Although not all people with chronic pain experience symptoms of depression, they frequently occur together. People who are in chronic pain are four times more likely to experience depression in their lifetime than those who don’t have chronic pain. In addition, experiencing chronic pain and depression is often much harder than experiencing just one of these problems because the two conditions often reinforce each other.
Let’s look at a few things like why pain and depression often occur together, suggestions that can be discussed with patients as well as why referring to a pain psychologist can be an invaluable support for your patients.
WHY DO SYMPTOMS OF DEPRESSION AND CHRONIC PAIN FREQUENTLY OCCUR TOGETHER?
People with chronic pain can experience symptoms of depression for a number of reasons.
- For example, some people might feel that pain has taken control over their lives, that they are able to do less than they did previously and that there is little they feel like they can do to lessen their pain.
- In addition to this, societal stigma and misunderstanding as well as growing social isolation can also contribute to these feelings.
- Chronic pain itself is distressing as pain works as an alarm system that has become chronically activated. Many people find this to not only be distressing but that it is a struggle to return to other valued life activities, goals, thoughts, plans or emotions when they are distracted by signals of danger.
*One in six Australians will experience depression at some point in their lives. *
A person may be depressed if they have frequently felt sad, down or miserable for more than two weeks, or have lost interest in many of their usual activities. Some symptoms of depression are included below, however, it is important to remember that many people experience some of these symptoms without meeting criteria for a mood disorder. Most of the time those with clinical depression experience symptoms that impede their ability to perform day-to-day activities, such as work, study, social activities or relationships.
Symptoms may include:
- Difficulty concentrating, remembering things, and making decisions
- Fatigue and decreased energy
- Feelings of guilt, worthlessness, and/or helplessness
- Insomnia (getting to sleep), early morning waking (too little sleep), or excessive sleeping.
- Irritability, restlessness
- Loss of interest in activities or hobbies once pleasurable, including sex
- Overeating or appetite loss
- Persistent sad, anxious, or “empty” feelings
- Thoughts of suicide or death
6 TIPS TO HELP YOUR PATIENTS COPE WITH DEPRESSION AND CHRONIC PAIN
In addition to support from a psychologist, there are a number of strategies that can assist patients in improving their psychological and emotional wellbeing in the face of chronic pain. These include:
1. Keep them active
Pain, or the fear of pain, may mean people stop doing participating in meaningful activities. It important to keep engaged in these things – even though patients may worry they will trigger pain, or they might not be feeling motivated to do them. (If they have stopped doing a favourite activity for some time, they may need to get their body moving again. SLOWLY.) Low impact exercise such as stretching, yoga, walking and swimming can also be beneficial for physical and emotional wellbeing and pleasant experiences produce endorphins which can help people cope with pain.
2. Get them to know their triggers
Figuring out the triggers that worsen patient’s pain/depression symptoms can be important steps to take. Knowing these may:
- Help them cope when they’re triggered
- Reduce the likelihood of pain flare-ups and depression spirals
- Help them feel more in control over their experiences.
3. Get them to feel safe
Engaging in activities that make patient’s feel calm, relaxed and happy. These emotions tell the system that its safe, and that being on high alert is not necessary. Over time, sensitivity will decrease.
4. Get them to be self-kind
Remembering that high standards can often be unrealistic. Remind patients that they’re doing the best they can in their current situation. With the right kinds of support, including Psychotherapy, many people can learn ways to effectively manage their pain.
5. Get them to create a routine
Develop and maintain an eating, sleeping, and exercising routine. A schedule should also include valued and meaningful activities. A routine can carry patients through stressful times.
6. Get them to make social connections.
Research has shown that greater social support is associated with more resilience and less depression. Social isolation and withdrawal can often reinforce feelings of depression and keeping connected will help break this cycle. Feeling comfortable with asking for support is also important as many people can worry about burdening those around them, creating isolation and a barrier between themselves and others.
REFERRING CHRONIC PAIN PATIENTS TO A PAIN PSYCHOLOGIST
As humans our past experiences, knowledge and beliefs help organise and make sense of our lives; and also help us anticipate future experiences. Beliefs about pain, its significance to our lives, as well as our thoughts around our ability to manage the pain can also shape our pain experiences and mean that no two people will experience pain in the same way.
Pain itself can also change the way we think and behave. The brain is adaptive and an experience like pain, which in itself can be distressing and traumatic, can over time lead to changes in how we perceive ourselves and the world around us, which can potentially lead to depression. Psychologists are experts in supporting people cope with the difficult thoughts, feelings and behaviours that may be associated with their pain. They also work with other allied health staff, including physiotherapists and occupational therapists to best support their patient’s wellbeing. A number of psychotherapeutic approaches have been shown as efficacious including acceptance and commitment therapy (ACT) and cognitive behavioural therapy (CBT). A supportive psychologist will work collaboratively with their client to find an approach and develop a plan that is tailored to their unique needs and strengths. Psychological treatments for pain have also been shown to alter how the brain processes pain so that Psychotherapy can be as effective as surgery for relieving chronic pain.
Chronic pain and depression often arrive together, and can act to reinforce each other.
Referral to a Psychologist can play a significant part in your patient’s journey to greater wellbeing and to help them to gain control of chronic pain and depression.
This blog article was prepared and written by Michelle Pangallo, pain psychologist
TREATING CHRONIC PAIN GP EBOOK
As one of Australia's leading multidisciplinary pain specialist clinics, we'll explain what chronic pain is and why it occurs. We'll also explain that chronic pain should be managed as a chronic illness and not just a symptom of an illness.