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15 Ways To Take Control Of Your Depression And Chronic Pain

After having her third child and going back to work full-time, Debbie Norris began feeling sad and overwhelmed by her responsibilities as a mother and a psychologist in Washington, DC. One day she woke up with severe all over her body. She couldn't lift her infant son, open a door, or even hold a book, and the pain kept her up at night. After 8 months, Norris was finally diagnosed with fibromyalgia, a condition affecting the muscles and joints. By then, she felt hopeless. "The doctor suggested I get a wheelchair while I could still walk," she says. "That was an all-time low."

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That wasn't the worst of it. As her pain persisted, her mood darkened further. Two years later, she was diagnosed again—this time with major depression. Norris had become one of the thousands of people whose twin afflictions—chronic pain and depression—are so intertwined they don't know where one begins and the other ends.

As many people with chronic pain attest, it's easy for the condition to wear you down. (One survey found that 6% of chronic pain sufferers questioned whether they could live with it.) What has become increasingly clear is that the converse is also true: A declining mental health state can lead to chronic pain.

"You can think of them in a bidirectional way: Chronic pain can lead to depression, and depression can also lead to pain," says Jamie Rhudy, a professor of clinical psychology at the University of Tulsa. "The third possibility is that the two conditions occur concurrently."

Pain and depression can be so intertwined that people who are dealing with both don't know where one begins and the other ends.

Statistics point to the frequency with which the two conditions coexist: Depressed people are three to five times more likely to develop chronic pain, and 65% of people who are depressed also suffer from chronic pain. But that's not the whole picture. "They have a reciprocal effect on each other that exacerbates the burden," says Kurt Kroenke, a professor of medicine at Indiana University. For those who suffer from both conditions, the good news is that after years of treating them separately, doctors and patients are finding success with a different approach. "When both conditions are present," Kroenke says, "it's more effective to treat them simultaneously than to treat just one of them."

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exercise for depression
Push back with exercise. Even 10 minutes of a nonimpact activity like tai chi can decrease physical and emotional pain.
Keith Negley

What Happens in the Brain

This tangled relationship most often occurs when the patient's underlying health condition is fibromyalgia, back pain, arthritis, neuropathy, or migraines (the most common causes of persistent pain), but it can happen with other painful illnesses, too, such as Lyme disease. Depression often accompanies these conditions because chronic pain and depression share common physiological channels.

"They operate on similar pathways in the brain, where physical and emotional pain signals get tangled up, causing the brain to misinterpret them," explains Charles Raison, a psychiatrist and professor in the School of Human Ecology at the University of Wisconsin-Madison. In addition, he notes that if levels of the brain chemicals norepinephrine and serotonin, which modulate pain and regulate moods, are low due to an underlying health condition, a person's ability to manage pain and moods can decline. (Discover the 5 best foods for your brain and other cutting-edge natural tips in .)

Then there's geography: Some of the areas of the brain that regulate pain also play a role in emotion processing and mood management. Experiencing chronic pain can trigger changes in these regions that knock you off balance emotionally. Underlying inflammation from an injury, obesity, or a disease like arthritis may also drive the development of depression and disrupt neurocircuitry regulating mood, motivation, and behavior, says Raison.

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The upshot is that emotions like anger and anxiety can exacerbate the sensation of pain, Rhudy explains. Over time, chronic pain can become intractable, which can lead to a sense of helplessness and hopelessness—in other words, depression. Experts don't know why some people with one condition don't develop the other. But they do know that some people are more susceptible to depression—because they have a family history of it, for example, or they suffered childhood adversity; meanwhile, some people have a lower tolerance for pain than others do.

"Chronic pain is a complex mind-body illness. Trying to address it with one treatment is too simplistic."

Treating the Twin Problems

After seeing a rheumatologist and a neurologist in addition to her primary care doctor, Norris was prescribed a muscle relaxant, which she worried would make her too groggy during the day. She also tried a single Prozac tablet, which gave her heart palpitations. So she decided to forgo meds and research lifestyle changes that might help her. "I woke up one day and decided I was going to do everything my way to conquer this," she says.

Gradually, she devised an approach that worked for her: Regular exercise, massage, an anti-inflammatory diet, and better-quality sleep eased her physical pain; she addressed her lingering depression by working with a therapist and learning mindfulness meditation, which she continues to practice daily. Her depression lifted, and within 2 years her fibromyalgia improved, too.

Since then, the medical community has developed formal programs that treat chronic pain in various ways, as Norris did on her own. "Chronic pain is a complex mind-body illness," says Rex Schmidt, a pain psychologist at the Nebraska-Western Iowa VA Health Care System in Omaha, NE. "Trying to address it with just one treatment is too simplistic."

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In particular, an approach called pain self-management training is proving beneficial. Through techniques such as positive self-talk, relaxation, stretching and other physical exercise, and social outreach, PSMT has been shown to reduce the severity of chronic pain and depression. Over the course of a year, researchers at Indiana University School of Medicine followed 250 people with depression and chronic pain; at the end, the PSMT study participants reported a 30% reduction in depression and a 40% reduction in pain.

Similarly, a 2019 study from Canada found that after people with chronic pain completed a 10-week PSMT program using cognitive-behavioral therapy (CBT) and physical exercise, their depressive symptoms decreased by 20% and their pain disability by 10%.

depression
Think positive. Avoiding absolute words like 'always' and 'never' can change your brain chemistry.
Keith Negley

Your Personal Pain Cure

Programs that teach self-management techniques for pain are on the rise around the country. Doctors have also become savvy about helping patients put together their own personalized plans of action. Here's a look at some of the treatments that research has shown can help both conditions.

Exercise.

Scientists have found that even a 10-minute period of exercise can decrease depression in people with chronic pain. The key is finding the right form of exercise for you, which may depend on the cause of your pain. Try a nonimpact activity such as yoga, Pilates, tai chi, or water aerobics, all of which are gentle on the bones and joints. Gradually increase the duration and intensity by no more than 10% per week to avoid injury.

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Find a therapist.

With chronic pain, it's common to think negatively, which can worsen your pain and plummet you into depression. Similarly, habits like assuming worst-case outcomes and generalizing from single bad experiences are common among depression sufferers. CBT targets unhelpful thinking and problematic emotional responses to help people identify and change their behavior. "The more you consciously monitor and change negative thinking, the more you'll program yourself to do it automatically," says Schmidt. "This can cause changes in brain chemistry that lead to a reduction in depression and pain."

A newer form of psychotherapy called acceptance and commitment therapy (ACT) focuses on helping people develop psychological flexibility and behave according to their personal values. A 2019 study in the UK found that people with chronic pain could also improve their physical performance with ACT. When 384 people with chronic pain underwent ACT 4 days a week for 4 weeks, their depression symptoms dropped by more than 30% on average and their ability to physically function improved by nearly 50%. Go to findcbt.org/xfat to find a therapist who specializes in CBT or ACT.

Learn better sleep behaviors.

Inadequate sleep can worsen pain and depression—and vice versa. Sleep problems vary individually, but Raison recommends starting with these two steps: Take adequate pain relief at bedtime so you can fall asleep and stay asleep, and change your presleep routine so that you power down electronic devices and relax for at least an hour before bed. He adds that if you still struggle to fall asleep, it might help to take a natural sleep remedy such as melatonin or a nonaddicting sleep drug like Ambien on a short-term basis.

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Sleep problems can also be eased with cognitive-behavioral therapy for insomnia (CBT-I), in which patients learn to identify thought patterns (like worrying) and behaviors (like napping) that can cause or aggravate problematic sleep issues, replacing them with others promoting a sound sleep. The National Sleep Foundation offers a list of sleep professionals by zip code; find it at sleepfoundation.org.

consider medication
Regain control. One way to conquer both conditions: cut stress with deep breathing and other relaxation techniques.
Keith Negley

Consider medication.

Doctors are moving away from prescribing opioids like oxycodone, hydrocodone, codeine, and morphine for chronic pain due to the recent rapid growth of opioid addiction. "With chronic use, opiates can sensitize the pain receptors and increase chronic pain," Raison explains. "They can also have depressant effects in some people."

Certain antidepressants—particularly newer serotonin-norepinephrine reuptake inhibitors like Cymbalta and Effexor and older tricyclic antidepressants like Amitid and Elavil—are increasingly prescribed instead for their significant pain-blocking properties and mood-elevating effects. Start low and go slow, recommends John J. Michalisin Jr., a clinical assistant professor of anesthesiology, physical medicine, and rehabilitation medicine at NYU Langone Medical Center. It might take several weeks for medication to take effect. Even then, says Michalisin, finding the drug that works for you may require several attempts. Discuss your options with your doctor.

"Staying focused on the present helps you become aware of negative thoughts that can make it harder to cope."

Reduce stress.

Techniques like progressive muscle relaxation (the systematic tensing and releasing of muscle groups) and autogenic training (using verbal commands to teach the body to relax) target your brain's limbic system, which controls emotion, to decrease both depression and pain. (Here are 10 easy ways to de-stress in under a minute.)

Likewise, deep breathing and expressive writing, in which you describe your feelings about stressful or emotionally charged experiences, can also dial down your stress response. Because it's more difficult to eliminate pain than to prevent a flare-up, staying ahead of it is key. "It's best to use relaxation exercises in a proactive manner at set times during the day, not in a reactive manner after you experience pain," Schmidt says.

Another option: mindfulness meditation, in which you maintain awareness of your current emotions and experiences without judgment, focusing on your breathing and body sensations. A 2015 study from McMaster University in Canada found that people who practiced this type of meditation experienced noticeable improvements in depression, anxiety, pain intensity, and quality of life. Says Schmidt: "Staying focused on the present helps you become aware of negative thoughts that can make it harder to cope with depression and pain." To learn any of these techniques, search online for classes or workshops near you. You can also download free guided meditations at marc.ucla.edu/mindful-meditation.






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Date: 05.12.2018, 05:53 / Views: 91282