Pain is something everyone experiences from time to time. It can come from an acute injury, an illness, or a tooth that’s gone bad. Once you address the problem, the pain dissipates, and you return to normal.
Unfortunately, though, chronic pain can lead to mental health concerns such as anxiety and depression, and mental health conditions can lead to physical symptoms that include pain. In these cases, each of the intertwined problems may be difficult to treat.
The development of anxiety and/or depression is particularly evident in chronic pain syndromes like fibromyalgia, irritable bowel syndrome (IBS), low back pain, headache disorders, and neuropathic pain.
At Umbrella HealthCare in Phoenix, Arizona, Dr. John Lewis and his staff are keenly aware of the relationships among pain, anxiety, and depression. That’s why they offer a range of physical and psychological modalities to address this trifecta of interrelated conditions. Keep reading to learn how they can stop the pain-anxiety-depression cycle and return you to your normal life.
Researchers once thought the relationships among pain, anxiety, and depression came primarily from psychological factors. However, as they learned more about how the brain functions, they discovered that pain shares some biological mechanisms with both anxiety and depression.
The somatosensory cortex (the brain region that interprets sensory information) interacts with the amygdala, the hypothalamus, and the anterior cingulate gyrus (areas that regulate emotions and stress); together they generate the mental and physical experience of pain. These same regions also play a role in anxiety and depression.
In addition, two neurotransmitters — serotonin and norepinephrine — not only contribute to pain signaling in the brain and nervous system, but are also implicated in both anxiety and depression.
It’s believed that having a psychological condition may drop the threshold for pain tolerance. For example, those living with depression tend to experience more severe and longer-lasting pain than other people. Some 65% of patients seeking treatment for depression also report at least one type of pain symptom.
It also works the other way. Approximately two-thirds of patients with IBS develop symptoms of psychological distress, most often anxiety. Psychiatric disorders contribute not just to pain intensity but also to increased disability.
When pain comes along with anxiety and depression, treatment can be challenging. Focusing strictly on the pain can dull the awareness that the patient also has a psychiatric disorder. And focusing strictly on the anxiety and depression overlooks the pain driving those conditions.
Fortunately, there are therapies that can help all three parts of the problem.
Cognitive behavioral therapy (CBT) is a type of psychotherapy not only established for treating anxiety and depression, but it’s also the best studied psychotherapy for treating pain. Our therapists use CBT to help you think of your symptoms in a healthier way so you can manage, rather than be victimized by, your conditions.
Exercise is another good option, boosting mood and alleviating anxiety, which may also help relieve pain.
The Cochrane Collaboration reviewed 34 studies comparing exercise with various control conditions to treat fibromyalgia. The reviewers found that aerobic exercise improved overall well-being and physical function and might relieve pain. More limited evidence suggests that muscle strengthening might also improve pain, overall functioning, and mood.
Medication can be effective, too, and some psychiatric medications also work as pain relievers. A number of antidepressants prescribed for both anxiety and depression help alleviate nerve pain, and the research most strongly supports using selective norepinephrine reuptake inhibitors (SNRIs) or tricyclic antidepressants. The findings are less robust for the ability of selective serotonin reuptake inhibitors (SSRIs) to alleviate pain.
Anticonvulsants can also be used “off label” to stabilize mood. They rein in the aberrant electrical activity and hyper-responsiveness in the brain that contribute to seizures, but because pain also involves nerve hypersensitivity, some of these medications may prove of use.
Most patients find that combining psychotherapy with medication offers the most complete relief. The Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study suggests such a combination approach might prove effective.
If you’re dealing with pain, anxiety, and/or depression and feel trapped in the cycle, it’s time to come into Umbrella HealthCare for an evaluation and effective treatment. Give our office a call at 623-242-1389, or book online with us today. We can help.