“12 Ways to Cope with Chronic Pain and Depression”

I often assert, when the question of depression and chronic pain come up, that I am not depressed; that if my pain was to disappear tomorrow I would be happy and all would be good in the world again. Perhaps a year or two ago that might have been true (or perhaps not). But as time has gone on and the effects of chronic pain on my entire life, including my emotional wellbeing, has taken its toll, I am slowly considering that perhaps it’s no longer just chronic pain and the direct effects it has on my ability to live my life how I want that gets me down. Maybe, my psychological state has been actually altered as a result of pain and lack of movement, medication side effects, and huge drops in taking part in those things that have historically provided me with the chemicals and hormones that make us feel happy and content; that if my pain did go away tomorrow I may still need to work on my emotional health a bit longer.

Now, I am still not saying that I am depressed. That’s a hard thing to admit to. But, I will admit that my emotional health needs some TLC. Ploughing through pretending it’s all going to sort itself out someone is not an answer any more, and my emotional health has taken some battering. I do reach for ways to improve my mood and help me feel better about myself.  I will tentatively do things to try to help, then throw my toys out of the pram reminding myself this is all down to pain and if I sort that out, I won’t be depressed, so I need to work on getting better. 

I’ve just read a great blog from Arthritis Health, called “12 Ways to Cope with Chronic Pain and Depression”. I guess I like it because, whether I am, or am not depressed as a result of my chronic pain, whether I accept I am depressed or don’t accept it, it has helped to remind me that changing holistic aspects of my life for the better will only benefit me. It will benefit anyone else suffering from chronic pain who might, or might not be depressed as a result, or for other reasons. 

We need to take care of our emotional health, whether or not we suffer from chronic pain; more if we have chronic pain, as our psychological self has a continual pounding as well as our physical self. I am going to work a little more on addressing my mental health needs, so that if I am depressed, I can move out of that space. And if I am not depressed, it will till help me to build my feel-good vibes, which will in turn help me manage my chronic pain.

For those that don’t like hovering – here’s the link to the article:

http://www.arthritis-health.com/living-arthritis/managing-depression/12-ways-cope-chronic-pain-and-depression

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Living With Pain That Just Won’t Go Away. Part 2

As promised, the insightful well written post by an insightful writer,  that made me cry. Again:

Written by Jane E Brody, published 6 November 2007 in the Health Section of The New York Times.

Pain, especially pain that doesn’t quit, changes a person. And rarely for the better. The initial reaction to serious pain is usually fear (what is wrong with me, and is it curable?), but pain that fails to respond to treatment leads to anxiety, depression, anger and irritability.

At age 29, Walter, a computer programmer in Silicon Valley, developed a repetitive stress injury that caused severe pain in his hands when he touched the keyboard. The injury did not respond to rest. The pain became worse, spreading to his shoulders, neck and back.

Unable to work, lift, carry or squeeze anything without enduring days of crippling pain, Walter could no longer drive, open a jar or even sign his name.

”At age 29, I was on Social Security disability, basically confined to home, and my life seemed to be over,” Walter recalls in ”Living With Chronic Pain,” by Dr. Jennifer Schneider. Severely depressed, he wonders whether his life is worth living.

Yet, despite his limited mobility and the pain-induced frown lines in his face, to look at Walter is to see a strapping, healthy young man. It is hard to tell that he, or any other person beset with chronic pain, is suffering as much as he says he is.

Pain is an invisible, subjective symptom. The body of a chronic pain sufferer — someone with fibromyalgia, for example, or back pain — usually appears intact. There are no objective tests to detect pain or measure its intensity. You just have to take a person’s word for it.

Nearly 10 percent of people in the United States suffer from moderate to severe chronic pain, and the prevalence increases with age. Complete relief from chronic pain is rare even with the best treatment, which is itself a rarity. Doctors and patients alike, who misunderstand the effects of narcotics, are too often reluctant to use drugs like opioids, which can relieve acute, as well as chronic, pain and may head off the development of a chronic pain syndrome.

Why Pain Persists

The problems with chronic pain are that it never really ends and does not always respond to treatment. If the pain initially was caused by an injury or illness, it can persist long after the injury has healed or the illness defeated because permanent changes have occurred in the body.

Mark Grant, a psychologist in Australia who specializes in managing chronic pain, says the notion that ”physical injury equals pain” is overly simplistic. ”We now know that pain is caused and maintained by a combination of physical, psychological and neurological factors,” Mr. Grant writes on his Web site, http://www.overcomingpain.com. With chronic pain, a persistent physical cause often cannot be determined.

”Chronic pain can be caused by muscle tension, changes in circulation, postural imbalances, psychological distress and neurological changes,” Mr. Grant says on his site. ”It is also known that unrelieved pain is associated with increased metabolic rate, spontaneous excitation of the central nervous system, changes in blood circulation to the brain and changes in the limbic-hypothalamic system,” the region of the brain that regulates emotions.

Dr. Schneider, the author of ”Living With Chronic Pain” (Healthy Living Books, Hatherleigh Press, 2004), is a specialist in pain management in Tucson, Ariz. In her book, she points out that the nervous system is responsible for the two major types of chronic pain.

One, called nociceptive pain, ”arises from injury to muscles, tendons and ligaments or in the internal organs,” she writes. Undamaged nerve cells responding to an injury outside themselves transmit pain signals to the spinal cord and then to the brain. The resulting pain is usually described as deep and throbbing. Examples include chronic low back pain, osteoarthritis, rheumatoid arthritis, fibromyalgia, headaches, interstitial cystitis and chronic pelvic pain.

The second type, neuropathic pain, ”results from abnormal nerve function or direct damage to a nerve.” Among the causes are shingles, diabetic neuropathy, reflex sympathetic dystrophy, phantom limb pain, radiculopathy, spinal stenosis, multiple sclerosis, Parkinson’s disease, stroke and spinal cord injury.

The damaged nerve fibers ”can fire spontaneously, both at the site of the injury and at other places along the nerve pathway” and ”can continue indefinitely even after the source of the injury has stopped sending pain messages,” Dr. Schneider writes.

”Neuropathic pain can be constant or intermittent, burning, aching, shooting or stabbing, and it sometimes radiates down the arms or legs,” she adds. This kind of pain tends ”to involve exaggerated responses to painful stimuli, spread of pain to areas that were not initially painful, and sensations of pain in response to normally nonpainful stimuli such as light touch.” It is often worse at night and may involve abnormal sensations like tingling, pins and needles, and intense itching.

Some chronic pain syndromes involve both nociceptive and neuropathic pain. A common example is sciatica; a pinched nerve causes back pain that radiates down the leg. In some cases, the pain of sciatica is not felt in the back but only in the leg, making the cause difficult to diagnose without an M.R.I.

Beyond Physical Problems

The consequences of chronic pain typically extend well beyond the discomfort from the sensation of pain itself. Dr. Schneider lists these potential physical effects: poor wound healing, weakness and muscle breakdown, decreased movement that can lead to blood clots, shallow breathing and suppressed coughing that raise the risk of pneumonia, sodium and water retention in the kidneys, raised heart rate and blood pressure, weakened immune system, a slowing of gastrointestinal motility, difficulty sleeping, loss of appetite and weight, and fatigue.

But that is hardly the end of it. The psychological and social consequences of chronic pain can be enormous. Unremitting pain can rob a person of the ability to enjoy life, maintain important relationships, fulfill spousal and parental responsibilities, perform well at a job or work at all.

The economic burdens can be severe, especially when the patient is the primary breadwinner or holds a job that provides the family’s health insurance. Only about half of patients with chronic pain ”who undergo comprehensive multidisciplinary pain rehabilitation are able to return to work,” Dr. Schneider reports.

As for the notion that chronic pain patients are often malingering — seeking attention and escape from responsibilities — pain specialists say that is nonsense. No one in his right mind — and most patients were in their right minds before the pain began — would trade a fulfilling life for the misery of chronic pain. 

Living with Pain That Just Won’t Go Away. Part 1

I have just read an article about how chronic pain changes a person. And, once again the tears flow as I write. I have pretty much stopped talking to people in real life about my back pain. People in real life have pretty much stopped asking. I am walking straight and I have medication. Some of that medication even makes me a bit happier as a side effect right?

It reminds me a little of when my mum died a few years ago. After a few weeks/months people stopped asking how I was, because I was over it right? Well, the development of this chronic pain, it’s quite a bit like grieving. The initial shock of it, the raw pain of it is hard to manage but people were there to help me cope in the early days when the pain was visible.  Then followed the process of trying come to terms with it, learning to accept that things are not the same anymore, that an important part of my life has been lost. And in time, that support disappeared as it had all become invisible, and people don’t want to hear it anymore, if it seems ok, best not to ask, or so it seems. I have struggled to keep myself going over the last 10 months, and it is not over, and just like grieving I think I am coping then something reminds me of what I am missing, a little thing that crops up that floors me all over agin. But it has now just conveniently been swept under the carpet of drugs, and my rotten mood and distancing from others is put down to the medication. The medication has changed me, right?

I had almost stopped crying for a while. But then, I read this article that I am going to post, and it is just like I have had a conversation with someone who understands again, someone who knows, who feels it, and who has got it right. It is like I have written bits of it. And it has opened the floodgates again as even though this was not written for me, or about me, and written before I even had chronic pain, it feels like for just a moment, today, someone was listening. Even though they weren’t.

I want to show it to all my friends, my family, my work colleagues, my GP, my husband and make them read it. I want to shout at them ‘you see?! it is not my fault I have changed so much, that I am so irritable and miserable and depressed. How can a stranger understand but not you?’

And the tears are now streaming down my face, and I can’t stop them. And don’t know if I want to stop them right now. I will post the article when I have composed myself.