What is the relationship between chronic pain and depression?
Chronic pain is the pain that lasts three to six or more months. Approximately about 20% of adults suffer from chronic pain in Australia.
Those individuals wake up in the morning, function during the day and go to bed at night trying to minimise the pain to maintain some quality of life.
They may be frequent visitors to a doctor or pharmacist to obtain medications for temporary pain relieve that it may become very costly and leading to addiction.
Overtime severe chronic pain individuals become hypersensitive to all incoming stimuli, their behaviour regresses and they will do anything to alleviate their suffering.
The pain is expressed by the musculoskeletal system and becomes the focal point of the individual’s life.
Typical pain generators are migraines, joint pain, digestive problems, chest pain and back pain.
Feeling “down” is a universal experience of depression, being sad or “blue” accompanies disappointments, setback, or loss in life.
For some people sadness becomes so intense and long lasting that influences every aspect of one’s existence.
Chronically depressed population feels powerless, overwhelmed, consumed by their helplessness and often unable to sleep.
When a person is continually stressed he goes through three response stages.
First there is recognition when a person becomes aware of the stress and is biologically alarmed. Adrenal, cardiovascular, respiratory and musculoskeletal functions increase.
In the next stage a person makes an attempt to cope and problem solve psychologically, biologically and socially. If these coping devices fail, physiological, mental and emotional exhaustion sets in.
The third stage, exhaustion, generally occurs when the interaction of chronic depression and pain collide. As coping responses fail, physical exhaustion depletes adaptive reserves and resistance disappear manifesting in depression, insomnia, fatigue, depression, musculoskeletal complaints, and medication.
Because depression and pain share a common neuro-chemical pathway they are both influenced by serotonin and norepinephrine- neurotransmitters.
Depression and associated painful physical symptoms must be treated together in order to achieve remission.
In fact, research has shown that physical symptom improvement was correlated with the improvement of other depression symptoms, which suggests that the person’s ability to achieve depression remission may be directly related to the reduction of painful physical symptoms.
A treatment regimen that does not address physical symptoms and only focuses on core emotional symptoms could result in an incomplete remission and a poor treatment prognosis for the individual.
It is necessary to choose efficacious therapeutic agents that promote the elimination of both the core symptoms and associated physical symptoms of depression to ensure remission and a return to full social functioning and to prevent relapse.
Fortunately, more chronic pain people every day are opting for alternative therapies to help deal with disruptive episodes of discomfort. Relaxation massage effectively alleviates stress that may lead to pain while pain management techniques are often able to break chronic pain cycles before they manifest as depression.
Although chronic pain and depression are closely linked, it has been proven that the two conditions do not have to co-exist with one another but if they do, one continually supports and reinforces the other.
However, as complimentary medical and manual therapy modalities continue to improve, touch therapists, psychologists and physicians, working together, are better able to collaboratively resolve both sides of the pain/depression dual diagnosis.