Depression and Chronic Pain

Living with chronic or long-term pain is a tremendous burden. But when you have chronic pain and depression, the burden gets even heavier.

Depression magnifies pain. It makes it more difficult to cope with everyday living. The good news is that chronic pain and depression are not inseparable. Effective medications and psychotherapy can help relieve the depression and make chronic pain more tolerable.

What is chronic pain?
Chronic pain is pain that lasts much longer than would be expected from the original problem or injury. When pain becomes chronic, your body may react in several ways. Chronic pain may be characterized by abnormalities in brain hormone, low energy, mood disorders, muscle pain, and impaired mental and physical performance. Chronic pain worsens as neurochemical changes in your body increase your sensitivity to pain. Then you begin to have pain in other parts of your body that do not normally hurt.

Chronic pain can prevent sleep and cause you to awaken frequently at night. This lack of sleep results in daytime fatigue and low productivity. The ongoing pain will cause additional irritation and make it difficult to deal with others. If you have to care for children or work full time, chronic pain may make your life seem too challenging. The overwhelming feelings can lead to irritability, depression, and even suicide for those who feel no hope for relief is in sight.

What happens with chronic pain and depression?
If you have chronic pain and depression, you've got plenty of company. Depression is one of the most common psychological issues facing people who suffer from chronic pain, and it often complicates the patient's conditions and treatment. Consider these statistics:

• According to the American Pain Foundation, about 32 million people in the U.S. report have had pain lasting longer than one year.
• From one-quarter to more than half of the population that complains of pain to their doctors are depressed.
• On average, 65% of depressed people also complain of pain.
• People whose pain limits their independence are especially likely to get depressed.

Because depression in patients with chronic pain frequently goes undiagnosed, it often goes untreated. Pain symptoms and complaints take center stage on most doctor visits. The result is depression -- along with sleep disturbances, loss of appetite, lack of energy, and decreased physical activity, which may make pain much worse.

Is there a cycle of depression and pain?
Pain provokes an emotional response in everyone. If you have pain, you may also have high anxiety, irritability, and agitation. These are very normal feelings when you're hurting. Normally, as pain subsides, so does the stressful response.

But with chronic pain, you may feel constantly tense and stressed. Over time, the constant stress can result in different emotional problems associated with depression. Some of the problems individuals with both chronic pain and depression have include:

• Altered mood
• Anger
• Chronic anxiety
• Confused thinking
• Decreased self-esteem
• Family stress
• Fatigue
• Fear of injury
• Financial concerns
• Irritability
• Legal issues
• Physical deconditioning
• Reduced sexual activities
• Sleep disturbances
• Social isolation
• Weight gain or loss
• Work issues

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11 Tips for Living With Chronic Pain

1. Learn deep breathing or meditation to help with chronic pain. Deep breathing and meditation are techniques that help your body relax, which eases pain. Tension and tightness seep from muscles as they receive a quiet message to relax. Although there are many to meditate, the soothing power of repetition is at the heart of some forms of meditation. Focusing on the breath, ignoring thoughts, and repeating a word or phrase -- a mantra -- causes the body to relax. While you can learn meditation on your own, it helps to take a class. Deep breathing is also a relaxation technique. Find a quiet location, a comfortable body position, and block out distracting thoughts. Then, imagine a spot just below your navel. Breathe into that spot, filling your abdomen with air. Let the air fill you from the abdomen up, then let it out, like deflating a balloon.
2. Reduce stress in your life. Stress intensifies chronic pain. Negative feelings like depression, anxiety, stress, and anger can increase the body's sensitivity to pain. By learning to take control of stress, you may find some relief from chronic pain. Several techniques can help reduce stress and promote relaxation. Listening to soothing, calming music can lift your mood -- and make living with chronic pain more bearable. There are even specially designed relaxation tapes or CDs for this. Mental imagery relaxation (also called guided imagery) is a form of mental escape that can help you feel peaceful. It involves creating calming, peaceful images in your mind. Progressive muscle relaxation is another technique that promotes relaxation.
3. Boost chronic pain relief with the natural endorphins from exercise. Endorphins are brain chemicals that help improve your mood while also blocking pain signals. Exercise has another pain-reducing effect -- it strengthens muscles, helping prevent re-injury and further pain. Plus, exercise can help keep your weight down, reduce heart disease risk, and control blood sugar levels -- especially important if you have diabetes. Ask your doctor for an exercise routine that is right for you. If you have certain health conditions, like diabetic neuropathy, you will need to be careful about the types of activities you engage in; your doctor can advise you on the best physical activities for you.
4. Cut back on alcohol, which can worsen sleep problems. Pain makes sleep difficult, and alcohol can make sleep problems worse. If you're living with chronic pain, drinking less or no alcohol can improve your quality of life.
5. Join a support group. Meet others living with chronic pain. When you're with people who have chronic pain and understand what you're going through, you feel less alone. You also benefit from their wisdom in coping with the pain. Also, consider meeting with a mental health professional. Anyone can develop depression if they're living with chronic pain. Getting counseling can help you learn to cope better and help you avoid negative thoughts that make pain worse -- so you have a healthier attitude. Asking for help is a sign of strength, not weakness.
6. Don't smoke. It can worsen chronic pain. Smoking can worsen painful circulation problems and increase risk of heart disease and cancer.
7. Track your pain level and activities every day. To effectively treat your pain, your doctor needs to know how you've been feeling between visits. Keeping a log or journal of your daily "pain score" will help you track your pain. At the end of each day, note your pain level on the 1 to 10 pain scale. Also, note what activities you did that day. Take this log book to every doctor visit -- to give your doctor a good understanding of how you're living with chronic pain and your physical functioning level.
8. Learn biofeedback to decrease pain severity. Through biofeedback, it's possible to consciously control various body functions. It may sound like science fiction, but there is good evidence that biofeedback works -- and that it's not hard to master. Here's how it works: You wear sensors that let you "hear" or "see" certain bodily functions like pulse, digestion, body temperature, and muscle tension. The squiggly lines and/or beeps on the attached monitors reflect what's going on inside your body. Then you learn to control those squiggles and beeps. After a few sessions, your mind has trained your biological system to learn the skills.
9. Get a massage for chronic pain relief. Massage can help reduce stress and relieve tension -- and is being used by people living with all sorts of chronic pain, including back and neck pain.
10. Eat a healthy diet if you're living with chronic pain. A well-balanced diet is important in many ways -- aiding your digestive process, reducing heart disease risk, keeping weight under control, and improving blood sugar levels. To eat a low-fat, low-sodium diet, choose from these: fresh fruits and vegetables; cooked dried beans and peas; whole-grain breads and cereals; low-fat cheese, milk, and yogurt; and lean meats.
11. Find ways to distract yourself from pain so you enjoy life more. When you focus on pain, it makes it worse rather than better. Instead, find something you like doing -- an activity that keeps you busy and thinking about things besides your pain. You might not be able to avoid pain, but you can take control of your life.

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Understanding Allergy and Hay Fever Medications

Antihistamines

Many antihistamine drugs are available without a prescription. Examples include the first-generation antihistamines such as brompheniramine (Dimetapp, Bromphen, Dimetane, Nasahist), chlorpheniramine (Chlor-Trimeton), clemastine (Allerhist, Tavist), and diphenhydramine (Benadryl), and a second-generation antihistamine loratadine (Claritin). Loratadine (Claritin) does not cause drowsiness.

Common prescription antihistamines (all second-generation antihistamines) include cetirizine (Zyrtec), desloratadine (Clarinex), and fexofenadine (Allegra). These antihistamines (and loratadine) are less likely to cause adverse effects like drowsiness or dry mouth.

Several antihistamine nasal sprays (for example, azelastine [Astelin]) are also available to treat symptoms such as runny nose, sneezing, and itchy nose.

How antihistamines work: These drugs compete with histamine for histamine receptor sites. By occupying the histamine receptor sites, they prevent histamine from causing allergic symptoms. Antihistamines are most effective when taken continuously during the allergy season.

Who should not use these medications: Antihistamines are contraindicated in individuals allergic to them. They may cause unwanted side effects in the following:

• Individuals currently using a monoamine oxidase inhibitor (MAOI)
• Individuals with narrow-angle glaucoma
• Individuals who are breastfeeding

Use: Antihistamines come in tablet, chewable tablet, capsule, and liquid forms. How often an antihistamine should be taken each day depends on the individual antihistamine's characteristics and the type of preparation (that is, the dosage form).

Drug or food interactions: Avoid taking other drugs that cause drowsiness, such as alcohol, sleep preparations, sedatives, or tranquilizers. Avoid taking MAOIs (for example, isocarboxazid [Marplan], phenelzine sulfate [Nardil], or tranylcypromine [Parnate]) within 14 days of antihistamines. For drug interactions specific to a particular antihistamine, talk with a doctor or pharmacist.

Side effects: Many antihistamines (particularly the first-generation agents) may cause the following side effects:

• Drowsiness
• Dry mouth
• Urine retention
• Blurred vision
• Before driving a car or operating machinery, be sure to know if the antihistamine affects the ability to concentrate and stay awake.
• Check with a doctor before taking antihistamines.
  

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Mental Health and Hypnosis

Hypnosis -- or hypnotherapy -- uses guided relaxation, intense concentration, and focused attention to achieve a heightened state of awareness that is sometimes called a trance. The person's attention is so focused while in this state that anything going on around the person is temporarily blocked out or ignored. In this naturally occurring state, a person may focus his or her attention -- with the help of a trained therapist -- on specific thoughts or tasks.

How Does Hypnosis Work?
Hypnosis is usually considered an aid to psychotherapy (counseling or simply therapy), rather than a treatment in itself. It helps with psychotherapy because the hypnotic state allows people to explore painful thoughts, feelings, and memories they might have hidden from their conscious minds. In addition, hypnosis enables people to perceive some things differently, such as blocking an awareness of pain.

Hypnosis can be used in two ways, as suggestion therapy or for patient analysis.

• Suggestion therapy: The hypnotic state makes the person better able to respond to suggestions. Therefore, hypnotherapy can help some people change certain behaviors, such as to stopping smoking or nail-biting. It can also help people change perceptions and sensations, and is particularly useful in treating pain.
• Analysis: This approach uses the relaxed state to find the root cause of a disorder or symptom, such as a traumatic past event that a person has hidden in his or her unconscious memory. Once the trauma is revealed, it can be addressed in psychotherapy.

What Are the Benefits of Hypnosis?
The hypnotic state allows a person to be more open to discussion and suggestion. It can improve the success of other treatments for many conditions, including:

• Phobias, fears, and anxiety
• Sleep disorders
• Depression
• Stress
• Post-trauma anxiety
• Grief and loss

It also might be used to help with pain control and to overcome habits, such as smoking or overeating. It also might be helpful for people whose symptoms are severe or who need crisis management.

What Are the Drawbacks of Hypnosis?
Hypnosis might not be appropriate for a person who has psychotic symptoms, such as hallucinations and delusions, or for someone who is using drugs or alcohol. It should be used for pain control only after a doctor has evaluated the person for any physical disorder that might require medical or surgical treatment.

Some therapists use hypnosis to recover repressed memories they believe are linked to the person's mental disorder. However, hypnosis also poses a risk of creating false memories -- usually as a result of unintended suggestions by the therapist. For this reason, the use of hypnosis for certain mental disorders, such as dissociative disorders, remains controversial.
Is Hypnosis Dangerous?

Hypnosis is not a dangerous procedure. It is not mind control or brainwashing. A therapist cannot make a person do something embarrassing or that the person doesn't want to do. The greatest risk, as discussed above, is that false memories can be created.
Who Performs Hypnosis?

Hypnosis is performed by a licensed or certified mental health professional who is specially trained in this technique.

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