Living with constant pain is a difficult burden for anyone. But multiply that by depression—one of the most common illnesses among chronic pain sufferers—and the result is almost unbearable.

Depression increases pain and makes a person powerless to fight it. However, the good thing about this situation is that both of these states are inseparable. Therefore, if you alleviate the symptoms of depression, you will be able to bear the pain more easily.

Chronic pain and depression: a sweet couple

If you suffer from chronic pain and depression, you are not alone. These are fairly common diseases that almost always occur together. Depression is the most common illness among people who suffer from chronic pain, which very often increases the feeling of pain and makes the treatment process more difficult. Here are the statistics:

• According to the American Pain Association, about 32 million Ukrainian citizens consult a doctor with pain that has not gone away for more than a year.
• Most of these people are also depressed.
• About 65% of patients diagnosed with depression also complain of constant pain.
• People whose pain affects their independence are more likely to experience depression.

Since patients suffering from chronic pain often simply do not notice the symptoms of depression, it proceeds without the necessary treatment. The doctor's attention is usually occupied by complaints of pain. As a result, the patient’s depression develops, and this leads to sleep disturbances, loss of appetite, loss of strength and decreased physical activity, which leads to increased pain.

According to Stanford University professor Stephen Feinberg, if a person suffers from pain, then automatically you should assume that he also suffers from depression and begin treatment from this point of view.

Chronic pain and depression: vicious circle

Pain causes an emotional outburst. Anxiety, irritability and anger are normal reactions to pain. But as the pain goes away, these emotions also subside.

But what happens if the pain does not subside? Over time, this emotional reaction to pain will cause more serious problems, leading to depression. Such problems include:

• constant feeling of anxiety
• confused thoughts
• fatigue
• irritability
• sleep disturbance
• weight gain or loss

In some cases, the connection between chronic pain and depression can be explained by a biological factor. Both pain and depression depend on the same neurotransmitters - nerve endings that transmit information from nerve to nerve. They even have the same pathways for transmitting information between nerves.

The impact that chronic pain has on a person's life also provides a strong impetus for the development of depression.

“Real pain comes from loss,” says Feinberg. “Loss of work, loss of self-esteem and the respect of other people, decreased sexual desire - all these problems provoke depression.”

Once a person becomes depressed, it intensifies the pain that already lives within him. Depression robs the patient of the ability to fight this pain.

Here are the results of a study that compared people suffering from pain and depression with people who only suffered from pain. In the first case, patients stated that:

• their pain intensified
• they feel like they have lost control of their life
• they use more unhealthy pain management methods

Because there is a close relationship between chronic pain and depression, both conditions can often be treated at the same time.

Treating Chronic Pain and Depression: A Lifelong Process

Chronic pain and depression affect a person's entire life. That is why, ideal option treatment is considered to be one that addresses all areas of the patient’s life.

Due to the close connection between these two diseases, it is only natural that their treatment methods are also interrelated.

Antidepressants

Because the same neurotransmitters are involved in pain and depression, this means that antidepressants can be used to treat both conditions.

"People don't want to hear that disease starts in their head, but that's what happens with pain," Feinberg says. “And antidepressants, by influencing the patient’s brain, change his perception of pain.”

The most effective are tricyclic antidepressants. However, due to strong side effects, their use is limited. Newer antidepressants, such as serotonin or norepinephrine reuptake inhibitors, also show good effectiveness, and they cause minor side effects.

Physical activity

Many people with chronic pain avoid exercise. They can't differentiate pain from the "pleasurable ache" that comes after exercising, Feinberg says. But the less often you exercise, the more out of shape you become. This puts you at greater risk of injury or increased pain.

This is why you need to break this vicious circle. Doctors say that regular and not too strenuous exercise is the key to defeating pain. Every person experiencing pain should do physical exercise. Together with your doctor, you can come up with a list of exercises that are safe and effective for you.

In addition, sports have been proven to help relieve depression. Because physical exercise releases the same chemical elements brain, like antidepressants, they can also be called a natural antidepressant.

Mental and Spiritual Health

Chronic pain interferes with your life, work, and responsibilities. This leads to a change in your attitude towards yourself, and not for the better.

“When a physician first encounters a chronic pain patient, they often see that the person is drowning in pain and becoming a victim,” says Throne.

That is why, a critical moment in treatment is the fight against the role of the victim. “These patients become inactive, leading to complete passivity,” says Feinberg. “And in order to return a person’s desire to active life, it is necessary to restore his sense of control over life.”

If your doctor does not see you as a victim, then you will succeed. The goal of treatment should be to transform the victim into a person who can control pain and life.

Treating Chronic Pain and Depression: Using Cognitive Therapy in the Treatment of Chronic Pain

Is it possible to change your brain? Is it possible to cope with pain with the help of thoughts?

It may be hard to believe, but research suggests that using certain techniques to change your mindset can reduce chronic pain.

And this can be done with cognitive therapy. During therapy sessions, the patient learns to recognize the “automatic” negative thoughts that accompany the feeling of pain. These thoughts very often twist reality. Cognitive therapy will teach you how to replace these negative thoughts with ones that help reduce your perception of pain.

“The idea behind therapy is that our thoughts and emotions have a huge impact on our ability to cope with chronic pain,” says Thorne. “And there is a lot of evidence that as a result of cognitive therapy, patients become more tolerant of pain.”

In one of his studies, Thorne noted that after 10 weeks of cognitive therapy, 95% of patients felt that their lives had improved, and 50% noted that pain had become less severe. In addition, many patients felt they were ready to reduce their medication dosage.

Treatment of chronic pain and depression: how to start

The best way to start treatment is to see your doctor and work with him to create a treatment plan. When chronic pain and depression are combined, the need to work closely with your doctor is even greater than in other situations. We will tell you where to start treatment:

• Make an appointment with your family doctor and tell them you want complete control of your pain. Once you create an action plan, remember that the key to achieving your goal will be your versatility. Because the action plan must touch every area of ​​life that is affected by pain. If your family doctor is not qualified in pain management, ask him to recommend a good specialist.
• If there are organizations in your city that specialize in helping people with chronic pain, join them. This will provide you with support during the treatment process.
• See a cognitive therapist who specializes in pain management.

Answer: learn to live with pain

Show me the MRI
Take photographs in flexion and extension.
See a neurologist and ask to describe your neurological status.

For now, take a look at this:
When an attack of back pain occurs, it is necessary to consult a doctor promptly (as early as possible). If it is not possible to seek help from a specialist, try the following measures to relieve the pain.
1. In case of acute pain in the back – “lumbago” – try to take a horizontal position. For example, sit gently on the edge of the bed and then slowly roll onto the bed if it is not too soft, or onto the floor with a mattress or blanket underneath. In a horizontal position, the least pressure is exerted on the intervertebral discs. Bed rest – 1-3 days; it is better to lie on your back with your arms bent knee joints legs (a bolster or a pillow under the knees), sometimes it is easier for the patient to lie on his side with his legs bent and brought to the stomach (fetal position). The base of the bed should be rigid (a wooden board is possible), not allowing the back to “sag,” and an orthopedic covering or mattress should be placed on top of it, providing a comfortable position, preferably with a preventive traction function. Only two companies have a patent for such mattresses: the German “DETENSOR” and the Russian “ORTOPELAX”.
When you have pain, you need to get out of bed by first turning onto your side. Bend your legs at the knee joints so that they hang off the bed, pushing with your hands to sit down and then stand up, without making sudden movements.
2. Although bed rest is comfortable and relieves back pain, it would be wrong to stay in bed for too long (no more than 2-3 days). There are two important reasons for this. Firstly, if you lie in bed for a long time without moving, your back muscles weaken amazingly quickly. Secondly, in conditions of early motor activity the nutrition of the intervertebral disc improves and recovery occurs faster. As soon as the acute pain passes, change positions more often, try to get up and walk around the apartment every half hour.
The same can be said regarding the use of orthopedic corsets. Constantly wearing a semi-rigid corset is advisable only during an exacerbation. After the pain subsides, the corset must be worn periodically, for preventive purposes during heavy physical exertion. Although modern semi-rigid corsets have reduced the risk of muscle weakening, continuous wear is not advisable.
3. The most urgent task of the acute period is medicinal pain relief. To do this, doctors recommend taking non-steroidal anti-inflammatory drugs, which have an analgesic and anti-inflammatory effect, which is very important, because degenerative processes in the spine, ligaments and muscles are associated with the development of non-infectious inflammation in them. These drugs include diclofenac, ortofen, ibuprofen, nimesulide, movalis, nise, etc. It is preferable to use drugs intramuscularly in the first 2-3 days from the onset of the disease, then switch to oral administration. Never exceed the daily dosage of medications, carefully read the attached instructions and, if your back pain does not subside within 3 days, consult a doctor. If back pain is relieved, consult your doctor about how long you should take these medications. medicines(usually no more than 2 weeks).
4. One of the important stages of treatment is taking medications that eliminate muscle spasm and thereby improve nutrition of the affected area in the spine and adjacent structures. Usually muscle relaxants (mydocalm, sirdalud) are used together with non-steroidal anti-inflammatory drugs. The duration of treatment does not exceed 7 days. Some of the muscle relaxants have sedative side effects (calming and inhibitory mental processes) effect, which is necessary to know for patients whose activities involve driving a car or require a quick switch of attention.
5. Do not forget to use topical agents on the affected part of the back. Use gels and ointments with non-steroidal anti-inflammatory drugs from the 3rd day of illness. Remember that skin products can cause a local allergic reaction, so first apply them to a limited area of ​​skin and evaluate the effect. Regarding the use of warming ointments such as finalgon and massage, it must be said that on the one hand, they relieve muscle spasms, and on the other, as a result of improved blood flow in soft tissues, swelling in them can worsen, which can increase pain.
6. Use dry superficial heat, such as applying a hot water bottle wrapped in a towel to the painful area. However, if coughing, sneezing or straining causes increased pain, then heating this area is contraindicated. You can relieve pain by applying cold compress in the form of a bottle of ice wrapped in a towel. Ten minutes is enough to understand whether it helps or not. Never apply a cold compress directly to the skin without first wrapping it.

To celebrate the release of my new book, How To Live Well with Chronic Pain and Illness: A Mindful Guide, I've compiled a list of 20 tips to help you cope with the health challenges everyone faces at some point in life. The book talks about each of the tips in more detail.

1. Your body is not your enemy.

On the contrary, it tries to support you. The book has a chapter “Appreciating the Wondrousness of the Human Body” (appreciate the amazingness of your body). Indeed, your body is amazing. However, it is vulnerable to disease and injury, and deserves your compassion, not anger.

1. Health problems are not your fault .

At one stage or another in life, everyone faces health problems. Don't make things worse by adding self-blame to your list of challenges.

1. Accepting the uncertainty and unpredictability of life, and the fact that it does not always meet your desires, is the first step towards coming to terms with your circumstances .

In the book I talk about this as coming to terms with life upside down.

1. Don't waste your precious energy worrying about how others evaluate your condition. .

Better spend it on taking care of yourself.

1. Forgive yourself - again and again and again .

And when you realize that you are not taking good care of yourself, forgive yourself immediately. It’s good to learn from mistakes, sensibly assessing how and why you behaved in a given situation, but it’s worth stopping at this point. Learn and move on. Self-forgiveness is a form of self-compassion, and self-compassion is one of the main themes of my book.

1. Be with those who support you as much as possible .

Some people may genuinely want to support you, but may not be able to show it. Our culture does not prepare people to be around illness and pain. Many people gain experience supporting loved ones throughout their lives.

1. Sometimes your friends and family may let you down.

Each of us from time to time feels like someone has let them down. But rather, it has to do with what is happening in this person’s life, not with us specifically.

1. You can turn envy and resentment into happiness for others by practicing it.

It's hard to be limited in what you can do, but being jealous and resentful of others when they're having a good time only makes you feel worse, mentally and often physically. With practice, you can not only overcome envy and resentment, but learn to be happy for others when they do what you cannot. And this will bring you happiness.

1. Learn to ask for help.

Many of us have been taught that asking for help is a sign of weakness. No. This is an act of self-compassion.

1. It's okay to feel lonely .

Dealing with the effects of loneliness and isolation can be difficult, and I devote an entire section of the book to this.

1. Help others whenever possible.

Lending a helping hand to those in need helps relieve some of the pain of isolation and allows you to take your mind off thoughts about your health.

1. Remember that even if your health is restored, life will not be perfect.

Don't let yourself fall into the "if only" trap of thinking that once you're healthy again, your problems will disappear.

1. Don't forget to thank those who care for you.

I devoted two chapters in the book to these invisible heroes.

1. Patience is a real virtue.

It is impossible to avoid the fact that there will be difficulties and problems in life. Patience helps you weather storms without worsening your symptoms. This is a skill you can learn.

1. Be realistic about what you will have to give up and try to accept it to make room for something new.

When we get stuck in an old identity, it can become a serious source of suffering and make it difficult to see new opportunities before your eyes. In the book I wrote about how I try to look at my new life like an adventure. I hope you will try to do the same.

1. With rare exceptions, when the body says no, you say no too.

Learning to say “no” takes practice. I know because I'm still learning. This is another manifestation of self-compassion.

1. Don't feel bad that you're no longer a workhorse.

Taking care of yourself as someone with chronic pain and/or illness is work! And often complete.

1. It's normal to feel like you've had enough sometimes.

I often say that it is normal to experience a state when you can no longer bear the disease. A bad day is just a bad day. Tomorrow you can start all over again. And if tomorrow is also a bad day, there will be a next day. Sooner or later, the universal law of balance will come to your rescue.

1. Become your unconditional ally.

With practice, this can become a lifelong habit. From the book: “If you find it easy to judge yourself, stop for a moment and think about how you would feel if you spent a day being kind, caring, and considerate to yourself. If you can imagine it, you can do it.”

1. Never forget that despite your health problems, you are still a whole person.

And don't let anyone try to convince you otherwise.

No, this is not a lyrical article about heartfelt and, therefore, masochistically sweet torments. And an attempt to express the feelings that some of us experience year after year. We're talking about physical pain. Amazingly, people who experience pain every second of the day and night rarely complain about their fate. It is in the tenacity of character and the desire to live in spite of circumstances that the core of their nature is hidden.

So, pain. I wake up in the morning. The feeling is disgusting, just like yesterday. The sharp pain causes nausea, but you can’t give up. Just hint that you might show any weakness, and she will grab you, squeeze you tighter than the strong one and strangle you with gloating in her metal claws. I hate her, but I can’t live without her. Pain always goes with me side by side, shoulder to shoulder, both in sorrow and in joy. She reminds me that everything I succeed in life is thanks to her.

Today I have to go to work. You can't give her a chance today. That's why I take a strong painkiller. Effervescent so that it is absorbed into the blood faster. I'm used to these little white balls. They are a sign of my immediate happiness. The tablet cracks, scattering into crumbs at the bottom of a glass of hot water. I like to drink them before tea, then after 5-7 minutes the disgusting taste in my mouth goes away. And after 20-30 minutes the pain subsides. Not for long, but this time is enough to get to work and do a few especially important things.

It’s not yet midday, and the pain is already hitting the thresholds. Whispers in my ear: “Just try to hit me with a pill again, and I’ll create a hurricane in your head!” And he’s not lying, the infection. I want to cry, be hysterical, hit everything around me, but I can’t. Tears are the most important taboo. Pain knows my secret and puts pressure on the weakest. After a few minutes spent in tears, life will become unbearable, and arguing with the pain will be pointless for at least a day. That's why I rarely cry.

Work is work, and lunch is on schedule. The pain will perceive food taken on time positively, and will go away for a short time - as gratitude. Which means there are a couple of hours for successful work, communication, laughter.

I talk a little and listen a lot. I'm not complaining. I give advice to my friends and help my colleagues with their work. It's easier to live with pain when you do something useful for other people. “I couldn’t live every day with pain!” - those around you say indignantly. I smile and answer: “It’s a matter of habit.”

The main thing is not to consider yourself “disabled”, less capable or more disadvantaged. It is important to strive for your goals: to realize yourself at work, in communication with friends, at home. Yes, at home it’s hardest. That's why I like to stay late in the office. When you are in constant tone, you control yourself and your body. At home, you relax and allow a lot of unnecessary things: eating cakes, lying on the sofa and... feeling pain. For the same reason I don't like weekends. But if there is no escape from the weekend, then under no circumstances should you sleep late. The daily rhythm should not be disrupted, otherwise the body will become completely insolent, and the days will become unbearable. Early rise, hot coffee (by the way, doctors have banned it, but without it the morning does not begin), pleasant activities, walks, interesting books– an ideal weekend schedule for those learning to live with pain.

I have long realized the uselessness of medications. And I don’t eat chemicals at all. But I simply cannot live without healthy herbs: mint, St. John's wort, chamomile. I am delighted with the huge red apples and am ready to drink liters of lingonberry juice.

It would be quite pathetic to mention sports now. But it didn’t help me, or rather, on the contrary, it made me feel worse, so I don’t play sports. But that doesn't mean that physical exercise contraindicated for others.

To learn to live with constant pain, you need to stop fighting it. Pain doesn't like it. It is important to be able to accept the pain, and then she will become uninteresting in you, she will remind you of herself a little less often. " And then I laugh. Maybe they simply do not have pain that would push them to overthrow great things?