Mental & Emotional Health

Complications of Chronic Pain and Depression

Both chronic pain and depression interfere with daily functioning at school, at work, and within relationships.

The most serious complication of depression is suicide. Patients who have both chronic pain and depression have a much higher risk of feeling suicidal, acting on those suicidal feelings, and successfully committing suicide. Treatments that both improve depression and relieve chronic pain may decrease the risk of suicide in patients.
Diagnosis of Chronic Pain and Depression

Unfortunately, depression can be a slippery diagnosis. When someone is already suffering from chronic pain, it may seem obvious that some degree of depression is likely. Depression may even worsen the physical symptoms of chronic pain. Similarly, untreated chronic pain may cause a cycle of distress and depression. Diagnosing the presence of both chronic pain and depression may be the first step toward breaking this cycle and improving both pain and depression.

And yet, depression is not an inevitable result of every chronic pain condition. Nor is chronic pain an inevitable result of depression. However, until researchers unravel the complex interactions between depression and chronic pain, it is important that both healthcare providers and patients be aware that these two conditions frequently co-exist. Diagnosing and treating only one of them could result in serious complications, debilitation, or decreased functioning.

A thorough evaluation by your healthcare provider should always include an inquiry into the presence of any chronic pain, as well as screening questions designed to uncover the presence of a mood disorder. A questionnaire called the SF-36 Health Status Survey is particularly helpful at uncovering the dimensions of chronic pain and the presence of depressive symptoms.

The good news is that there are medications available that treat both depression and chronic pain. Certain medications traditionally used for depression also have a significant effect on decreasing chronic pain. This association has been tested in individuals who suffer from chronic pain without depression; when these patients are asked to fill out rating scales that describe the intensity of their chronic pain, those patients who are given antidepressants rate their pain as significantly decreased. But these medications are prescribed by your doctor and can have side effects. Consult with your doctor about what would be best for you.

The antidepressant medications that have been successfully used to decrease chronic pain include:
* Tricyclic antidepressants
o Amitryptiline (Elavil)
o Desiprimaine (Norpramin)
o Imipramine (Tofranil)
o Doxepin (Sinequan)
o Nortiptyline (Pamelor)
* Selective serotonin reuptake inhibitors
o Fluoxetine (Prozac)
o Sertraline(Zoloft)
o Paroxetine (Paxil)
o Fluvoxamine (Luvox)
o Citalopram (Celexa)
* Atypical antidepressants
o Venlafaxine (Effexor)
o Nafazodone (Serzone)
o Trazodone (Desyrel)
o Bupropion (Wellbutrin)
o Mirtazepine (Remeron)

Psychotherapy, referred to commonly as therapy, in which a person with depression talks to a licensed and trained mental healthcare professional, can also be helpful for patients who are struggling with both chronic pain and depression.

In addition, a variety of other treatments are available that may improve pain and lessen depression, such as:
* Behavioral therapy
* Biofeedback
* Massage
* Occupational therapy
* Yoga
* Stretching
* Relaxation techniques
* Hypnosis