PAIN AND DEPRESSION

1
PAIN AND DEPRESSION

• Radu Vrasti, PhD

2
Pain and depression-old common experiences

• When our ancestors faced physical damage
• or failed to understand their surroundings, they
• became frustrated, down, fearful, angry, guilty
• and learned to suffer
• Physical pain or emotional pain both use
• the same pathway to our brain
• Pain and depression has the same
• meaning for our mind suffering!

3
Emotional Relationship Between Pain and
Depression

• SUFFERING (FRUSTRATION)
• PAIN
  DEPRESSION
• SUFFERING
  (REINFORCEMENT)

4
Acute pain

• When pain arises our
• mind receives a ring that
• something wrong has
• happened in the body

5
Chronic pain

• In cases of chronic pain
• there is a false alarm
• and the bell continues
• to ring without apparent
• cause

6
Pain Prevalence in population

• 25 to 30 percent of the North-Americans suffer
  from chronic pain
• 50-75 of those experiencing chronic pain are
  partially or totally disabled for a period of
  days (i.e. headache) or weeks and months (i.e.
  back pain, arthritis, fibromyalgia)

7
Pain Some statistics

• 1 in 3 Canadians suffer from some form of
  recurring pain
• 1 of every 3 families contain a person who suffer
  from chronic pain
• 4 out of 5 people have one severe headache a year
• 1 in 5 Canadians experiences migraines or other
  headaches
• 1 in 7 Canadians is affected by arthritis

8
Depression statistics

• 7.9-8.6 of adults will have major depression
  during their lifetime in Canada
• 6.5 of women have a major depressive disorder
• 3.3 of men have a major depressive disorder
• lifetime incidence of major depression found that
  7.9 to 8.6 of adults over 18 years of age

9
Pain and depression statistics

• People with chronic pain have three times the
  average risk of developing depression
• People with depression have three times
  likelihood developing chronic pain
• 75 of patients with clinical depression present
  to their doctors because of physical symptoms
  including pain
• 40-60 of patients being treated at pain clinics
  report experiencing symptoms of depression.

10
Pain and depression brain chemistry

• The same neurotransmitters (serotonin and
  norepinephrine) and the same neural pathways and
  brain centers (limbic area) are involved in the
  regulation of mood (depression) and pain.

11
Pain vocabulary

• throbbing, flashing, shooting, sharp, dull ache,
  hurt, sore, intense, flickering, quivering,
• pulsing, beating, pounding, jumping, pricking,
  boring, drilling, stabbing, lacerating, cutting,
  pinching,
• pressing, gnawing, cramping, tugging, pulling,
  wrenching, hot, burning, scalding, searing,
  tingling, itchy,
• smarting, heavy, tender, taut, rasping,
  splitting, tiring, exhausting, sickening,
  suffocating, fearful, frightful,
• terrifying, punishing, grueling, cruel, vicious,
  killing, wretched, blinding, annoying,
  troublesome,
• miserable, intense, unbearable, spreading,
  radiating, penetrating, piercing, tight, numb,
  drawing,
• squeezing, tearing, cool, cold, freezing,
  nagging, nauseating, agonizing, dreadful,
  torturing, continuous,
• steady, constant, rhythmic, periodic,
  intermittent, brief, momentary, transient, mild,
  discomforting,
• distressing
• (Wendy Duggleby, The Language of Pain)

12
Characteristics of chronic pain

• Medications taken excessively or
  inappropriately
• Inappropriate patterns of accessing the medical
  system
• Physical inactivity and weakness
• Depression and other emotional problems
• Lack of coping skills to deal with pain and
  disability
• Family, work, and community problems associated
  with pain.

13
Characteristics of chronic depression

• Feelings of worthlessness, self-reproach, or
  excessive or inappropriate guilt
• Loss of interest of pleasure in usual activities,
  or decreased sex drive
• Complaints or evidence of diminished ability to
  think or concentrate
• Poor appetite or significant weight loss or
  weight gain
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Loss of energy or fatigue
• Recurrent thoughts of death

14
Type of Pain

• Back pain, neck pain 13.9 ()
• Joint pain 13.8
• Headache 13.3
• Muscle pain 9.9
• Stomach pain 4.0
• Premenstrual pain 3.7
• Dental pain 1.9
• Other 2.0

15
Mental Factors Involved in Pain

• Consciousness
• Focus of attention
• Memories
• Expectations
• Your mental attitudes and beliefs

16
Three ways of conceptualizing pain

• Pain as a teacher or reminder
• Pain as an opponent
• Pain as a survivable event

17
Ways to Close the Gate of Pain

• 1. Physical self-management
• - Application of heat or cold
• - Massage
• - Exercise,
• 2. Emotional self-management
• - Keeping emotionally stable
• - Managing tension
• - Experiencing positive emotions
• 3. Mental self-management
• - Distracting your attention away
• - Increasing your involvement in life
  activities
• - Having positive attitudes toward yourself,
  others, and the future
• 4. Actions
• - Maintaining an appropriate level of physical
  activity
• - Striking a good balance between work,
  recreational, and social activity
• - Maintaining good physical health

18
12 Steps to Manage Pain

• 1. Accept the fact of having chronic pain.
• 2. Set specific goals for work, hobbies, and
  social activities toward which you will work.
• 3. Let yourself get angry at your pain if it
  seems to be getting the best of you.
• 4. Take your analgesics on a strict time
  schedule, and then taper off until you are no
  longer taking any.
• 5. Get in the best physical shape possible, and
  keep fit.
• 6. Learn how to relax, and practice relaxation
  techniques regularly.
• 7. Keep yourself busy.
• 8. Pace your activities.
• 9. Have your family and friends support only your
  healthy behavior, not your invalidism.
• 10. Be open and accessible with your doctor.
• 11. Practice effective empathy with others having
  pain problems.
• 12. Remain hopeful.

19
Difficult Moments

• There are many reasons to hold on to a feeling of
  hope
• Your current mental state is natural but
  temporary
• There are many reasons to remain hopeful
• You'll help yourself if you get up and change
  what you are doing to something different.

20
Benefits of Exercise

• More muscle strength
• Less body fat
• More energy
• Better breathing
• Less joint pain
• More flexibility
• Less depression
• Better memory
• Increased reasoning
• Increased self-confidence
• Better sleep
• Less chance of heart attack

21
Good Nutrition

• Eat a variety of foods.
• Maintain an optimum weight.
• Avoid excessive fat and cholesterol.
• Avoid excessive sugar.
• Eat foods with adequate starch and fiber.
• Avoid excessive salt or sodium.
• Limit alcohol consumption.

22
More Water

• Drinking adequate water is crucial to the
• proper functioning of the body
• The human body is about 60 water, the brain is
  75 water, and the blood is 85 water
• Dehydration can contribute to pain and
  disability
• Dehydration is a particular problem in older
  people, who generally need more water than
  younger people
• Bottled or filtered water, fruit juices, and
  decaffeinated teas are good sources, as are
  fruits and vegetables which are 75 to 85 water
• For optimum health, sip water frequently
  throughout the day, perhaps keeping a small
  bottle or glass handy in areas of the home where
  you spend the most time, rather than trying to
  gulp whole glasses at a time.

23
Setting Goals

• Goals should be
• Concrete and specific
• Realistic
• Achievable