depression and chronic pain

Secret Weapons Stop Pain and Depression

Research finds that self-care strategies improve pain and depression symptoms, over and above the benefits of medication.

Secret Weapons Stop Pain and Depression

Mindful meditation can help turn off chronic pain.

RODALE NEWS, EMMAUS, PA—Relying solely on medication to treat the common combo of depression and chronic pain leaves some powerful treatments out of the picture, suggests a study published in the Journal of the American Medical Association. The study found that people on antidepressants who underwent drugfree pain-management counseling were more likely to see their depression lift than people who underwent traditional depression counseling.

That’s important because the two conditions often occur together. “Depression commonly occurs in people with chronic pain,” says Kurt Kroenke, MD, of the Indiana University School of Medicine and Regenstrief Institute, who was lead author of the study. In 30 to 50 percent of pain or depression cases, the two conditions coexist. “Some people who have chronic pain develop depression because they’re always in pain and their mood drops,” he says. But there are physiological reasons as well. “Depression heightens your sensitivity to pain,” explains Dr. Kroenke. Also, there are neural pathways in the brain that are common to both pain and depression.

More ways to manage pain and depression:
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THE DETAILS: Adults who’d had low-back, knee, or hip pain for more than three months and had at least moderate depression were divided into two groups. The first group was told its members had depressive symptoms and were advised to seek treatment, without the researchers influencing what kind of treatment they received. The second underwent an intervention therapy divided into three stages. During the first stage the patients were given traditional antidepressants, and during the second they were taught pain self-management techniques, such as relaxation, exercise, and psychological tricks for coping with and distracting themselves from their pain. In the third stage, nurses assessed their depressive symptoms and adjusted their antidepressant medication as needed.

More patients in the intervention group saw significant improvements in their depression and pain symptoms: 47.2 percent reported overall improvements in pain, compared with 12.6 percent in the other group. 17.9 percent of the intervention group patients saw significant improvement in their depression symptoms after a year, compared to 4.7 percent of the usual care group, and 26 percent rated their improvement as a 50 percent reduction in depression symptoms and a 30 percent improvement in pain, as opposed to only 7.9 percent of the usual-care patients.

WHAT IT MEANS: Medication helps, but it shouldn’t be the only tool in dealing with depression, especially in cases of depression that are accompanied with physical pain. “Both [medication and drugfree pain-management techniques] are beneficial,” says Dr. Kroenke. “They complement one another. We use medications to treat symptoms as best we can, but since pain tends to be a chronic disorder, people also need to learn strategies to deal with it.” Not only will you decrease your pain by doing so, you may save money, both when it comes to medication and to missed workdays. “Pain and depression are the leading causes of reduced work productivity,” he notes.

Here are a few ways to help manage both pain and depression:

• Talk about it. Many people think that either depression or chronic pain may be all in their heads, says Dr. Kroenke. But both are medical conditions that should be taken seriously. Start by talking to your primary-care doctor and see if a depression test is warranted. This gives you an opportunity to communicate the severity of your pain and discuss options.

• Stay active. Exercise and physical activity not only improve your mood, they help reduce chronic pain. Get a good mix of structured exercise—aerobic activity or weight lifting; just be mindful of your physical limitations—and “lifestyle activity”—walking to the store, gardening, or doing housework. Research has found that endorphins, chemicals released by your body when you exercise, are more powerful painkillers than any medication.

• Be mindful. Studies show mindful meditation, or concentrating on living in the moment, can reduce pain. The Center for Mindfulness in Medicine, Health Care, and Society sells books and CDs that provide tips.

• Relax actively. In addition to mindfulness and meditation, relaxation can be a powerful tool in pain management. Just don’t “relax” by sitting passively on the couch in front of the TV. You can try yoga, deep breathing exercises, or the “tense and relax” technique. For the latter, get into a comfortable position, whether sitting or lying on the floor, and tense the muscles in a major muscle group (for instance, your legs and feet, arms and hands, or face) for two seconds. Take a deep breath when the muscles are tense and then exhale.

Need more ideas? Beat the blues with a natural depression remedy.


Published on: May 29, 2009

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Depression is always painful for every one who experences it. My first experience with depression strated when i took psycho illness tests.

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I find that doing things I enjoy greatly like singing, gardening (to a limited degree) and writing greatly improve my depression and pain. I believe that some of the blame for using antidepressants across the board should be attributed to insurance companies. I was discussing this with a friend of mine who is a psychiatrist. Melissa and Doug Easel

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fatigue and moving antidepressants

I have been depressed due to a Doctor's mistake for 2 years. I went back on my same antidepressant (Effexor XR) but in order to help me, I had to increase the dosage two fold. It still isn't completely helping me but my new doctor won[t increase my dosage. I have lost 10 lbs. by changing my eating habits and walking 1 hour/day.
I also volunteer 2 hours per week. After all this, I am fatigued everyday around 2 o'clock until around 4o'clock. Will this fatigue eventually go away? It is as bad as depression (which is much better.)

Drugs should be a last resort!

My courageous partner has recently gone off drugs after a lifetime of use for depression.

They would have her on one drug, then it would seem to stop working, then put her on another, until it seemed to stop working. Some drugs would make things much worse, even near-suicidal. Bottom line: anti-depressant drugs are a shotgun solution: shoot them at the patients and see what sticks, which is pretty scary when you consider all the side-effects.

It has been difficult, but ultimately liberating for her. But really, really difficult. She was pretty good for a while, then lost some weight, and many of the symptoms came back with renewed vigour. An ayurvedic doctor she's been seeing explained that the drugs store up in fat cells, and can be release for a long time afterward.

For now, talk therapy, ayurvedic treatment, and supportive relationships work better than the drugs ever did. But it is really, really difficult.

Depression, antidepressants, chronic pain

I have recurrent depression. It runs in my family and in some members resulted in alcoholism. I have studied treatment for depression. Talk therapy and exercise are good. Eventually, after dealing with pain from a back injury, I went on antidepressants. I did not do this lightly. I made the decision to go on antidepressants because the depression was interfering with my ability to function. In my case, antidepressants do help. The ones that I am on actually reduce the pain of my injuries to some extent. However, I do not view the antidepressants as a panacea. They do not solve everything. I recently worsened my back injury and I am going to physical therapy. I'm also doing exercise which helps both the injury and the depression. People want simple solutions for situations that cannot be solved by only taking a pill.I have gone to counselors and changed my way of looking at the world. I find that doing things I enjoy greatly like singing, gardening (to a limited degree) and writing greatly improve my depression and pain. I believe that some of the blame for using antidepressants across the board should be attributed to insurance companies. I was discussing this with a friend of mine who is a psychiatrist. Thanks to the attitude of the insurance companies, the new drugs are used almost to the exclusion of talk therapy. Talk therapy is expensive, not always effective, and difficult to measure. Insurance companies would rather pay for drugs.

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