Living With Chronic Pain: Coping & Managing Symptoms
Living with chronic pain will naturally impact your mental health and quality of life, but there is a lot you can do to manage your symptoms and to cope with the difficult emotions that come up. Some of the major takeaways from the research on what works in therapy for chronic pain involves not exaggerating or focusing on the negative aspects of your pain or worrying about what else could go wrong with your condition.
Instead, try to stay in the present moment, do what you can to manage your pain, but accept that some pain sensation may be inevitable. Focus your attention on what you want from life and figure out a way to take your pain along for the ride.
Here are some additional ways to cope:
- Practice Active Stress Management: The muscle tension associated with stress can make chronic pain worse. Watch your stress levels and use relaxation tools, like deep breathing, to help you relax.
- Track Your Pain: Keeping some sort of record of your pain levels can help you learn more about what helps with your pain and what doesnt. For example, if you notice you barely slept the night before a hard pain day, it is a clue that good sleep is essential to managing your pain.
- Take Breaks and Modify: Rather than not doing what you love, try to figure out a way to modify your favorite activity and/or take regular breaks. If possible, try to take breaks before your pain flares.
Assessment Of Chronic Pain
In the simplest form, chronic pain assessment is accomplished using a one-dimensional scale such as the visual analog scale , numeric rating scale , or verbal descriptor scale . These scales are self-rated and give a snapshot of the intensity of a patient’s pain. However, it has been shown that chronic pain is highly complex, with multiple factors affecting what the patient experiences with his or her pain, and one-dimensional measures may over-simplify the assessment. Factors affecting chronic pain experience include psychiatric co-morbidities such as depression and anxiety., These disorders may also carry overlap in somatic symptoms with chronic pain, and may worsen pain outcomes., Thus it is beneficial to include psychiatric, emotional, and psychological components as part of a multidimensional assessment of chronic pain patients.,,,, In fact, in 2005, the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials group of pain professionals recommended that six core domains be assessed for chronic pain outcomes. Among these was emotional functioning alongside pain and physical functioning.
Can Depression Cause Anxiety
Prolonged or severe periods of depression can also be a source of anxiety. Symptoms of depression can make it difficult for someone to function normally in their daily life, which can even lead to feelings of anxiety about work, school, or relationships.
Over time, ongoing depression can lead to anxiety due to the persistent negative effects depression has on the mind and body, such as insomnia, hopelessness, and low self-esteem.
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Comparisons Of Psychological Factors By Primary Cancer
Psychological factors are detailed in Table 3. Overall, depression levels approached clinical significance and were greatest for individuals with lung cancer, followed by HNC, and then prostate cancer. The difference was statistically significant between lung and prostate cancer patients only . The mean values for trait- and state-anxiety indicated mild to moderate levels of anxiety. There were no significant differences in state- or trait-anxiety levels among the cancer groups.
Diagnostic And Assessment Issues
The association between depression and chronic pain, though widely accepted, is marred by diagnostic difficulties. In research for depression various definitions exist in studies, leading to a variety of assessment methods, including self report instruments, chart reviews and structured or unstructured clinical interviews. Many studies relating to depression and chronic pain include heterogenous groups of patients with different chronic pain conditions and unspecified diagnostic criteria for depression. This clearly questions the validity of studies.
These points illustrate the unique difficulty present in the study of depression in chronic pain patients. It is not surprising that meta-analyses or systematic reviews in this area are relatively scarce. Just as depression is not a single entity but a spectrum, chronic pain patients are also a very heterogenous group of patients. All these have to be borne in mind when reviewing papers and studies of depression in chronic pain.
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Arthritis And Mental Health
Learn more about the connection between arthritis, depression and anxiety, and how these conditions can make your arthritis worse.
Having any form of arthritis osteoarthritis , rheumatoid arthritis , psoriatic arthritis , juvenile arthritis, lupus, ankylosing spondylitis, gout, fibromyalgia or related conditions can have a negative effect on your mental health. This most commonly manifests as depression or anxiety. It works the other way around, too. Mental health problems can worsen arthritis symptoms.
Defining Anxiety and Depression
According to the American Psychological Association:
- Anxiety is characterized by feelings of tension, worry and irritability along with physical changes like increased blood pressure.
- Depression is characterized by sadness, a lack of interest in daily activities, weight loss or gain, sleeplessnessor excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness or excessive guilt, and recurrent thoughts of death or suicide.
How Mental Health Affects Arthritis
Rates of depression and anxiety in people with arthritis-related diseases vary depending on the population, the size of the study, and the measurement tools used. But data shows that the rates can be between two and 10 times greater than the rates in the general population, depending on the type of arthritis.
Pain and Depression
Inflammation and Depression
Lifestyle and Depression
Chronic Pain Is Unique
Chronic pain is generally defined as any pain that continues more than 3 to 6 months. Please note that this discussion is specifically focused on chronic pain that is not due to cancer or other disease process. This type of pain is also termed chronic non-cancer pain or chronic benign pain.
See Modern Theories of Chronic Pain
Back pain and neck pain can become chronic in a few ways, for example:
- Some chronic pain may be due to a diagnosable anatomical problem, such as degenerative disc disease or spinal stenosis, that can cause continual pain despite attempts at treatment.
- Prolonged pain appears to set up a pathway in the nervous system that sends pain signals to the brain, even in the absence of an underlying anatomical problem in the spine. In such cases, the pain is itself the disease.
- After spine surgery, it is possible for the patient’s pain to either continue or to become worse. When this occurs, it is broadly referred to as failed back surgery syndrome.
In any type of chronic back or neck pain, it is essential to be aware of the potential development of depression, as depression can prolong and/or worsen the pain.
Often, health professionals will refer to a patients suffering which is the pain plus its emotional component . As such, one can have a great deal of chronic pain with little suffering or minimal pain with great suffering
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Chronic Pain And Depression Are Interconnected
When we evaluate the true effect pain has had on an adolescents life, we encounter missed opportunities, broken relationships and, most of all, a loneliness that comes from being left out at a time when being with peers takes on the utmost importance. As many teenagers struggle to see beyond their current frustration, they describe worries that they will live the rest of their lives dragged down by pain.
The physical symptoms that accompany pain often mimic those of depression and anxiety . Chronic pain patients struggling with depression and anxiety are unable to escape these symptoms, even when pain has temporarily abated. As with the often described sick role, being a patient with pain becomes a part of each patients personality.
Fortunately, there is hope. The Pediatric Pain Rehabilitation Program helps patients move past their pain diagnosis and utilize their strengths and resources to return to a more active, fulfilling life.
A vital piece of this return to functioning includes adequate treatment of any psychiatric disorders that are present, to give a patient the best chance of recovery.
While these evaluations are not required as a part of the pain program, they are often recommended based on team consensus and/or parent request. Evaluations include interviews with patient and family, a review of the patients medical records, and input and observations from the rehabilitation team.
Chronic Pain And Depression
The relationship between depression and chronic pain and illness is well-documented. According to the American Chiropractic Association, between 30 and 80 percent of people with chronic pain also have depression, and the combination of illnesses can result in greater disability than either condition would cause on its own.
People with chronic pain live with changes to their body, mental state and social circles. Pain can keep them from sleeping and make it hard to concentrate or hold down a job. These changes can create a cycle of pain that leads to depression, which can lead to more chronic pain.
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Try A Walk Around The Block
According to 2019 research, 2.5 hours of exercise each week can help relieve both depression and anxiety. Exercising outside also appeared to offer more benefits than exercising indoors.
Physical activity can help naturally boost your mood by prompting the release of happy hormones in your brain.
That said, exercising when living with depression or anxiety can be a challenge. If youre able to exercise, it can help to start with small activities you can incorporate into your routine, such as:
- a walk around your neighborhood after dinner
- a weekend hike
Physical Symptoms You Didnt Realise Depression Could Cause
Many people dont realise that depression can have a very real affect on your whole body â not just your mind.
Most people will agree that depression can cause emotional symptoms feeling sad, low, down, numb But what many dont realise is that depression can have a very real effect on your body as a whole.
We are taking a look at seven common but surprising physical symptoms of depression.
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What Causes Anxiety Chest Pain
When youre anxious, your body can and often does produce physical reactions like sweating or shortness of breath.
When you become anxious, your brain and body set off an immediate stress response. This includes a physiological change. Your body may tighten up or grow tense.
A stress response can also include a psychological or emotional response. You may become aggressive or upset more easily. These responses are referred to as the fight-or-flight response. When you become stressed or anxious, your body prepares to fight back or run away.
If you experience this fight-or-flight stress reaction infrequently, your body should fully recover within 30 minutes. But if you experience it frequently, your body cant recover as quickly. This can lead to increased muscle tension, and this tension may become painful in your chest.
Likewise, in an even more stressful moment, your heart rate may increase, and the force of your heartbeats can grow stronger. That combined with tight chest muscles can make you feel unusual pain.
If you feel anxious, there are some simple techniques you can try. These techniques may not work every time, but theyre a great starting point when you need help managing your anxiety.
Take Stock Of The Situation
Accept your feelings of anxiety, recognize them, and then work through putting them in perspective.
Are you worried about something you cant control? Are you fearful of an outcome thats unlikely? Are you dreading a situation you cant control the outcome of? Talk your way through your feelings to find the source, and then work to put them into perspective.
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How Psychotherapy Fits Into Chronic Pain Management
There are many ways therapy can help you to cope with chronic pain. As we talked about, the ways you think about and manage your pain can impact whether or not you will also experience associated depression and anxiety. For instance, focusing on and magnifying the negative aspects of your pain typically makes you feel worse.
A therapist can help you learn to catch these thoughts patterns, so you can replace them with more balanced and helpful thoughts. Acknowledging the pain without judgment, reducing maladaptive ways of avoiding the pain , and learning to live a full life despite the pain.
Therapy can also teach you things about pain that will help you learn to manage it more effectively. For instance, you might learn about how pain information gets to your brain, so you can learn how to use things like distraction to reduce pain. You will also learn tools for coping with pain, such as relaxation techniques and activity pacing.
Many people with chronic already struggle with feeling like a burden to their friends and family, so therapy can provide you with a space where it is okay to talk about difficult emotions. A therapist can also help you learn how to get the most from your existing support system or may encourage you to begin to develop one.
Half Of Adults With Anxiety Or Depression Report Chronic Pain
In a survey of adults with anxiety or a mood disorder like depression or bipolar disorder, about half reported experiencing chronic pain, according to researchers at Columbia Universitys Mailman School of Public Health. The findings are published online in the Journal of Affective Disorders.
“The dual burden of chronic physical conditions and mood and anxiety disorders is a significant and growing problem, said Silvia Martins, MD, PhD, associate professor of Epidemiology at the Mailman School of Public Health, and senior author.
The research examined survey data to analyze associations between DSM-IV-diagnosed mood and anxiety disorders and self-reported chronic physical conditions among 5,037 adults in São Paulo, Brazil. Participants were also interviewed in person.
Among individuals with a mood disorder, chronic pain was the most common, reported by 50 percent, followed by respiratory diseases at 33 percent, cardiovascular disease at 10 percent, arthritis reported by 9 percent, and diabetes by 7 percent. Anxiety disorders were also common for those with chronic pain disorder at 45 percent, and respiratory at 30 percent, as well as arthritis and cardiovascular disease, each 11 percent. Individuals with two or more chronic diseases had increased odds of a mood or anxiety disorder. Hypertension was associated with both disorders at 23 percent.
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Reducing Anxiety To Fight Joint Pain
Still, the main thing you need to do is reduce your anxiety. If anxiety is causing your joint pain, then the only way to ensure that it will go away completely is to stop experiencing anxiety. Unless you control your anxiety, you are going to constantly struggle with not only joint pain but also all of the other anxiety symptoms that make it so hard to enjoy your life.
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Chronic Pain And Suicide
The most pressing concern in regards to chronic pain and mental health is the fact that individuals who experience chronic pain are at increased risk for suicide. Specifically, research has found that individuals with chronic pain are at least twice as likely to report suicide behaviors or complete suicide.5
The psychosocial factors that seem to contribute to increased suicide risk for people living with chronic pain include:
- Mental defeat
- Perception of being a burden
- Feeling that you dont belong
Of note, the above psychosocial factors were more strongly related to suicide risk than actual pain characteristic or physical status was.
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What’s The Best Way To Manage Pain And Depression
Team up with a pain specialist or even your family doctor to create a treatment plan. When chronic pain and depression are combined, the need to work with a doctor is even greater.
As you develop a plan, keep in mind that the ideal pain management plan will have many parts.
There are resources that can help you, such as:
- The American Chronic Pain Association: www.theacpa.org/
- The U.S. Pain Foundation: uspainfoundation.org/
- The Academy of Cognitive Therapy: www.academyofct.org/
Stay committed to the plan until you feel in control of your pain and depression and can fully live your life and do the things you enjoy.
Find a cognitive therapist near you with experience treating chronic pain. The above groups can help you find one.
Treatment Of Chronic Pain
It is crucial that treatment of chronic pain focuses on the involvement of the patient and the need for their cooperation and participation. The treatment course should be presented as a process of rehabilitation from a biopsychosocial perspective. This involves physical and/or occupational therapy to increase function, psychological treatment like cognitive behavioral therapy, and pharmacologic treatment. Pharmacists can provide education to the patient on realistic goals of pain medication management and the importance of adherence with all aspects of the pain rehabilitation process. The patient should be informed that pain medication will not relieve all pain but help decrease pain intensity and frequency so the patient can improve functional ability.
Antidepressants have the most evidence in treating chronic pain with comorbid anxiety or depression. Serotonin-norepinephrine reuptake inhibitors may be considered as first line treatment in these patients. The SNRI’s venlafaxine, duloxetine, and milnacipran have been shown to attenuate neuropathic pain and fibromyalgia with and without coexisting depression. Lower doses of duloxetine may be sufficient for pain, but doses of up to 120 mg daily may be necessary. Venlafaxine may be considered, but the dose may need to be titrated up for efficacy likely due to lack of norepinephrine reuptake inhibition at doses less than 150 mg.,,
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