PainCare - the leading Pain Management specialists in NH

by Leslie A. Leduc, MS, ARNP  

Depression and anxiety often co-exist with chronic pain.

When patients have chronic pain, it often radically changes their lives. The hard working construction laborer is no longer able to lift 100 pounds, a flooring installer can’t bend to lay tile all day, or a roofer can’t climb and bend to nail shingles in the hot sun. The bread winner becomes less and less functional and more and more dependent on a spouse or significant other to "bring home the bacon." For the disabled laborer, often the only outlet is to try to learn a new job skill. If roofing or construction is all they've ever known this produces a conundrum from which anxiety and/or depression can result. It is our job to be aware of the potential for this emotional turmoil, and recognize and treat any anxiety or depression along with the pain. It makes sense that severe pain exacerbates depression and anxiety. More subtle is the fact that depression and anxiety exacerbate our perception of pain. To make matters worse, narcotic pain medications can sometimes make depression worse, even while relieving pain!

How do you know if you have depression or anxiety?

Depression is characterized by sadness, frustration, and/or feeling down most of the time. It is usually accompanied by excessive sleepiness, or conversely the inability to sleep. The depressed patient may also experience decreased energy for and interest in activities, an inability to concentrate, little appetite for food or sexual activity, and may even feel suicidal. A patient’s anxiety may be provoked by a preoccupation with his/her health and, quite often, racing thoughts prevent a restorative nights' sleep. The focus becomes the pain and the fear that it is going to get worse. Anxiety can also cause panic, often accompanied by chest pain, shortness of breath, abdominal pain, or migraine headache. There is a strong mind and body connection.  It is the healthcare provider’s duty to ask their patients if they experience these symptoms since optimal pain care depends on first acknowledging the presense of depression and then treating the depression and anxiety along with the pain. 

What helps the depression and anxiety in light of pain care?

The first line of treatment usually consists of medication. Here is a list of some of the more commonly used medications:

• Tricyclic antidepressants (for pain and depression, and also aids sleep and to some extent pain). Examples are Amitriptyline, Nortriptyline, and Imiprimine.
• Selective Serotonin Reuptake Inhibitors (for depression, anxiety and pain). Examples are Paxil, Prozac, Zoloft, Celexa, and Lexapro.
• Selective Serotonin and Norepinephrine Reuptake Inhibitors (for depression, anxiety and pain). Examples are Effexor XR, Cymbalta, and Remeron.
• Antianxiolytics (for anxiety and sometimes pain associated with muscle spasms). Examples are Ativan, Xanax, Klonipin, Valium, and Buspar.

The second line of treatment involves counseling. The patient must first admit that they have depression/anxiety, then develop cognitive (logic based) strategies to control negative emotional responses to pain. It is difficult but necessary for the pain patient to understand that despite the pain, life is not over, could always be worse, and needn't be joyless or humorless!

 

If you experience any of the symptoms mentioned above and have chronic pain, you should see your healthcare provider. Your provider can help you choose the best approach. 

 

We are sincerely grateful for the contribution of this article by our friend and colleague Leslie Leduc.  She continues to be greatly missed.