Dr. Jay Greenstein, CEO of Sport and Spine Rehab, and Dr. Bruce Kehr, President of Potomac Psychiatry, discuss the connections between chronic pain and chronic depression in today’s video blog. Check it out to learn why these connections exist and how to ease emotional and physical pain.
How Does Chronic Pain Cause Chronic Depression?
If chronic pain is improperly treated for a year or more, it results in a major depression 100% of the time. Just think about it. If someone is dealing with chronic physical pain, emotional pain is often right there beside it. When studying the brain, there are many underlying mechanisms that explain why chronic pain causes emotional pain.
There is a certain kind of stress called “Learned Helplessness.” Learned Helplessness is when a person repeatedly experiences something emotionally distressing that he or she can’t control or stop. Chronic physical pain is a perfect example of this type of stress.
How does Learned Helplessness affect our brains?
Learned Helplessness actually causes sections of our DNA to stop manufacturing the proteins that protect our brain cells and protect the connections between our brain cells called synapses.
What happens when our brain cells and our synapses are unprotected ?
They get repeatedly damaged by inflammation and oxidative stress.
What happens when our brain cells and synapses get repeatedly damaged ?
Our brain cells stop functioning normally. They no longer have the energy to power themselves. When our synapses are damaged, the connections between our cells also no longer function properly. While this damage is reversible, if our brain cells can’t communicate with each other, how are we going to end up feeling? This is what results in chronic depression.
Does chronic depression have any effect on physical pain?
Yes. Chronic depression often worsens chronic physical pain. It is a cycle. Once the cycle starts, the sleeplessness, the anxiety, the depression, and the pain all fuel each other.
So what solutions do we have to end this vicious cycle?
First of all, it’s important to know that if you are stuck in this cycle, remain hopeful. There are a variety of treatment options, so there is no reason to feel that this pain, this cycle, is a life sentence.
From the Psychiatry standpoint, a medication called SNRI (Serotonin-Norepinephrine Reuptake Inhibitors) is often prescribed. This medication boosts serotonin and norepinephrine in the brain, which helps reduce anxiety, lifts mood, and block pain impulses from the spinal cord. SNRI also helps repair the segments of DNA that were not functioning properly because of the stress from the chronic physical pain. While this is a great start, it is still important to get to the root cause of the problem, the physical pain.
To attack the physical pain, we must first take a full history–not only of past conditions but how the current pain is affecting the patient’s life. Is he or she avoiding certain activities because of it?
Next, our doctors perform a full and functional physical exam. During our exams, we do not just look at the location of the pain. We analyze the functional and biomechanical elements that may be causing the chronic pain. For example, if a patient presents with chronic low back pain, rather than just looking at the back, we look at the whole body to see if there are any functional or biomechanical limitations (such as hamstring or hip flexor tightness). For plantar fasciitis, the functional limitation is often a tight Achilles tendon. After this thorough examination, it is just a matter of implementing the appropriate treatment based on evidence, physician experience, and patient values.
What is the outlook for someone suffering from chronic pain and depression?
There is hope. First of all, the earlier that pain is addressed, the better off you will feel in the long run. Not just because you will be relieving your pain faster, but also because you will be preventing yourself from suffering from the inevitable depression, anxiety, and insomnia that follows chronic pain.
Secondly, research shows that if you are suffering from chronic pain, there are many treatment options. For example, if you are suffering from a spine-related pain, the American College of Physicians recommends that you try spinal adjustments, physical therapy, yoga, Thai Chi, and acupuncture. By arming yourself with all of these tools to combat the physical pain, you will simultaneously decrease your stress. That Learned Helplessness will start to fade away because you will become empowered to do something constructive for your life.
In the end, it all comes down to combining approaches to get the best outcome. Just functional rehabilitation is not going to get rid of chronic depression and just psychiatry is not going to get rid of chronic pain. The two combined together can really combat this cycle.