Fighting The Depression That Comes With Pain

Yesterday I had one of those halting, heart breaking phone calls.

A good friend of mine has been fighting debilitating pain for months, and kept in good spirits - but last night, it was clearly taking its toll.

I’d never heard this fighter sound so defeated before. Ordinarily, he is a tireless champion for both himself, his family, and others, but this invisible pain with no obvious cause was bringing him to his knees. It was robbing him of the tools he ordinarily used to fight, and what tools the pain didn’t take away, the medication for the pain did. Without a clear diagnosis, healthcare, insurance, and employers were acting skeptical, further demoralizing him.

It wasn’t until after we hung up that I realized just how normal his depression was… and just how intertwined depression and pain likely are.

Pain is a heck of a monster to battle. It changes your brain chemistry, and clouds your mind. It robs you of your sleep, which further clouds your mind and weakens your brain and body. It can be debilitating and disabling — keeping you from doing the things you love, the things that you live for, the things you do to let off stress and help yourself cope.

In the face of all of that, it’s easy to feel out of control, needy, and even hopeless, especially when the pain is keeping you from fulfilling what you see as the meaning of your life. All of these factors can lead towards a downward spiral, even in people someone who normally would never be at risk for depression… its estimated that the risk of major depression is at least quadrupled for someone with chronic back pain.

But while depression is a normal and natural response to debilitating pain, it is *especially* important to fight against it — because depression itself diminishes the body’s ability to deal with pain. There is complex brain chemistry and pathways involved, that I don’t pretend to understand, but the links are there… and once depression sets in, the stress and difficulty of the disability is that much harder to deal with. Pain causes depression, depression causes pain.

So while my friend can’t do much about the cause of the pain itself until he has a diagnosis, he *can* fight the associated depression - treating the depression may help with the pain, and certainly will provide him with a course of action, a named enemy, and allow him to develop a battle plan: Putting yourself back in control is often the first step out of depression.
Here’s a few points to consider while in drafting that war strategy:

• Talk to your doctor specifically about depression; you might want to discuss specific antidepressants that are sometimes prescribed for pain even without depression, and be aware that some pain medications are known to worsen depression.
• Be gentle with yourself - the pain beats you up enough. Don’t beat yourself up, too. Consider how you’d treat others in your position, and treat yourself with that same kindness.
• Remember: pain-related depression is not a character flaw. It’s a normal reaction to a stressful, very real physical condition.
• Don’t fall out into negative thinking patterns . Learn cognitive therapy techniques for keeping a more positive outlook - it will make you better equipped to deal with the physical as well as mental challenges.
• Consider family and relationship counseling: it may sound silly, since the problem is in your body, not your relationships.. but debilitating pain can be rough on relationships, and counseling may strengthen the lines of communication and support open. With the right approach, your relationships may come through this even better than before.
• Practice relaxation/stress-reduction techniques . Hypnosis, biofeedback, and certain meditative techniques are all worth investigating, and can have a dual benefit with both pain management and mood.
• Ask (and accept) help from the people around you… even if its with little things, like remembering to take meds, helping you find counselors, or learning relaxation techniques with you. And please don’t see yourself as a burden. Those who love you deserve the chance to help you - don’t deny them that opportunity. Learn to receive.
• Practice compassion.. Not only towards others, but to yourself, to your depression, and to your pain. This alone can transform an experience.

I’m going to cut this here, because I know my friend has trouble sitting for long at the computer. But I truly hope I have helped - and at the least, demonstrated my concern and affection….

With love and compassion,

M.T.