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It’s Not Just in Your Head

Chronic pain generally refers to persistent, non-acute, sometimes disabling pain in the spine, extremities, or other areas of the body. This pain can be associated with a known cause such as an injury, or it can be a symptom of other chronic painful conditions like as fibromyalgia or migraine headaches. Naturally, a person experiencing persistent pain may begin to struggle with depression and various other mental health conditions. It is estimated that about 35% of the American population has some degree of chronic pain, and up to 50 million Americans have some form of disability due to chronic pain.

Many individuals suffering from chronic pain may also have mental health disorders like depression or anxiety that can significantly impact the underlying chronic pain condition. The convergence of depression and pain is reflected in the pathways of the central nervous system. These pathways (which control the transmission of pain signals to the brain), use some of the same neurotransmitters involved in the regulation of mood and emotion such as serotonin and norepinephrine. When the regulation of mood and emotion fails, the existing pain is often intensified, along with feelings of sadness, hopelessness, and anxiety. Like depression, chronic pain can alter the optimum functioning of the nervous system and perpetuate itself.

A classic example of overlapping depression and pain is seen in fibromyalgia, a condition marked by widespread muscle pain and tenderness at certain pressure points with no evidence of tissue damage. Because there may be no physical explanation for the pain they are experiencing, fibromyalgia patients are typically frustrated, discouraged and depressed. Fibromyalgia is more closely associated with depression than most other medical conditions. Functional MRI studies of people with this condition show heightened pain processing in cortical and subcortical regions of the brain, leading to the hypothesis that this condition could be caused by a brain malfunction that compounds sensitivity to both physical discomfort AND mood changes.

There are strong links between anxiety and chronic pain conditions, with some studies showing that nearly 45% of chronic pain sufferers reported having symptoms of at least one or more of the common anxiety disorders. Chronic pain can inevitably cause mental distress and without treatment, keep a person from being able take the necessary actions to return to a normal, productive and desired lifestyle. Numerous guidelines on evaluating and managing chronic pain conditions, like lower back pain, recommend clinicians assess patients for psychological factors that may contribute to a poorer prognosis and address them with appropriate treatments. Because chronic pain and mental health can be cyclical, it is imperative for patients to feel that their healthcare providers listen, understand, and support them in their healing process. It is also important for care-givers to advocate for psychological treatment plans that correlate with the physical treatment plan for chronic pain sufferers.

Advanced Pain Care offers a comprehensive, multidisciplinary approach to treating chronic pain disorders and their associated psychological conditions. Our providers recognize the strong overlap between mental health and how it affects one’s pain symptoms. Each patient is screened to identify risk factors for depression and anxiety and treated accordingly. Sometimes antidepressants that work on neurotransmitters like serotonin and norepinephrine are more beneficial than traditional painkillers in treating certain pain conditions. Furthermore, Advanced Pain Care’s ancillary services like cognitive behavioral therapy may help patients cope with depression and anxiety while medical doctors treat the ongoing pain. Functional Restoration, a program available through Advanced Pain Care, is a concept specifically designed to help workers compensation patients return to day-to-day activities. This program utilizes physical therapy, neuromuscular re-education, and, equally as important, treatment of psychological distress to help patients get back to a functioning lifestyle. With the support structure in place to build a patient’s confidence, many of the psychological barriers that accompany chronic pain can be eliminated resulting in a whole new life both physically and mentally.