on chronic pain and depression

According to the U.S. National Institute of Mental Health, “Scientists don’t yet know how depression and chronic pain are linked, but the illnesses are known to occur together.”

Hmmm. Let me propose a connection.

The link between chronic pain and depression is not some mysterious “co-morbid” condition: many of us folks with chronic pain, despite the positive front we often sport, are pretty sad about the stuff we can’t do anymore, pretty sad about cancelling some major life plans, and pretty sad because ongoing pain, physiologically, makes sadness. Perpetual sadness? I think they call that depression.

Over the course of my two and a half years with chronic pain, I have come across the same very sound advice from a variety of trusted sources that suggest I avoid living in the past in order to manage the pain better without the accompanying emotional fallout, and they’re right. Those moments where I can shut out dreams of the effervescent past and resist lamenting a future without daily music, high energy, and red wine are certainly better than the alternative. To this end, regular meditation and visualization have been key in living in a present and imagining a future I feel really good about.

But even with these strategies, and even though loss gets easier with time, there are just going to be those moments where you feel well enough to sing, so you do, and you’re so overwhelmed with how much you miss the sound of your own singing voice (narcissist) that you have to weep/sing for a bit for fear you’ll never get to use that singing voice on a daily basis ever again… fun, sexy time, no? Oh, and you’re also dealing with intense pain or pain management every. day.

Before having chronic pain, I don’t think I could have possibly understood how pain and depression are not just distant cousins, but twins — both evil — that never go anywhere without each other. I would have rationalized it: the pain is just pain, the mind can overcome. It’s all about attitude, right?

Um… Nope. Because I work harder on my attitude now than ever before in my whole little life and I’m struggling with depression for the first time. I have to rest, meditate, and do yoga like a pro, because if my tired, angry, or irritable barometer goes above a certain level the forecast is calling for pain. Perhaps this is the specific cause & effect that still perplexes scientists, but it’s real for many of us.

But please, do not be tempted to call out,

“See? You admitted it: You bring on the pain yourself with your poor emotional state!”

I’m no scientist, but I gather that not matter how rational, serene, equanimous, or laid back, most humans are susceptible a variety of emotions now and then. What also seems about right to me is that not all humans have chronic pain. Thus, I deduce that having feelings such as anxiety, anger, irritation, tiredness are not the primary underlying cause of chronic pain in the first place, nor do they cause “attacks” or “flare ups”. They have the capacity to exacerbate the pain, you bet, but unfortunately, these feelings are still routine parts of being a human, and thus difficult to avoid, especially while you have to adopt a new lifestyle, micro-manage your energy, and try to deal calmly with a massive ongoing transition period.

I think I can relate to Barbara Ehrenreich in Smile Or Die: How Positive Thinking Fooled America And The World when she responds to people’s insistence that her illness is a “gift”:

Breast Cancer, I can now report, did not make me prettier or stronger, more feminine or spiritual. What it gave me, if you want to call this a “gift”, was a very personal, agonising encounter with an ideological force in American culture that I had not been aware of before – one that encourages us to deny reality, submit cheerfully to misfortune and blame only ourselves for our fate.”

Putting on a happy front is not always healing, and having a wide range of emotions is a natural part of life. So please, let’s not ever blame pain solely on attitude or “stress.” While people with chronic pain might be grateful for their pasts and excited about new future plans, we are often still grieving lost abilities while wrangling with ongoing, disabling, depressing pain, and that’s just hard.

For the people who don’t get it:

%22think postive%22 depression and chronic pain

To doctors who recognized that chronic pain and depression must be treated together: thank you for doing your homework. Thank you to the spoonie community that tells it like it is, and to the vast majority of people in my life who listen to me and tell me how strong I am. I am a lucky woman (maybe minus the whole chronic pain thing though).

Anna

9 comments

  1. What an excellent post, Anna. And you’re spot on. I’ve also wondered why “scientists” haven’t figured out why chronic pain and depression often go hand-in-hand. It seems pretty obvious. Maybe they’re thinking too hard.

    1. Thank you Wren. Agreed. It seems pretty obvious to me too, but I guess the physiological processes must be understood to make such a claim, and I gather that’s pretty complicated. Nevertheless, the term “co-morbid” doesn’t cut it in my books given the scientific information we do have.

  2. First, I am in agreement with almost everything you wrote. I too try to have the best attitude in spite of the pain, and yet that can’t stop it. But I want to pose this idea, from a scientist’s point of view (as I was one in a past life, pre-pain):

    I think the depression scientists are linking, is very specific in nature, and NOT related to what is happening in someone’s life. There are two main types of depression. The way you are describing, is due to life events/challenges/difficulties (there is no good word to express how REAL and HARD this is). Then there is a biological disorder of Depression, where people are depressed regardless of what is occurring in their lives… the depression that despite everything going right, all you feel is deep-dark-sadness for no reason at all. The type of depression that you start crying out of nowhere, with no cause – except for a a biological, chemical issue in the brain. I know this biological depression exists, for I have lived it during the “everything is going right” moments in my life. And now, as a Spoonie, I also have lived the situational depression, caused by my pain, loss of dreams, loss of abilities, etc.

    They feel they same. They are equal. The suffering from each cannot be compared, because they are equally terrible. All I am saying is, when scientists talk about the link between depression and chronic pain, from what I have read, they are looking specifically for those people who have biological depression. I hope I made sense. I am just a former scientist-life long sufferer of depression-Spoonie and I am hoping I am clearing up a misunderstanding…? I’d love to hear your response/take on my main idea, as I love a good, friendly discussion.

    Either way, this is a beautiful, heartfelt, and truthful entry. I really love your writing and the way your mind works! Thanks again for being fearless, and talking publicly about taboo topics.

    Respectfully,
    Liliit/LeeLeeBot

    1. Yes, this explanation does shed light on the reason for “the link is not yet understood”-type statements. My feeling though is that (and I have no kind of science background whatsoever) the circumstances that might instigate or exacerbate depressed feelings might be sometimes inseparable from the chemical/biological phenomenon that is depression. Rather, that the two can work together very closely. I can grasp that the biological processes are not fully understood, and that’s fine, but would like researchers and doctors to frame the link the way you have done: to say that the circumstances surrounding pain involve grief and loss, and that alone is difficult. Compounded with the pain itself (which can also exacerbate depression, even though we don’t exactly understand how) puts people with chronic pain at higher risk for clinical depression. Something like that… I think I just get really frustrated when experience (an experience that is so blatantly obvious to me) is not factored into “scientific evidence”… Feels like more disbelief, you know?

      1. Excellent retort! Very well said.

    2. I guess what I mean to say is that scientists concerned strictly with biological processes/evidence should also acknowledge experience in abstracts and the like, especially when dealing with poorly understood, invisible illness. Otherwise it’s like, we don’t yet understand it, so who’s to say it’s real!

  3. Reblogged this on sickinthehead and commented:
    Things to consider while learning to cope with Chronic Migraine and other chronic pain disorders

  4. A really well written blog, focussing on the very same features I am talking about in my own blog. I have posted a link to your post on my Facebook page https://www.facebook.com/Tearsofstrength because I felt that it was such a similar message to the one I am trying to put across at the moment. Well written Anna! I particularly love the evil twins reference!

  5. […] shall let this be a reminder that “positive thinking” and effort are pretty useless without actual, tangible resources, and anyone who thinks that […]

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