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Depression Pain Cycle: Part II of the Downward Cycle of Chronic pain

March 2, 2010 by  

In the previous post, I discussed how the mind/body interaction could lead to a vicious cycle of increased pain. We focused on the Stress Pain Cycle; however, there are many other mind/body interactions that lead to a downward cycle of increased pain. Let’s look at the cycle involved in pain and depression.

Estimates are that over 80% of people who have chronic pain will also experience depression. Symptoms of depression include loss of motivation, isolation, reduced pleasure, anticipation of negative future events and decreased activity level. Being in pain and being depressed are bad enough, but unfortunately depression can aggravate the situation by increasing the experience of pain even more.

One factor in this cycle is the neurotransmitter called serotonin. Often referred to as the “feel good chemical”, serotonin is associated with mood. People who are depressed often have lower levels of serotonin in the brain. A low level of serotonin also has an effect on the experience of pain. Often, by increasing serotonin, people feel reduced depression and report improved pain tolerance.

It is thought that serotonin helps to reduce pain by enhancing the effects of endorphins, the body’s natural painkiller. When serotonin levels are low, our endorphins are not as effective at lowering pain levels. In addition to interfering with the effectiveness of endorphins, low levels of serotonin also can contribute to muscle cramping and headaches.

Depression affects pain in other ways as well. People who are depressed often find it difficult to think of things other than the pain. Not only do they focus on pain, but they also tend to “catastrophize”, or predict extreme or horrible future consequences of the pain. We know that focusing on pain and catastrophizing about the pain lead to feeling even more pain.

In addition, people who are depressed often find it difficult to stay motivated to be active. This lack of activity often leads to muscle weakness and eventually to more pain and again, to less activity.

Over time, the cycle of depression along with the other pain cycles, will result in increased pain levels even though there is no further injury to the body.

Breaking out of the Depression/Pain Cycle

As I mentioned in the last post, just hoping the depression will decrease when the pain goes away is not good enough. We know that it is essential to address the depression, while at the same time teaching pain management strategies.

Reducing depression with antidepressant medication and cognitive behavioral therapy often leads to reduced pain. Some of the most commonly prescribed antidepressants for pain and depression include Cymbalta, Elavil, Pamelor, Anafranil, Norpramin and Tofranil.

If you are concerned, talk to your health care providers about the Depression/Pain Cycle and its possible effects. Discuss the treatment option of entering into cognitive behavioral therapy for pain management. If you would like more information, read one of the manyexcellent self-help books for managing pain that are based on the cognitive therapy approach.

In the next post, we will discuss a very common pain cycle, the Physical Deconditioning Cycle.

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