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Chronic illness and its link to depression

Can chronic pain lead to depression? Can depression lead to chronic pain? Read on for the link between chronic illness and depression.

Since 2009, Linda, 48, has been waking up – and going to bed – in severe pain. Every day, she suffers with stiffness in her joints, and often has tingling in her hands, feet and scalp. She endures massive headaches. She is constantly fatigued, and as a result has trouble concentrating and making decisions.

“I have this dull ache all over my body, all the time,” explains Linda, a postal service employee. “It’s everywhere – it’s in my legs, my back, my shoulders, my head. Everywhere.

“And because of the kind of work I do, I never not notice I’m in pain.”

Ron, 55, has irritable bowel syndrome and tinnitus. Both illnesses have severely affected his social and professional life. “IBS is such a personal and embarrassing affliction,” says the advertising manager. “It’s not something that you can casually share with people, like ‘Oh, I’ve got such a terrible headache, or oh man, this back pain won’t go away.’ You can’t say to people, ‘I didn’t make it to the bathroom again,’ without them wanting to throw up.”

Ron’s tinnitus (constant ringing in the ears), however, seems to give him more anxiety than his stomach concerns. Like the 50 million Americans who experience tinnitus, Ron feels as though he’s living in a nightmare he can’t wake from – sometimes the sound is ringing, but he’s also heard scratching, static, or high-pitched squealing. It’s least troubling when he’s in a loud, crowded space, because the sounds “on the outside” take over the sounds only he hears. But in the quiet of night, when he’s trying to calm down, relax and fall asleep, the excessive sound has nearly driven him to the point of “screaming.

“Imagine someone drilling into your brain – you’d want to scream too,” says Ron. “There’s no cure for this. I’ve wished on more than one occasion that I was dead.”

While Linda and Ron have very different ailments, they share something in common: the undesirable combination of chronic pain and depression, which has had a devastating, debilitating effect on their lives and their mental health.

What is chronic pain?

Chronic pain lasts significantly longer than what is expected, usually lasting over 12 weeks. Whereas acute pain occurs immediately after an injury, starting to go away as your body begins to heal, chronic pain ensures that you stay in pain for weeks or months after the injury or illness. Even more mysteriously, sometimes, chronic pain begins with no known or obvious cause.

When you have chronic pain, it’s possible that you also have low energy and suffer from exhaustion. You may experience high levels of stress, mood swings, and you might start hurting in places when you never used to feel pain or discomfort before. You may be losing sleep because of your pain, which results in lower productivity during the day.

Chronic pain causes: why am I feeling like this?

Although chronic pain is often caused by some kind of injury, like a pulled muscle, many medical professionals believe that chronic pain is likely to develop after nerves have become severely damaged. Because of that, the pain sharpens and last much longer than expected. This means that even after treating the original injury, the chronic pain continues.

What conditions lead to chronic pain?

The following are associated to chronic pain, but you don’t have to experience any of these to have chronic pain. They are:

Fibromyalgia, which is widespread pain throughout the body, including bones and muscles
Migraines, or other types of headaches
Arthritis, a disorder that affects the joints
Crohn’s/colitis/IBS, or any diseases that disrupt your body’s ability to digest food
Nerve damage, which may be caused by stretching or cutting of the nerve, and which might result in numbness, weakness, or pain
Back problems, which might be a result of activity, injury or other underlying medical conditions
Knee injuries, which may be due to previous activity, injury, or age
Chronic fatigue syndrome, which is extreme exhaustion accompanied by pain
Interstitial cystitis, which causes bladder pressure and pain
Endometriosis, which is when the uterine lining grows outside of the uterus
Temporomandibular joint dysfunction (TMJ), which is a popping, locking or clicking of the jaw
Vulvodynia, chronic vulva pain
Past surgeries

Chronic illness and depression

Studies have reported that approximately 32 million Americans report to having pain that has lasted longer than 12 months, and over half of that population says that they are depressed.
Experts say that because pain symptoms and physical ailments are often the focus of medical visits, depression experienced by those with chronic pain will often go undiagnosed or ignored.
Pain is uncomfortable, no matter the level. “I hurt every day, which is really inconvenient,” says Linda, who says that she tries to use humor to alleviate her pain. “So that means on most days, I’m grumpy, irritable, and frustrated – and that’s just on the outside! I come off like this grouchy old lady and I’m not old!

“Inside, do I feel old? Hell, yes. Do I feel hopeless, depressed, and completely inconsolable? Hell yes. If my pain went away, I can almost guarantee my depression would too.”

What are the symptoms?

The symptoms below are the ones most associated to individuals struggling with chronic pain and depression:

Mood swings, more often low than high
Lowered self-esteem or self-worth
Poor sleep
Weight gain or weight loss
Sexual difficulty
Decreased interest in activities you once enjoyed
Exhaustion or fatigue
Financial stress
Family stress
Social isolation
Experts report that depression and chronic pain share the same neurotransmitters, or the brain chemicals that travel between nerves and which are responsible for sharing messages. The physical and emotional feelings you will experience from chronic pain overlap with and contribute to feelings of depression. Those feelings then feel magnified and seemingly impossible to overcome.

Chronic pain treatment: what are the options?

Because the frequency and severity of everyone’s pain is different, treatment plans are personalized specifically for you. Your doctor’s main goal will be to reduce your pain and improve your quality of life, so that you can start living the way you used to.

Your doctor will likely prescribe medications to help treat your chronic pain. Some types of medications that you may be given to try are: over the counter pain relievers, like aspirin, ibuprofen (better known as Advil) or acetaminophen (what you might recognize as the brand name Tylenol).  More severe pain may be treated with opioid pain relievers, like codeine, hydrocodone or morphine.

Many health care practitioners will also prescribe antidepressants, which are known to ease the symptoms of both depression and chronic pain.

There are also medical procedures available to treat chronic pain and depression. They include electrical stimulation, which is thought to reduce pain by sending mild electric shocks into your muscles; acupuncture, an ancient treatment that involves the pricking of skin with tiny needles;  and nerve block, an injection that prevents nerves from sending pain signals to your brain. In some cases, if your doctor feels as though you may have had a previous injury or surgery that hasn’t healed properly and may be contributing to your chronic pain, a second surgery may be recommended.

Alternatively, you can go the natural route – if medication and medical procedures aren’t an option for you, you can opt for natural remedies. These include:

Music therapy
Tai chi
Art therapy
Pet therapy

Mindfulness in particular is very helpful for chronic pain and depression. In the mid-90s, psychologists from the University of Oxford, University of Toronto and University of Cambridge developed a new form of cognitive behavioral therapy, called mindfulness-based cognitive therapy (MBCT). Described as a marriage of Eastern meditation and Western cognitive behavioral therapy, mental health practitioners work with patients over the course of eight sessions.

This is a typical meditation exercise:

1. Sit upright, with your feet flat on the floor. Some experts recommend being barefoot, so you can be conscious of the feeling of your feet on the ground.
2. Close your eyes, breathing and in out. Imagine your breath flowing in and out of your body. Don’t change the way you’re breathing, and don’t feel conscious of anything or anyone else around you. Just breathe.
3. If your mind wanders, bring your attention back to breathing. It’s ok that your thoughts have gone away, but the key to mindfulness is being aware that you’ve wandered away. Just bring your attention back.
4. You will eventually feel calm and grounded through this exercise of breathing.
5. Repeat daily for 30 minutes.

Psychologists from the University of Exeter reported in 2011 that MBCT proves a better therapy than medication or traditional counseling in the treatment of depression, with three quarters of the patients in their study feeling well enough after MBCT to stop antidepressant medication.
While Linda has not seen a therapist who specializes specifically in MBCT, she is conscious to practice mindfulness as much as she can throughout the day. “Even if I’m out driving and I start to feel myself spiraling, or I’m in so much pain I want to rip my hair out, I’ll pull over,” she says. “I’ll get into a parking lot, close my eyes, and just breathe. I tell myself that with every breath I’m letting out, I’m letting the pain go.

“Some days it works within seconds, other times it takes a solid 20 minutes,” she adds. “But it always works. It brings me to a better place, every time.”

How else can I deal with my chronic pain and depression?

Because chronic pain is different for everyone, there’s no single magic cure. But it is manageable, and in addition to the suggestions above, there are other things you can do to mitigate your stress levels and alleviate your pain. It’s a good idea to build your emotional skills so you can cope with the stresses and trials of your chronic illness. Here are some ways how you can do that:

Self-care. Taking care of your body is a great way to de-stress and keep yourself healthy. Keep up with your hygiene, eat well, exercise regularly, and treat yourself to a massage, a hair appointment, or some kind of luxurious self-indulgence once in a while. It doesn’t have to be expensive, but it should be something that’s just for you.

Take up a hobby or do something you really love. If you’re looking to lift your spirits, do something you enjoy. It could be reading, golfing, going to the movies, or watching a whole series on Netflix in one fell swoop. Better yet if you do something with a group of people, whether it’s a wine tour on a trolley, a paint-by-numbers night, or joining a ballroom dancing class. By surrounding yourself with other people, or immersing yourself in an enjoyable activity, it distracts you from your pain and helps boost your mood.

Ask for help. This is not a sign of weakness. Seeking support from friends and family members isn’t something you should feel ashamed of. If you’re experiencing a particularly painful day, ask a friend to swing by to chat. If your body is in considerable pain, and you’re having a hard pain just completing your daily tasks, ask a friend to come over to help you do dishes or do laundry. Not only will you have physical assistance, you’ll have the opportunity to bond and get an emotional boost from someone you love – and someone who loves you.  

If you’re suffering from chronic pain and depression and need assistance, please contact us today to speak to a member of our highly qualified and helpful mental health team.

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