1 in 5 people will develop a mental illness in their lifetime. And you know chronic pain increases those odds. Hell, with fibromyalgia we are 30% more likely to develop depression, 3 times more likely to have major depression. And 67% less mental health overall. Similar stats can be seen for a lot of pain conditions. For example, depression is three times more likely in migraines as well.
Other than norepinephrine and serotonin being both involved in pain and depression it really isn’t a mystery why there is such a connection between the two of them. Not for me anyway. Chronic pain, when not treated, seems rather mood altering. However, when you do have both, the main problem remains: What to then do about it. Because they feed each other. Depression makes the pain worse, and pain certainly feeds the depression.
Comorbid pain and depression may be more difficult to treat than depression alone. Treating only one or the other may prevent the patient from ever achieving remission. As discussed, pain may perpetuate the depression and depression may perpetuate the pain. Thus, clinicians need to be aware of all of the comorbidities of pain and depression and use an integrated approach to treatment, including medical, physical, and behavioral therapies.[89-91] Pain, sleep disturbances, depression, and other physical, behavioral, or psychosocial factors all must be addressed to maximize chances of success.
Because ongoing, untreated pain leads to structural changes in the central nervous system and this, in turn, augments the risk of persistent pain, physicians should have a low threshold for referral, consultation, and treatment for patients with comorbid pain and depression. Untreated depression and pain can lead to dire psychosocial consequences, including job loss, substance abuse, and suicide Medscape
I believe they fundamentally have to be addressed together. I ignored the depression, the insidious beast that it is, and my pain management was non-existent no matter what I did. Not that I had much pain management at the time, which was a problem. But what worked was when the depression was Effectively addressed. And then I had some modest pain management. That pain management would not have worked, in the least bit, without the depression managed. My depression fed off the pain in a brutal way. High pain, plummeting moods. And there was a lot of high pain days in there. If I didn’t have the depression treated pain management wouldn’t have even worked. I am well aware of that fact. And now I have far less high pain because I have modest pain management, which makes the treated depression much easier to manage itself with the techniques you pick up via therapy. Because depression medication while awesome doesn’t eliminate all of the thought patterns and mood dips associated with chronic pain, so you have to work at the rest. Especially when pain is at its peak. Easier to do when pain isn’t 7-9 every single day.
Anyway, I suffered with unmanaged chronic pain and undiagnosed Major Depressive Disorder it must have been a decade, before I finally got effectively diagnosed and treated. I started myself by seeing psychologists. Then that psychologist sent me to one who specialized in pain, to help me with pain coping strategies and biofeedback. That is where I got the diagnosis. Then finally got sent to the pain clinic where I received proper treatment for the pain and medication for the depression. Somewhat a sign of a failed system that I wasn’t offered this treatment a decade ago when it wouldn’t have impacted my career and life so much. And having to Suffer so much. I gave some pretty strong signs along the way it was fundamentally necessary that were ignored. As well as flat out saying it was necessary, which, naturally, were ignored. Such stigma. Such failure to help someone thrive in the world.
I can scream out on a rooftop this mental illness awareness week that Pain Management is fundamentally necessary to our wellbeing in the world. To our quality of life. To our mental and emotional wellbeing. And that pain management has to take into account at the same time our mental health. I could do that and no one would listen. If I was ignored for a decade, well two decades, if you count the decade of pain where I wasn’t severely depressed but also likewise untreated, Then. Think about Now. With the opiate crisis and their fear of properly treating patients with the tools that may help that specific patient. Who even cares about quality of life anymore, eh? Just those of us in pain that actually want to function with it, work with it and live with it. They should think a little bit on the lives they destroy. Just a little.
Nevertheless, I was treated. And I did survive. And I am surviving. Depression and pain are a vicious combo. To survive that, that is something. And I hope every single person who has both is surviving as well and gets that effective level of treatment needed to be able to at least function again. At least have some quality of life without the depression stealing what life we have.