Chronic Pain. Depression. They are regarded as the one-two punch that — even as we refine and improve medical and pharmaceutical technology — keeps millions of Americans out of work and on their backs. Indeed, pain and depression might be considered the Bonnie and Clyde of misery—so rarely is one without the other.
Ariadne Montare, 33, a Manhattan lawyer, has battled the combination for over a year-ever since she was diagnosed with fibromyalgia, a syndrome characterized by sleep disturbances, muscle pain, and overwhelming fatigue.
“When I first started experiencing pain and depression together, it was like the chicken and the egg riddle,” she says. “I couldn’t tell which came first, or if they were separate or linked.”
Montare battled the two alone for months, convinced at times that the moodiness that accompanied her pain was all in her head. “I’d never thought of myself as an unhappy person,” she says, “yet here I was, unable to get out of bed.” That is, until her doctor hit upon the right treatment combination, which includes pain medication and antidepressants.
Montare’s struggles are far from unusual. Studies show that approximately 20% to 70% of chronic pain patients also suffer from major depression. Researchers further report that patients with clinical depression are more likely than their depression-free counterparts to develop headaches and chest pain.
New research suggests that the neurotransmitter serotonin plays a significant role in creating such synergy. Serotonin is responsible for regulating a variety of mental and physiologic functions, including sleep, mood, and anxiety. Many experts believe a lack of serotonin may play the same role in pain as it does in depression — enhancing its perception — and, as a result, disrupting sleep and heightening anxiety. “Serotonin, which plays a role in the perception of pain, is also a factor in our perception of depression,” explains Patrick Randolph, Ph.D.. Dr. Randolph is the Director of Psychological Services in the Pain Management Center at Texas Tech University Health Sciences Center in Lubbock.
What may hurt the most, however, is that many patients are regarded as malingerers, whose problems wax and wane with their need for attention or a day off from work. Randolph points to stress as a prime culprit. “Stress causes the sympathetic nervous system to go into overdrive, which, in turn, produces prolonged muscle spasms and releases pain-producing substances.” Montare agrees. “I feel better when I’m not at work and worse when I’m [under] stress.”
The most effective way to cope with an unending cycle of pain and depression is with an interdisciplinary approach. “By using the power of medicine, mind, and body, you can help break the cycle and improve your quality of life,” says Randolph. Here’s what you need to do:
* Take your medication regularly as prescribed by your physician.
* Try yoga.
“The mind-body benefits of yoga can be helpful,” says Randolph. “One of the best things about yoga is that everyone starts out making slow, small movements. It reacquaints people with their bodies and helps them realize that they can reach physical goals and actually feel good at the same time.”
He has proof: Dr. Randolph’s latest study examined chronic pain patients who took part in an 8-week program that included meditation and yoga. Eighty percent said that their ability to cope with the stress of life improved, and 79% reported they felt better.
* Talk to a therapist.
Many people who experience chronic pain suffer major life losses, whether it’s a job or a lifestyle. “These losses can be quite devastating,” says Randolph. “Grieving for them with a therapist helps you work through this pain and helps you rethink your expectations of yourself and others.” Ariadne Montare agrees. She used to “get frustrated and berate myself” if she had to cancel high-energy social plans. “Now, instead of getting upset, I invite friends to do something I can enjoy close to home instead.”
Understanding the way you relate to pain is also important. A study done at Brown University in Providence, Rhode Island, found that chronic pain patients who believed pain would impair their daily functioning were more likely than others to suffer impairments. “A therapist can help you learn to separate your feelings about pain from the pain itself. Also, she or he can help improve the way you cope, thereby reducing your chances of succumbing to depression,” says Randolph.
* Try cognitive re-framing.
Chronic pain may prevent you from doing some of the things you love, but it doesn’t have to prevent you from enjoying yourself. Cognitive re-framing is a technique that helps you evaluate the activities you enjoy, then select the aspects of the activity you can still incorporate into your life. If you love tennis but your arthritis prohibits you from playing, think about what made you love it in the first place. Was it being outdoors? Competing against other people? Finding new ways to incorporate these elements into your life will make you feel less helpless and help you learn new activities as well.
* Practice stress management
“Meditation induces deep relaxation, and it allows people to help separate emotions from the physical experience of pain,” says Randolph. From a psychological and physiologic standpoint, relaxation is the best state from which to deal with pain. “Pain causes the body to go into fight or flight mode, forcing up blood pressure and stress hormones. The result: lowered resistance to more pain and depression,” says Randolph. The relaxation that results from meditation helps to shut these damaging responses down. Randolph adds that “biofeedback and stress management therapy can also provide similar results.”