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chronic pain

How We at APC Address Mental Health and Chronic Pain Together

By Robin Hendershot, LPC

You might not think that a pain care clinic pays much attention to mental health, but one of the things that I love most about working here is being part of a team that knows the importance of addressing both chronic pain and mental health together.

I’d estimate that 50%-70% of the clients here at Advanced Pain Care have some sort of combination of chronic pain and depression or anxiety symptoms. That’s a huge number.

Let’s answer some questions about how we at Advanced Pain Care address mental health and chronic pain together.

Can chronic pain come from depression or anxiety, or does it always start from physical pain?

Some patients have had a history of depression or anxiety prior to their chronic pain issues, and others have never had any history of mental health problems, but once they’re dealing with chronic pain, experience symptoms of depression such as a loss of interest or pleasure in doing things, having trouble sleeping, or having problems with relationships.

In other words, chronic pain can lead to anxiety and depression symptoms, especially if patients have had them in the past. Here’s why:

There are a whole bunch of ways people manage depression and anxiety. Some use medication, and some use coping skills on the more active side such as walking, gardening or golfing. But then, chronic pain happens.

All of a sudden, their coping skills may not be feasible. Their pain could easily trigger a depressive relapse, since they’re not able to do what helps them manage their mental health. On top of that, chronic pain can increase tension and tightness in the body, which makes sleeping more difficult, impacting mental health and mood even more.

This is one of the main reasons that we’re always trying to address the whole person as an integrated system here at Advanced Pain Care. We believe that physical health isn’t separate from emotional health, so in that sense, it’s vital that the two are worked on simultaneously.

What are some difficulties that could happen when a patient is going through both physical and mental pain?

From a therapist’s standpoint, depression or anxiety don’t necessarily make a patient’s treatment less effective, but it may make a person less likely to want to get treatment or follow-up with the treatment that would otherwise be effective.

The one thing we know about depression especially is that people who are dealing with moderate or severe depression often have an impact on their energy level and motivation. It’s easy for them to get stuck in that down, sad, depressed mood, and not feel the motivation to find help and engage in treatment.

A patient, let’s call her Sara, could be suffering from depression as well as chronic pain, and her family, friends or co-workers might know that she needs help, but if Sara doesn’t have the mental capacity to schedule a doctor’s appointment to get the initial interview done and to seek treatment, it’ll be much more difficult for her to work to solve the problem.

If she does get treatment, it’s vital that she continues to follow-up and communicate with her doctors to follow the treatment plan. People who suffer from depression need a lot of support to continue getting their follow-up care. Friends, family and the providers at Advanced Pain Care can play a vital role in encouraging patients.

What are some ways that you help patients work with their mental health struggles?

Here at Advanced Pain Care, we make sure to always ensure our patients, especially those suffering from depression or anxiety on top of their chronic pain, are taking the best care of themselves. We ask them about their medication and how effective they are. If they’re not seeing results, we encourage them to follow up and schedule visits with their prescribers to let them know what steps need to be taken.

There are certain things that I like to suggest to my patients when they’re struggling with mental health on top of their chronic pain, a big one being journaling. 

Journaling is something I’ve found is really helpful for patients, especially when they’re starting therapy or chronic pain management. Spending some time every day reflecting on how they’re feeling is a great way to check in. Especially as the repercussions of the pandemic begin to wind down, a lot of people have been living in a very depleted mental state. I suggest they journal their mood, how it felt in their body, how long it lasted, what the thoughts they were having, and anything else that came up, so they can reflect on it later. 

This building awareness is a great first step in the journey of working with mental health and chronic pain. 

I also suggest sleep, which might seem typical, but is a very common problem with people suffering from depression and anxiety.

I often ask patients about their experience with insomnia, because sleep is such a key element in mental health. When people are experiencing pain, they often tense up their muscles, which makes sleeping a lot harder. Then, when patients aren’t sleeping, they’re not able to function properly during the day. 

This last one might be dependent on their capabilities, especially if they’re feeling way too much chronic pain to move, but exercising is also a huge suggestion as far as coping with mental health and chronic pain. It’s a great tool for people when they’re seeking to relieve depression or anxiety, but if their chronic pain is too bad and this coping skill is taken away, many patients feel even more lost and down by not being able to move their bodies.

When we are starting behavioral health services with a patient, we often begin with weekly sessions.  Having regular sessions helps with rapport building, developing coping skills and forming the therapeutic bond. Since we as humans tend to have an emotional response to our pain, i.e. “I’m a bad worker for always calling out sick,” or “I’m a problem child for never being healthy,” we explore how the story we tell ourselves about pain is often a big element in our experience of having chronic pain.  

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What makes Advanced Pain Care’s treatments different?

One thing that I’ve been really impressed with working at Advanced Pain Care is having patients fill out depression and anxiety screening questionnaires during their regular doctor visits, so we can get a sense of their baseline of depression and anxiety– even if they’re not coming specifically for mental health.

If they score on a higher level for these two mental ailments, it automatically triggers the system to send a behavioral health referral to one of the counselors. This way, we can see if they’re interested in these services to see what their needs will be.

Many other pain management clinics didn’t do this, so I was really impressed when starting with Advanced Pain Care to know that we took mental health so seriously. 

Another thing I really love about working at APC is being amidst the skilled doctors and mid-levels who are very communicative with me about patient’s stressors in sessions. We can easily drop by each other’s spaces or shoot each other a quick email to stay on top of patients so we’re always in the know about action steps to best help them with their mental or physical pain. 

And last but not least, we started offering a suicide prevention questionnaire for all new patients and on a quarterly basis for current patients. I truly believe it’s a really important step for all health care providers to make the extra effort to ask patients about suicidal thoughts so anything concerning can be caught and addressed early on.

Working in a pain care clinic where we take pride in mental health is something I’ve very passionate and proud of.

For anyone who’s suffering from depression or anxiety, especially that’s stemming from their chronic pain, APC can help. Click below to find resources near you so you can get help today.

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