Mental & Emotional Health

The psychiatrist that my husband and I use is known as one of the few doctors in town that treats chronic pain.  And, I haven’t always had chronic pain.  When I was 24 weeks pregnant with our second child, I went into labor.  At that time it was discovered that I had 3 herniated disks in my low back.  It was discovered because I couldn’t use my left leg.  Anyway, I was given the option of having surgery at 24 weeks pregnant, which I declined.  I opted for bed rest.  But, the pain was so intense, it would continue to put me in labor.  So, my ob/gyn team would help me with pain medications on a regular basis to  use while pregnant.

Fast forward to the time that the child turned 4 months old and I had back surgery.  I was told it would take about 3 months to fully get over it.  At the end of 3 months, I was still taking pain medication quite frequently.  At that appointment, the doctor said "it will take 6 months before you will really feel better".  And, I continued to take pain medication.  At 7 months post surgery, I fell down a flight of steps.  Of course, you can only imagine that this meant more pain meds and a longer recovery time.

It has now been 4 years.  I have chronic pain in my tailbone.  The surgery was performed on the upper 2 sacral disks and the last lumbar disk.  So, for the most part, I’m fused together from the last lumbar disk all the way to the tip of my tailbone.  Which?  The tip of my tailbone was broken many years ago as a child.

Anyway, I told you all that to say this, I have been treated for chronic pain for at least 4 years.  Many people say that chronic pain will enhance depression.  About 3 months ago I opted out of the pain medication in search of some other methods.  In the last 3 months, my attitude, my mood, my over-all mental and emotional well-being has declined.  I called my doctor today to ask for pain mediation and instead of giving it to me, he suggested I see the neurosurgeon again.  If you’ve ever had lumbar surgery, you probably don’t need me to tell you that I WILL NEVER DO THAT AGAIN.  It was difficult to even be a human being after that.  I will find a way to deal with the pain, I will simply suffer if need be, but I won’t have surgery again.

I plan to let my doctor know on my next visit that I can tell that my mood and attitude are changing quite drastically due to the pain.  And, the neurosurgeon doesn’t have an appointment for 3 months.  So, what do I do?  Just suffer?  Beg for pain meds?   Go some where else?  How do you cope when you know that pain is fueling or at least partially fueling your depression. 

I want to run and play with my kids.  I haven’t picked my 5-year-old son up but a handful of times since he was 3  years old because I simply can’t.  I tell both of my children "let me go sit on the sofa and you can sit in my lap" because they both know that I am not able to pick them up.  If that doesn’t depress you, nothing will.  Not being able to run and play and ride bikes with your own children, that sucks.  And, to know that 3 weeks ago when my son fell and cut his head, I couldn’t even pick him up, I had to sit down on the ground and hold him.  I just can’t do it. 

So, with that, I give you a couple of quotes.

Depression and Chronic Back pain

Depression is by far the most common emotion associated with chronic back pain. The type of depression that often accompanies chronic pain is referred to as major depression or clinical depression. This type of depression goes beyond what would be considered normal sadness or feeling "down for a few days". The symptoms of a major depression occur daily for at least two weeks and include at least 5 of the following (DSM-IV, 1994):

• A predominant mood that is depressed, sad, blue, hopeless, low, or irritable, which may include periodic crying spells
• Poor appetite or significant weight loss or increased appetite or weight gain
• Sleep problem of either too much (hypersomnia) or too little (hyposomnia) sleep
• Feeling agitated (restless) or sluggish (low energy or fatigue)
• Loss of interest or pleasure in usual activities
• Decreased sex drive
• Feeling of worthlessness and/or guilt
• Problems with concentration or memory
• Thoughts of death, suicide, or wishing to be dead

  Chronic pain and depression are two of the most common health problems that health professionals encounter, yet only a handful of studies have investigated the relationship between these conditions in the general population (Currie and Wang, 2004).

  Depression is more commonly seen in patients with chronic back pain problems than in patients with pain that is of an acute, short-term nature. How does depression develop in these cases? This can be understood by looking at the host of symptoms often experienced by the person with chronic back pain or other spine-related pain.

  • The pain often makes it difficult to sleep, leading to fatigue and irritability during the day.
  • Then, during the day, because patients with back pain have difficulty with most movement they often move slowly and carefully, spending most of their time at home away from others. This leads to social isolation and a lack of enjoyable activities.
  • Due to the inability to work, there may also be financial difficulties that begin to impact the entire family.
  • Beyond the pain itself, there may be gastrointestinal distress caused by anti-inflammatory medication and a general feeling of mental dullness from the pain medications.
  • The pain is distracting, leading to memory and concentration difficulties.
  • Sexual activity is often the last thing on the person’s mind and this causes more stress in the patient’s relationships.

Several psychological theories about the development of depression in chronic back pain patients focus on the issue of control. As discussed previously, chronic back pain can lead to a diminished ability to engage in a variety of activities such as work, recreational pursuits, and interaction with family members and friends. This situation leads to a downward physical and emotional spiral that has been termed "physical and mental deconditioning"

The individual ultimately feels totally controlled by the pain, leading to major depression. Once in this depressed state, the person is generally unable to change the situation even if possible solutions to the situation exist.

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