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Pain, Depression and Anxiety
Most people can tolerate severe pain, such as childbirth or kidney stones, as long as the pain is temporary. However, few people can endure severe unrelenting pain for weeks or months without the risk of developing significant psychological dysfunction.
Scientists believe that chronic pain often leads to chemical and structural changes in the brain triggering mood swings and even personality changes. The changes are often manifested in the form of depression or anxiety. The psychological changes also induce feeling that the original pain “hurts” worse.
Depression
Depression is by far the most common psychological problem faced by patients suffering from chronic pain. It may start slowly, usually with insomnia, followed by fatigue, irritability, lack of concentration, decreased sex drive and changes in appetite. Mild depression may be difficult to distinguish from the normal frustration induced by the pain, making it difficult to decide when to start treating it.
When severe, depression induces feelings of guilt and worthlessness, and it is not uncommon to have thoughts about suicide. It appears that the same brain chemicals that keep us from being depressed also relieve pain, therefore it is necessary to treat depression when treating chronic pain. Seldom does a patient suffering from untreated depression get adequate relief from chronic pain.
Treatment for depression includes medications, psychological therapy or a combination of both. Fortunately, several drugs used to treat depression are also effective in the treatment of many types of pain including headache, neuralgia and fibromyalgia. Elavil, Tofranil, Prozac, Zoloft and Paxil are just some of the many antidepressant options available today. Determining which drug to prescribe is based on age, previous medical history and the type of pain.
Nearly 10 percent of normal people have a genetic predisposition for depression and develop at least one bout of depression during the adult life. Therefore, it is not uncommon to see patients whose depression is diagnosed prior to chronic pain. In such cases, treatment s may need to be prolonged. It is important for patients to know that preexisting depression can exacerbate pain. For example, existing depression may transform a simple case of postoperative pain into severe chronic pain.
Anxiety
Anxiety is a common problem for patients suffering from chronic pain. Symptoms vary and can be mild, such as increased worrying about family or finances to continuous irrational, paralyzing fears. Anxiety may cause symptoms such as a permanent state of alertness that results in sweating, racing heart and tremors among other symptoms. Anxiety may take on special forms depending on an individual’s state of mind and other environmental factors. Prolonged anxiety can lead to or worsen depression.
Panic Disorder
Panic Disorder is a relatively common form of anxiety. It may strike unprovoked or may be induced by certain events, such as being in a crowded elevator. Symptoms often include feelings of shortness of breath or smothering, which may lead to hyperventilation resulting in dizziness, tingling of the hands, feet and lips and sometimes even fainting. It is also common to experience a racing heart, chest or abdominal pain and sensations of imminent death or impending doom. Patients can easily confuse these symptoms with heart attacks or strokes, and they often end up in the emergency room only to be told “nothing is wrong.” Panic attacks usually last 15 to 30 minutes and in severe cases may occur several times a day.
Obsessive-Compulsive Disorder
Obsessive-Compulsive Disorder (OCD) is another form of anxiety leading to irrational fears and uncontrollable repetitive behavior to alleviate these fears. For example, obsessive fear of germs can causes a person to wash his or her hands dozens of times a day. In mild cases, OCD may cause nothing more than getting up a couple of times a night to check to make sure the doors are locked or the oven is turned off. In severe cases, it may lead to continuous obsessive thoughts that can’t be shut down and compulsive behaviors such as incessant counting. OCD is not as common as panic attacks, but it can be devastating.
Treatment
Drug treatment can be very effective and combinations of antianxiety drugs and antidepressants are successful. Valium, Ativan and Xanax are some of the drugs used for the treatment of anxiety disorders. Although these drugs are very effective for the short term, they may be addicting and should be used under close medical supervision. Antidepressants such as Elavil, Tofranil, Prozac, Zoloft and Paxil may provide a more reliable long-term solution without the potential for dependency. Psychological therapy, family support, patient education and learning coping skills are also available. |
