We all know what it’s like to be caught unaware by slamming a toe savagely into the pavement or the edge of a stair. We’ve smacked our funny bone against the door frame and growled ‘that wasn’t funny’ or we’ve placed a finger onto the hot part of the saucepan and then pressure hosed it under the tap for an insufficient amount of time. When these things happen, it hurts. But, fortunately, the pain usually only remains from a few seconds to a couple of days; it is not long lasting.
Chronic pain, however, does not have a short expiry date. Rather, chronic pain can last anywhere from three months to several years.¹ Pain receptors and the associated neurones that carry the pain signal to the brain, instead of being stimulated for a short period of time following an injury, are stimulated continuously for months or years on end.² Not only does it involve long-term pain, but a number of neurological functions may be affected as part of the deal. Chronic pain sufferers may notice symptoms of decreased concentration, faulty memory, and mood disorders.³ In fact, 32 to 82% (with an average of 62%) of chronic pain patients show some type of depression or depressive problem, with the rate of clinical depression increasing linearly with pain severity.⁴
Why does this trend appear in people suffering from chronic pain? Is chronic pain causing the depression that up to half of its sufferers display? Pain psychiatrist Dr Xavier Jimenez explains that the two conditions overlap, with chronic pain having the potential to cause depression and depression having the potential to cause pain. This can generate a cycle that amplifies the severity of both conditions.¹
But how does chronic pain cause such a disruption in someone’s mood to develop? A number of reasons have been suggested to explain this relationship, all of which have the potential to contribute to the development of depression in chronic pain patients, especially when the factors occur simultaneously.
- Sport and Spine Rehab CEO Dr Jay Greenstein and psychiatrist Dr Bruce Kehr suggest that chronic physical pain causes “Learned Helplessness”, which involves someone experiencing an emotionally distressing situation which is repeated and that they can’t control or stop. These feelings of helplessness and worthlessness may just be because of the perceived inability to get better from the pain or may be related to their struggle to perform daily tasks, support their family, or attend work. If the person is unable to attend work, the financial difficulties that arise may also contribute to the stress and worthlessness the person feels.⁵
- Isolation and lack of sleep may also contribute to the development of depression. Chronic pain can also cause sufferers to isolate themselves from others as they have difficulty with movement and getting out and about due to their pain. They then become confined to the home and have little to take their mind off their pain and their situation. Moreover, people suffering from chronic pain often struggle with sleep, so will experience fatigue during the day, which increases irritability and negative emotions, which don’t assist the sufferers when they are alone with their thoughts.⁴
- In response to chronic pain, large amounts of pain relief and anti-inflammatory medication can cause gastrointestinal distress, which increases discomfort, and a general feeling of mental dullness.⁴ Pain medication can also depress mood and cause isolating behaviour. Unfortunately, what many chronic pain sufferers do not realise is that strong pain medications such as opioids and benzodiazepines, if taken over an extended period of several years, can make the pain significantly worse. The medications work by blocking the transmission of pain signals to the brain so that the person does not actually the pain, or feels it to a lesser degree. If this transmission is blocked for an extended period of time, the nerves begin to send the signals more strongly so that the message will reach the brain properly. The medication dosage is, therefore ‘upped’, and the cycle continues until the pain receptors begin to perceive most stimuli, which would normally be encountered as part of everyday life, as painful.⁶
While all of these factors do assist depression to develop in chronic pain patients, the most significant cause of depression as a result of chronic pain is neurological. A Northwestern University research study found that back pain persisting for six months or longer coincided with abnormal brain chemistry in the area of the brain associated with emotional assessments, decision-making and social behaviour. The team commenced a subsequent study, in which they found that chronic back pain caused the human brain to shrink by as much as 11%, with a rate of loss of brain density of 1.3 cubic centimetres per year of chronic pain being calculated. This loss of brain density was found to particularly occur in the hippocampuses of the people suffering from back pain compared to the healthy people.²
Retrieved from https://www.brainhq.com/brain-resources/image-gallery/brain-anatomy-images?page=1
The hippocampus is a region of the brain that is largely associated with memory but also functions for learning and emotional processing. It is part of the limbic system, which is the emotional centre of the brain and the hippocampus is also one of the few places that humans can grow new neurones.³ Lead researcher of the Northwestern study, A. Vania Apkarian, concludes that, as chronic pain is characterised by constant stimulation of the neurones that transmit and perceive pain signals, these neurones become overused and either die or are left damaged, which causes brain density to decrease.² As a result of this wasting away of neurones in an area with a significant role in mediating mood and processing emotions, chronic pain sufferers’ ability to perform these functions effectively is decreased, so they can experience major depression.
So how can you treat chronic pain and any associated depression? First, find a doctor that will help you to address the pain as soon as possible and will help you to accomplish the best outcome by assisting you in determining the combination of treatment options that works best for you. Exercise and physical activity are important treatment options as they improve mobility, keep the body healthy in order to maximise its healing ability, and do help to reduce pain. Be mindful of your body during exercise and physical activity so as to not cause excessive pain or injury. The American College of Physicians recommends spinal adjustments, physical therapy, yoga, Thai Chi, and acupuncture for those suffering from spine-related pain.⁵
As the chronic pain is treated, the depression that arose as a result of the pain will begin to subside and hopefully cease completely. While the treatment of the chronic pain is still in process, however, it is still important to take measures to manage depression while it remains. Possible options include:
- Cognitive behavioural therapy, which helps patients manage their pain by developing coping skills. It involves teaching patients how to identify dysfunctional thoughts and to healthily and effectively manage and respond to them.⁷
- Exercise and physical activity, as well as assisting in the health and healing of the body, help to boost mood.
- Self-help groups provide psychological support for chronic pain sufferers while they endure through the daily challenges of their condition.¹
- If confined to the home, make an effort to organise for visitors to keep the person company, to provide them with support, and to help them in maintaining a healthy mindset.
- Most importantly, Sport & Spine Rehab says “remain hopeful”⁵. Keep in mind that there is treatment available for your condition, and that healing is possible.
As has been stated, chronic pain does not just involve ongoing pain and discomfort. It can cause mood disorders, particularly depression, that make it that much harder for the people suffering from an already difficult condition. It is vital to begin treatment for chronic pain as soon as possible to reduce the amount of time that the pain is experienced and to prevent neurological damage from overstimulation of pain neurones. Numerous techniques are available to help manage any depression that develops as a result of the condition, and it is important to find a combination of these options that will help the sufferer best. And, most importantly, “remain hopeful”.
- Why Chronic Pain Brings You Down — and How to Feel Better. (2017). Health Essentials from Cleveland Clinic. Retrieved 3 March 2018, from https://health.clevelandclinic.org/why-chronic-pain-brings-you-down-how-to-feel-better/
- Chronic Pain Shrinks the ‘Thinking Parts’ of the Brain. (2004). Northwestern. Retrieved from http://www.northwestern.edu/newscenter/stories/2004/11/chronic.html
- Sutherland, S. (2012). How Chronic Pain Affects Memory and Mood. Scientific American. Retrieved from https://www.scientificamerican.com/article/how-chronic-pain-affects-memory-mood/
- Deardorff, W. (2004). Depression and Chronic Back Pain. Spine-health. Retrieved 3 March 2018, from https://www.spine-health.com/conditions/depression/depression-and-chronic-back-pain
- Greenstein, D. (2017). Chronic Pain And Chronic Depression: A Connection Not To Miss. Sport & Spine Rehab. Retrieved from https://ssrehab.com/chronic-pain-chronic-depression/
- Benner, R. (2015). Chronic pain not only hurts, it also causes isolation and depression. But there’s hope. The Washington Post. Retrieved from https://www.washingtonpost.com/national/health-science/chronic-pain-not-only-hurts-it-also-causes-isolation-and-depression-but-theres-hope/2015/01/12/db576178-7fe7-11e4-81fd-8c4814dfa9d7_story.html?utm_term=.7bfd83b2f490
- Brain and Spine Team. (2017). How Can You Relieve Chronic Pain — Without Drugs?. Cleveland Clinic. Retrieved from https://health.clevelandclinic.org/how-can-you-relieve-chronic-pain-without-drugs/