, then I make sure to do what it takes to feel better. Rest, massage, heat, ice, acupuncture. Try them all! I think living with chronic pain is trial and error.”

Dilauro: "For the past year, I've been going to a rehab theraputic pool twice a week and having seen other people that have problems, many worse, helps you get by."

Baileesmom: “I find that funny movies help, even though it hurts to laugh sometimes it is worth it.”

Krazigirl: "I'm with you on the silly movies and ice cream - sometimes when you want to just say screw the meds, screw the pain, forget the world - you just grab a pint of Ben & Jerry's, sit down in front of the TV, and lose yourself."

Don’t go it alone: ask for help if you need it

Manda: “It’s good for you to reach out here and talk about what you are feeling with others who have similar experiences and know that you are not alone in this... I know for me it helps to talk about it and feel my feelings with others who can hear me. I now see a therapist to help me with the emotional aspects of the physical pain as physical pain and emotional are very inter-related... all I can say is that after I have gone into some of my feelings the physical pain often subsides and I feel much better and much clearer.”

ErinM: "Just do the best you can do. That is all anyone can ask for… A good support system is a very helpful thing in this position. Don't be ashamed or too proud to ask for help when you need it.”

Baileesmom: “Your family just doesn't know what to say to make you feel better. Hopefully you can find support from the people that you meet here who understand EXACTLY where you are and can go along for the ride.”

Don: “Hopefully (your family) will give you the support that you need , but when ya need that little extra understanding , visit this site - we here know all too well what you’re going thru. I think this board is one of the best things that I have found for a place to go with understanding people that will listen and offer support as best as they can. It is not easy, but in this site u can get a lot of understanding that is very well needed. The chronic pain is the worst issue I have had to deal with. So just don't ever forget these three words, DONT GIVE UP, there is always someone here to listen to ya, so hang in there ok.”

Me: See, no whining? (Well, precious little). Seriously though, all doctors and clinicians treating chronic pain patients - please ask them if they're getting enough support, and if not give them some resources - online or off - that they can turn to for help. With support, they are likely to do much better.

Posted by: Stephanie

5 Things You Should Know About Chronic Pain

spine-health — Wed, 13 Jun 2007 16:47:41 -0700

June 13, 2007
by: Stephanie

Aside from the obvious problem with chronic pain - i.e. the PAIN - there are many other downsides to [url:137,type=|term|,content=|chronic pain|] that are important to know about. For those living with and enduring chronic pain, pass this along to your loved ones to help them understand and be supportive.

1. Pain is rarely "all in your head" People in pain are often treated as if their pain is actually made up or greatly exaggerated. While it is true that pain is subjective (people simply perceive pain differently) and some people may report pain because they have other agendas – for the vast majority, the pain is VERY REAL and present. It is not made up. The problem is that chronic pain is often caused by types of anatomical problems that are difficult or impossible to diagnose using standard medical tests, and pain cannot be diagnosed like other medical problems (such as a broken bone that can be seen on an X-ray)

Fortunately, most in the medical community are now trying to understand and appreciate that and needs to be treated and managed differently.

2. Pain is not the only problem - it breeds other health problems

Thoughts and emotions related to the pain also can come into play and aggravate or alleviate the pain. For example, [url:138,type=|term|,content=|depression|], which is a serous disease, can worsen the pain. [url:161,type=|term|,content=|Sleep problems|], again caused by the pain, can also make the pain worse. Often all conditions related to the pain need to be treated concurrently in order for the patient to get any relief.

3. Pain is deeply personal Everyone experiences and expresses pain differently. Any two people with the exact same health condition are likely to feel and express their pain in unique ways depending on a number of factors. Newer chronic pain theories now have physiological explanations for how and why people experience pain differently.

When it comes to back pain, this is especially true. In fact, it is not uncommon that no anatomical cause of the pain to be detected. Why is this important? It means that chronic pain often needs to be treated as the primary problem, which is different than the conventional medical approach of identifying and treating the underlying problem causing the pain.

4. Chronic pain is its own beast Unlike acute pain, which functions as a warning signal (e.g. I just stepped on a nail! Get off it!) chronic pain does have any useful function. It just is. Often, chronic pain is caused by [url:2204,type=|node|,content=|nerves continue to send pain signals|] to your brain. When dealing with chronic pain, often one of the most frustrating things is that there is nothing to "fix". It just exists in your body.

5. Chronic pain is LONELY After awhile, many people with chronic pain – especially pain that is caused by a condition that cannot be seen – begin to feel isolated. Here the Internet has done a world of good helping people in pain connect with others in similar situations and find a supportive peer group through online communities of people in similar situations. There is an awesome thread about this on our message boards right now.

Posted by: Stephanie

Main reference:

[url:137,type=|term|,content=|Chronic Pain Health Hub|]

Nearly 60% of People With Back Pain Suffer from Depression Too

spine-health — Tue, 12 Jun 2007 17:18:10 -0700

June 12, 2007
by: Stephanie

Estimates on prevalence of depression among the chronic pain population range from 18 - 32% , but we think it's much higher. Based on our survey, nearly 60% of people with back pain suffer from depression.

Unrecognized probably means undertreated. And studies show that if depression is present it needs to be treated along with the pain.

Posted by: Stephanie

Additional reading:

[url:819,type=|node|]
[url:1079,type=|node|]

More Personal Freedom = Less Depression

spine-health — Fri, 08 Jun 2007 18:38:30 -0700

Hat tip to KevinMD for pointing out new research about how personal freedom leads to less depression in Dutch women than in other cultures.

Posted by: Stephanie

A Long and Exhausting Path to Pain Relief

Wed, 06 Jun 2007 10:59:51 -0700

June 6, 2007
by: Stephanie

A personal, compelling account of trying to get pain relief for severe back and [url:887,type=|node|,content=|leg pain|]. Very interesting read that anyone in a similar situation will identify with.

Posted by: Stephanie

New Study Shows Depression Can Lead to Back Pain

spine-health — Fri, 25 May 2007 14:21:09 -0700

May 25, 2007
by: Stephanie

[url:137,type=|term|,content=|Chronic pain|] is not just a physical problem, it pervades every aspect of one's life, including emotions, mood, behavior and ability to function at even a basic level in everyday life. Major depression is thought to be four times greater in people with [url:819,type=|node|,content=|chronic back pain|] than in the general population. Let's face it, pain is depressing.

Now, however, a recent study has shown that depression can lead to development of back pain.

The three-year prospective study of 148 people aged 35 to 70 years showed that depression was actually a stronger predictor of an individual's propensity to develop low back pain than the results of MRI scans of the spine. None of the study participants had back pain at the start of the study, but 67% developed back pain during the three-year study. Those who reported depression when the study began were 2.3 times as likely to develop back pain as those who didn’t report depression.

In contrast, any progression of [url:673,type=|node|,content=|anatomic abnormalities|], as seen on MRI, was infrequently and only occasionally associated with new onset of back pain.

Source: Spine (Volume 30, page 1541).

Posted by: Stephanie