It is possible to interrupt and even stop the cycle of depression and chronic pain. Treatment can help give patients a sense of control over the pain, allowing them to begin a “positive spiral” toward physical and mental reconditioning.

Simultaneous, Multidisciplinary Care for Pain and Depression

Treatment for pain and depression should be done simultaneously, because untreated chronic pain can interfere with the treatment for depression and vice versa. Experts suggest the most effective treatment uses a multidisciplinary approach, involving at least one physician and one mental health professional.

These professionals can treat and monitor a patient’s pain and depression and communicate with each other. It’s important for these physicians to understand that changes in the physical symptoms of pain can also be related to changes in a patient’s mental and emotional state.

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Finding Relief for Pain and Depression

The treatment of clinical depression most often includes:

    Psychological interventions. Counseling, relaxation training, practicing distraction, music therapy, guided imagery, and other psychological interventions are often the first line of treatment for depression.

    Anti-depressant medication. Some people may not need anti-depressant medication, or may only need it temporarily, while other people require long-term use. For people who have moderate to severe depression, the combined treatment approach of medication and psychological interventions, may yield better outcomes than either of the interventions alone.16

    Physical rehabilitation. Painful joints can often be treated with therapy. Physical and occupational therapists can help a patient build strength and muscle memory, enabling the patient to re-gain physical abilities and function.

    Regular exercise. People experiencing pain and depression can find it difficult to establish an exercise routine, but the benefits are both physical and mental.

    Lifestyle adjustments. People can live successfully with chronic pain by finding ways to work around day-to-day problems. For example, joint pain may make carrying a full, large-sized laundry basket difficult, but carrying a smaller load of laundry may be reasonable. If a person’s knee pain makes sitting through a 2-hour movie seemingly impossible, he or she can try an aisle seat at the back of the theater in order to take an “intermission” to stand up and walk and stretch. People who make lifestyle adjustments tend to feel more in control over their lives and are less likely to develop depression. These people avoid all-or-nothing thinking and focus on what they can do, rather than what they cannot do.

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    Pain medication management. Drugs prescribed to relieve pain should be carefully managed. Narcotic, or opioid, drugs such as as hydrocodone (e.g. Norco®, Vicodin®) and oxycodone (e.g. Percocet®), are powerful pain relievers. These medicines are commonly used for acute pain, but must be used with extreme caution in chronic pain. These drugs can have side-effects and can interact with other medications, including antidepressants. In addition, patients’ bodies can become tolerant to the medication and need larger doses to get the same relief. Lastly, long term use of narcotics can actually cause depression. Pain medication management is a complex issue and choices should be made on a case-by-case basis by a qualified healthcare professional in consultation with the patient.

References:

  1. Pampallona S, Bollini P, Tibaldi G, Kupelnick B, Munizza C. Combined pharmacotherapy and psychological treatment for depression: a systematic review. Arch Gen Psychiatry. 2004 Jul;61(7):714-9. Review. PubMed PMID: 15237083..
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