Depression and Pain

Pain is “an unpleasant sensory or emotional experience associated with actual or potential tissue damage or described in terms of such damage.”

International Association for the Study of Pain

Physical pain may be a common, often unrecognized initial manifestation of depression. It is a complex experience that affects thoughts, mood and behavior and can lead to isolation, immobility, and drug dependency.

According to numerous observations, more than 50% of depressed patients that visit general health practitioners present mainly with physical symptoms, including pain. Studies suggest that if physicians tested all pain patients for depression, they might discover 60% of currently unrecognized cases of depression.

More than 70 % of depressed people taking antidepressants also reported having physical pain. The most frequent symptoms they presented with are: headaches, back pain, abdominal pain, and joint pain. In 30% of patients with co-morbid physical and emotional symptoms, pain persisted much longer.

People with chronic pain have three times the average risk of developing psychiatric symptoms (usually mood or anxiety disorders) and depressed patients have three times the average risk of developing chronic pain. Response to antidepressant therapy in pain-suffering patients is much less (four to two times) comparing to those without pain.

Recent research showed that brain chemicals, serotonin and norepinephrine, which are known to play key roles in regulation of emotions, are now believed to also transmit pain stimuli. When regulation fails, pain gets intensified along with sadness, hopelessness, and anxiety.

Almost every psychotropic medication can also serve as a pain medication by relieving anxiety and depression, stabilizing mood and improving sleep. Amitriptyline is an antidepressant most often recommended as an analgesic. SSRI’s (Prozac, Zoloft etc) can be used as well and they are less risky than tricyclic drugs.

There is also a connection between depression and migraines, which, in fact affects more than 10% of Americans. For example, a person with a history of major depression is 3 times more likely to have a first migraine attack, and a person with a history of migraines is 5 times more likely to have a first episode of depression.

Depression happens 4 times more frequently in people with chronic back pain than in the general population. And vise versa: 32 to 82 % (average 62%) of patients with low back pain present with depression. Moreover, spine surgery patients with pre-operative clinical depression may continue to display depression symptoms post-operatively, which can negatively impact the surgery outcome. Such patients present with low motivation, sleep disturbance, slow healing time, difficulty with physical rehabilitation and inability to perceive improvements.

According to numerous studies and research the combination of chronic back pain and depression is more likely to lead to disability than either depression or chronic back pain alone. Treatment for depression is often part of a preparation for spine surgery program.

Resources

American Academy of Pain Management
www.aapainmanage.org
209-533-9744

An organization for professionals working with people in pain. It provides accreditation, continuing education, publications, and other services.

National Foundation for the Treatment of Pain
www.paincare.org
916-725-5669

Provides comprehensive information and referrals to pain specialists.

American Chronic Pain Association
www.theacpa.org
800-533-3231

American Pain Foundation
www.painfoundation.org
888-665-PAIN (7246)

These organizations provide information, advocacy, and support for chronic pain sufferers and their families.