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Depression and Anxiety Special Report

The Pain-Mood Connection

Pain is one of the most common symptoms people with depression complain about, and people who are depressed experience more impairment from their pain than those who are not depressed. Often, the depression-pain scenario plays out in a vicious cycle, and to find relief from one, you must treat the other.

Although we like to think of ourselves as stoic, physical pain can wear down even the most robust of spirits and eventually lead to depression or anxiety. For those who have a family history of mood disorders or have had prior episodes, the stress of pain can trigger a new episode. So if you're struggling with persistent pain and find your mood is becoming affected, it's important not to ignore it and to seek treatment.

Pain Pathways -- Pain can be debilitating, unpleasant, and bring on a wide range of negative emotions from anger to despair and fear. Because it stirs up uncomfortable feelings and may be associated with a loss of function and the ability to interact with others and enjoy life, it's no surprise that chronic pain can cause depression and anxiety. Chronic pain is stressful, both physically and psychologically, and may alter your brain chemistry in a way that makes you vulnerable to such mood disorders.

In addition, the more pain you feel, the more severe your mood symptoms tend to be, and the longer your pain persists, the more likely you are to feel depressed – 30-80% of people with chronic pain suffer from clinical depression.

Pain and anxiety are also closely linked: Anxiety about pain can intensify its severity -- if you fear that you'll have pain after surgery, it's likely you will, according to one study. Previous experiences with pain can also increase your anxiety about it in the future: If you've thrown your back out in the past, doing so again in the future may bring on the same or more intense pain. Finally, anxiety about pain may inhibit you from getting exercise or cause you to stiffen up in anticipation of painful sensations, which can lead to even more pain.

Managing Pain and Your Mood – Chronic pain can be difficult to cure, but it almost always can be managed. The first thing to do is to see a healthcare provider, your primary care doctor, or perhaps even a psychiatrist or pain specialist who can treat both your pain and the accompanying depression or anxiety.

  • Medication. In the arena of medications, both the selective serotonin reuptake inhibitors (SSRIs) -- such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and the like— and the serotonin and norepinephrine reuptake inhibitors (SNRIs) -- such as duloxetine (Cymbalta), trazodone, and venlafaxine (Effexor) -- affect brain chemicals that are responsible for both mood and pain and are therefore often very effective.
  • Psychotherapy. Beyond medications, cognitive-behavioral therapy and interpersonal therapy can help you deal with depression by teaching you how to change your mindset and attitudes toward life and uncover emotional conflicts that could be increasing your pain. For instance, it's been found that people who are prone to catastrophizing -- focusing on the worst that could happen in any situation -- have more pain than people who are more realistic or optimistic.
  • Stress management. Stress management techniques such as relaxation exercises, listening to music, hypnosis, and biofeedback also can help in distracting you and teaching you to reduce both pain and stressful feelings. However, such non-medication approaches require you to be an active participant in their use in order for them to work -- that means you have to be motivated to practice them on a regular basis.
  • Combination therapy. Finally, like all forms of depression, it's important to be aware that the first treatment strategy you try may not work immediately or completely. Doctors have noticed that there are differences in the way that men and women experience pain (women feel more of an emotional component, while men tend to perceive it in a more cerebral or analytic manner) and react to pain treatments (women may not respond as well or to the same medications as men). There are also natural individual variations in the response to various pain medications.

So you may have to experiment to find the right combination and doses of medications and psychotherapy that will offer the most relief for your physical and psychological distress. But don't give up -- given the many different treatments available today, help can be found.

Posted in Depression and Anxiety on June 17, 2009

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