Depression and Physical Pain

chronic-pain-depression-aLower back pain, sciatica, fibromyalgia, joint pain, headaches, migraines, irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are the most common physical ailments associated with people who are depressed.  Depression can make chronic pain worse. Back pain sufferers are in greater pain when suffering from depression and headaches and stomach problems are common with people who are depressed or anxious. Many people don’t realize that that their physical symptoms may be exacerbated by depression.  Salonpas interviewed leading medical experts to learn how chronic pain sufferers can lift their depression and lighten their pain.

Allen Wagner LMFT 2014 (3)It’s not uncommon for a doctor to ask a patient suffering from back pain, or recuperating from back surgery, if they are feeling depressed.  “As a therapist I have worked with people who are on worker compensation or work disability for serious physical injuries, and the impact of specifically chronic pain, is highly related to depression,” says Allen Wagner, Marriage and Family Therapist.   “There is a hopelessness to watching days go by, and never feeling better. There is a perceived lack of empathy from the world, and specifically a failure to understand the disabling nature of their pain.  This often plays a role in their professional lives as well, creating a perfect storm for disruption in both personal and work life.”

How can people determine if their physical aches and pains are caused by depression or an organic derivation?  “One way is to get tests like X-rays, MRI’s and CT scans which will tell if there is an organic cause,” said Dr. Jeanette Raymond, a licensed psychologist in Los Angeles.  “Similarly, blood tests can help determine if there is inflammation and an overreaction of the immune system such as an autoimmune disease.”nov09_to_next_level_Jeanette

“Depression is often preceded by relationship stress and insecurity,” adds Dr. Raymond. “Stress causes more sensitivity to pain. Depression is an inward focus of doubt, fear, protest and most of all anger. The tension involved in anger turned inwards is hard to bear. Its easier to tolerate if that rage and disappointment is embodied – it provides a language with which to self-talk and ‘externalize’ the emotions in a safe way. The emotions in the body represent the hurt. It protects your loved ones from being damaged or destroyed by your anger if you expressed it physically or explode on them emotionally. So you make the self-sacrifice of directing the anger inward (depression ) and have to bear the pain of the self-destruction.”

“What we know about magnesium is that it is very much depleted by pain,” says Carolyn Dean, MD, ND and Medical Advisory Board Member, Nutritional Magnesium Association.  “Magnesium deficiency can be the cause of pain and the anesthetics used in surgery can deplete magnesium.  Stress depletes magnesium as well.  People with back pain don’t sleep properly and insomnia, too, is a symptom of magnesium deficiency.”

“Because about half of the body’s magnesium is found in bone while the other half is found inside cells of body tissues and organs, a blood test will not accurately show whether or not you are low in magnesium despite how much shows up in a blood test,” says Dr. Dean.  A more accurate test that Dr. Dean recommends is a Magnesium Red Blood Cell test (RBC).  “A Magnesium RBC test can provide an earlier indicator of Magnesium deficiency than a standard Magnesium blood test,” says Dr. Dean.  “When levels are low, the body will pull Magnesium from the cells to keep blood levels normal.  In this case a Magnesium blood test may show normal levels while a Magnesium RBC test will give a more accurate result.”

“Research reported in Frontiers in Public Health  suggests that joint diseases are often caused by inflammatory processes, which have also been indicated for certain types of depressive disorders. Therefore, inflammatory processes may represent the link between depressive symptoms and physical diseases,” adds Dr. Raymond. “However, there is no definitive answer. Many organic diseases cause no pain and often go undetected, and many emotional issues that go unprocessed turn into stress, and stress changes the body chemistry and that may lead to pain and depression.”

drsinnet“Stanford University ran an exhaustive study to determine the number one factor or predictor of back pain,” said Dr. Todd Sinett, a NYC-based chiropractor who challenges the current approach to back pain by addressing structural, emotional and dietary factors to identify and treat the root cause of the pain.

“The results were actually quite astonishing – stress and emotional outlook were the best way to predict who would suffer from back pain and who wouldn’t.  With this discovery, it should have resulted in a complete shift in how we diagnose and treat back pain.  Our current model, which is erroneously based off the orthopedic/structural model, is the wrong approach creating an epidemic of back pain.  A further study also was done that showed that anti-depressants actually work better than anti-inflammatories in the treatment of back pain. Based on this information any doctors who treat back pain that don’t inquire about patient’s stress levels are doing a complete disservice to the patient.”

“Emotions are psychological and physiologic,” says Dr. Sinett who is the author of “Three Weeks to a Better Back” (October 2015).  “It is the physiologic response that must be conquered to free your stress-related back pain.  A physiologic response could be an elevated heart rate, sweaty palms, an upset stomach and tight and tense muscles.  How to alter this effect is different for everyone, but for some people it could be exercise.”

“Studies have shown that rigorous exercise has been as effective anti-depressants,” says Dr. Sinett. “Anyone who is feeling blue or depressed should take up exercise even if it is just regular walks.”  “Exercise beefs up the endorphin levels in the body that reduce the experience of pain and lift depression,” says Dr. Raymond “but exercise needs to be combined with psychotherapy because without an understanding of the key source of pain/depression, the exercise will just be a ‘band aid’ that will come off when it wears down.” “Yoga is a fantastic way to focus your energy and attention while working your body very consciously,” adds Wagner.

“Changing your diet can also help up your diet is a great way to beat those dietary or sugar blues,” says Dr. Sinett.  “Reduce and eliminate sugars, caffeine, white breads, desserts and alcohol, as these foods can alter your sugar levels and impact your energy and moods. “

If is determined that back pain is caused by stress, some doctors recommend biofeedback.  “A biofeedback practitioner is able to measure your physical responses of stress by measuring skin temperature, heart rate and muscle tension,” says Dr. Sinett.  “The practitioner can help the person to change their stress response.  Athletes use this technique to get into peak performance or the ‘zone.’”

Additional stress reduction techniques recommended by Dr. Sinett include:

  • Breathing technique done while sitting or lying down. Inhale for a count of 4 seconds, hold the breath for 4 seconds and then exhale for 4 seconds do this for 2 minutes.
  • Get out and walk! Walking is one of the best exercises and a great stress reducer.

“I also recommend a counselor, therapist, or psychologists as these practitioners are trained to discuss and help their clients respond to their stress in a much healthier manner,” says Dr. Sinett.  “If they are not able to help though, the next step would be to go to a psychiatrist, as they are medical doctors who can prescribe medications to help one manage their stress more effectively.”

“It’s best to see a psychologist or psychiatrist who can work with the patient on the source of their emotional wounds and stress triggers, not just medicate them to be numb,” says Dr. Raymond.  A study in PAIN magazine found that patients who took opioids for chronic pain were more likely to experience depression.  Additionally, Dr. Raymond says that “there is strong evidence that selective serotonin reuptake inhibitor drugs (SSRI’s), a class of compounds typically used as antidepressants in the treatment of depression, are no better than a placebo, especially when stress is chronic. Drugs like Cymbalta target pain and depression but sometimes have unpleasant side effects.”

How can depressed pain sufferers identify the stress triggers that increase their chronic pain?  “Self-monitoring is a helpful tool for a lot of symptoms in therapy,” says Wagner. “Having a person track themselves for a week, can lead to significant insight, and also add predictability into their mindset.  Becoming conscious or mindful of your body (what it feels like escalated), your response to specific people and other triggers can teach you a lot. Slowing life down allows people to see the things they usually miss.”

“The biggie is anticipating pain when it has diminished to a degree,” says Dr. Raymond.  “Waiting for pain to intensify is the biggest cause of a heightened pain sensation.  I have found that with my patients, distraction with daily life routines, doing things for others and keeping their minds focused on the present moment instead of the future is the key.”  Dr. Raymond has one patient who said that when he is with his kids having fun or doing something self-empowering he is not aware of any pain but as soon as he anticipates problems with his wife, mother or siblings, his pain level shoots up.

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