How chronic pain affects your mood

How chronic pain affects your mood

Q&A with Dr. Edward Lubin on the link between mental illness and pain that lasts longer than six months

Chronic pain, which is defined as pain that lasts longer than six months, can be so much more impactful on a patient’s daily life than a seven-word description.  The type of pain can vary in frequency and intensity.  While one person might experience mild or episodic discomfort regularly, others might suffer from excruciating or severe pain on a consistent basis.  Regardless of the type of pain or its cause, however, the inevitable emotional strain caused by chronic pain can make an already delicate situation more complex.  We talked with Dr. Edward Lubin, a board-certified pain management physician at Gessler Clinic as well as the president of medical staff at Winter Haven Hospital, about chronic pain and depression.

Central Florida Health News (CFHN): Does chronic pain often lead to depression?  How often do you see this in your patients?

Dr. Edward Lubin: Depression is one of the most common psychiatric diagnoses given to people who suffer from chronic pain—and it complicates the treatment of pain.  Any chronic condition such as pain can make you sad and frustrated, and everyone can suffer from the blues.  Yet, the formal coexistence of clinical depression with pain also is quite common.  Of the more than 30 million Americans with chronic pain of one year’s duration, between one quarter and one half also complain of symptoms of depression.  Looked at the other way, 65 percent of patients with clinical depression also have chronic pain complaints.

CFHN: Can medications used to treat chronic pain lead to depression?  Please explain.

Dr. Lubin: Many medications lead to symptoms of clinical depression.  Among these are beta blockers, corticosteroids, benzodiazepines, anti-Parkinson’s drugs, and anticonvulsants.  Of these, corticosteroids and anticonvulsants are used commonly in the treatment of depression.  Careful monitoring of pain patients’ mood and symptoms on these medications is required.

As symptoms of chronic pain and depression overlap, so, fortunately, can effective treatment with medication.  Common problems among chronic pain patients include loss of appetite, lack of energy, and decreased desire for physical and emotional engagement and sexual activity.  Successful early and ongoing treatment of these problems of daily living have a salutary effect on chronic pain.  Treatment with antidepressant medication has a twofold benefit.  Firstly, it relieves depressive symptoms and reduces functional impairment from pain.  Secondly, there is considerable evidence to suggest that antidepressants have direct analgesic qualities.

It must be mentioned that opioid medication, a mainstay in treatment of chronic pain, also has mood-enhancing effects, though these must be managed carefully.  Other adjunctive treatments for pain, including physical therapy and insomnia management, have clear and obvious benefits for the depressed patient.

CFHN: What are the signs that a patient suffering from chronic pain is also depressed?

Dr. Lubin: Pain physicians must constantly be on the lookout for signs of depression in their patients.  The syndromes frequently go together, and depression can hamper pain treatment, as noted here.  Inevitably, the question of cause and effect arises.  Do pain and depression always go hand in hand?  Does one cause the other?  Part of the answer lies in the definition of pain.  Pain is an emotional response to putative tissue damage.  Therefore, changes in mood, cognition, irritability, and vegetative function (sleep, sexual activity, and weight maintenance), along with emotional elements that accompany and define pain, can also make the diagnosis of depression.

Much work has also been done to examine common neurological pathways in depression and pain, which paves the way for greater understanding of the cause and cure.

CFHN: Please discuss the importance of dealing with depression early.

Dr. Lubin: Most chronic illnesses worsen with time.  The symptoms become intractable, the risks multiply, and treatment becomes more problematic.  In the case of depression, this is worrisome, as complications of depression include social withdrawal, reduction in individual productivity and function, and the looming threat of suicide.

Pain problems also tend to worsen.  As acute pain (usually of short duration and related to the specific injury) worsens, it becomes chronic.  It involves more body systems, requiring less intense triggers to manifest itself, and involving more dysfunction in activities of daily living.  This has a profound deleterious effect on mood as well.

Depressed patients commonly express their turbulent emotional state in terms of physical debility.  It is a medical truism that the depressive patient somaticizes what is difficult or painful to acknowledge as emotional pain.  Understanding this process is crucial to the proper treatment of painful symptoms, not least to avoid needless pain therapy where a psychiatric treatment focus is required.

Early treatment has profound effects on both conditions.  Treatment in early stages is more likely to be successful, winning greater patient compliance with medication therapy, avoiding polypharmacy, and therefore drug-drug interactions.  Seeing success early is also a great patient motivating factor.  It is easier to face the chronicity of disease at a stage where success can be achieved and doctor-patient cooperation can be maximized.

The overlap between chronic pain and depression calls for greater cooperation and information sharing between professionals who manage these problems independently, or who treat previously separated populations at risk of suffering from both conditions.  Welcome professional developments are the increased presence and participation of psychiatrists at pain conferences, and the growth in number of pain physicians with psychiatric background.  This cross-fertilization will go far to address the complex issues in the treatment of chronic pain and comorbid depression.

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