For more than 20 years, Tom Norris has moderated several American Chronic Pain Association support groups in the Los Angeles area. The members have become a second family for him; meetings often start with tears but end with laughter. Everyone in his 12-person group lives with both chronic pain and depression.
“People are having a hard time dealing with their pain and depression, but everyone tries to help each other,” he says. “We’re willing to express ourselves during the support group and stand next to each other to help one another get through the tough times.”
Norris, a retired lieutenant colonel from the Air Force, understands the personal battle of fighting depression as well as chronic pain. He developed severe pain from an overdose of radiation therapy to battle testicular cancer when he was 35 years old. The pain started in his left hip and traveled through his groin and up his spine. Norris continued with the Air Force, but the pain became unbearable and limited his ability to work. After 23 years of military service, he was medically retired at age 41.
“Upon my retirement, that’s when the depression really started, and I didn’t feel like I was worth anything,” he says. To treat his pain, his doctor prescribed an opioid medication. Even though the opioid blocked the pain, he felt like his entire body was covered in a thick blanket. Norris also hated the detoxes when the doctor didn’t write a refill in a timely manner or the pharmacist didn’t fill the prescription right away. His doctor also recognized his symptoms of depression and prescribed Prozac and Xanax.
Norris’ story is not uncommon. Millions of people living with chronic pain also suffer from depression. Depression is one of the most common psychological issues people with chronic pain face. Of the more than 100 million people living with chronic pain, about one-third also have major depression, according to researchers.
Depression can negatively affect a person’s life at home and in the workplace, as well as relationships with loved ones, friends, and colleagues. People living with depression experience profound sadness, guilt, and loss of energy and interest in activities.
“For people with chronic pain, the depression could be a result of a neurological condition but could be the result of an injury,” says psychologist Julia Kim, Ph.D., with the Hospital for Special Surgery in New York.
She adds that people whose pain limits their independence are especially likely to get depressed. “Because depression in patients with chronic pain frequently goes undiagnosed, it often goes untreated,” she says.
That’s why it’s important to tell your doctor about any signs of depression so he or she can involve a therapist or mental-health professional. With a team approach, both the pain and depression can be addressed together, and your doctors can develop an appropriate treatment plan.
“Pain and depression shouldn’t be a life sentence,” says pain specialist Gary Kaplan, D.O., founder and medical director of the Kaplan Center for Integrative Medicine in McLean, Virginia, and author of Total Recovery: Breaking the Cycle of Chronic Pain and Depression (Rodale, 2015). “Chronic pain should be assessed from a psychological perspective.”
Breaking the cycle
Sue Ellen Johnson, who lives near Sacramento, California, developed an anxiety disorder and depression following a boating accident. Without warning, the boat that her husband was sailing stopped, and she slammed her jaw against a counter, leading to severe jaw pain and frequent migraines.
“I got to a very dark place,” she says. “Unfortunately, I think it happens to a lot of people with chronic pain.”
For 13 years, Johnson’s pain management doctor prescribed opioids. She developed opioid-induced hyperalgesia, in which patients taking opioids become more sensitive to pain over time. A retired nurse, Johnson was living with increasing pain and falling deeper into depression.
Finally, her primary care physician intervened and referred her to a psychologist. He advised her to stop taking the pain medications. She soon visited Stanford University Medical Center’s Pain Management Center in Redwood City, California, where she met pain psychologist Ravi Prasad, Ph.D., and psychologist Heather Poupore-King, Ph.D.
Johnson was admitted into a weeklong program to manage her physical and psychological dependence on opioids. The program was not easy. “It was six long days for me,” she says. “Withdrawing from the opioids was very difficult. I never understood the power those medicines had over me because I was in denial and trying to do the best I could.”
At the center, a team of physicians, nurses, physical and psychological therapists, and other staff fashioned an individualized treatment plan for her. “We explore all the options through the help of a multi-disciplinary team,” says Prasad.
Of the patients he sees, Prasad estimates that about three-quarters are living with chronic pain and depression. He adds that some patients never had depression until their pain started, while others had depression that became worse when they developed pain. “The reality is whether the pain or depression comes first, the treatment pathway is still the same because it’s all about treating the underlying condition,” he says.
One of the harsh realities of chronic pain is that sometimes there is no cure. That’s difficult to accept in an age in which medicine can battle so many conditions. Then the goal becomes changing chronic pain from incapacitating to manageable.
While medication plays an important role in managing certain symptoms, several other approaches can help get patients back on track and reemerge from their pain and depression. They include meditation, exercise, stress management, and acupuncture.
– Mind over body: Meditation has been proven to help manage anxiety, depression, and pain, according to a review of 47 studies published in 2014. The effects may be modest, but they have been shown consistently, researchers say.
Johnson learned about meditation and deep-breathing exercises through Stanford’s Pain Management Center. “In the three years since Stanford, I have made a big shift in my thinking,” she says.
While she receives Botox shots for migraines and takes an anti-depressant to regulate her mood, she also practices daily mindfulness exercises, takes walks, gets regular therapeutic massages, and spends more time with friends and family. Importantly, Johnson knows when she needs to reach out to her doctor at Stanford and when she needs to take medication for her migraines and over-the-counter pain relievers for general pain. “I try to take the smallest dose of any medication.”
Johnson most enjoys spending time with her grandkids. “They are such a source of joy and such wonderful reminders of how to be present in each moment of living, regardless of what else is going on in the world.”
– Get moving: Psychologist Julia Kim is a big proponent of exercise because it provides a sense of empowerment and gives patients control. Physical therapists or rehab specialists are often available to people living with chronic pain and depression to help get them interested in exercise.
For example, Johnson really enjoys taking daily walks in a nearby park by a river while listening to music.
– Stress blockers: Most people underestimate the effects of stress in their life, but this tendency is even more pronounced in people living with chronic pain and depression, says Kim. “Stress heightens the experience of pain as muscle tension presses on the body’s nerves and makes the pain increase,” she says. “You add that to someone who already has pain and depression, and it makes it much worse.” That’s why Kim recommends adopting relaxation techniques to better manage stressful times.
– Relief with acupuncture: More people are using acupuncture not only to treat pain but also depression. More studies support the effectiveness of the traditional Chinese practice. Acupuncture involves placing fine needles with heat and pressure to certain spots on the skin to activate the body’s own self-healing mechanisms. It is thought to work by blocking pain messages to the brain through the release of endorphins — the body’s natural painkillers.
Trained as a medical acupuncturist, Kaplan uses acupuncture to treat his patients holistically on physiological, neurological, and psychological levels. In his book, he recalls learning about acupuncture early in his medical career from one of the pioneers in the field, Hector Prestera, M.D. “I observed him treat hundreds of patients and saw for myself how powerful and successful acupuncture therapy could be for a multitude of medical conditions.”
Kaplan later worked with the National Institutes of Health to establish acupuncture as a medically effective treatment for a range of chronic pain problems.
From magnets and electricity to medications and faith healing, Norris has tried many ways to resolve his pain. These days, epidural shots help control his pain and Prozac keeps his mood stable. But he credits volunteer work with his church and the support groups with helping him stay positive. It’s rewarding, he says, to see many group members evolve and grow.
Norris highly recommends that anyone living with chronic pain find a support group. The American Chronic Pain Association offers support groups throughout the country. You can find one by searching by state at https://theacpa.org/Support-Groups.
“Find a support group and get involved,” Norris says. “It will lift your spirits in ways you never expected.”
Three books that tackle the topic of pain and depression:
– Total Recovery: Breaking the Cycle of Chronic Pain and Depression, by Gary Kaplan, D.O., Rodale, 2015, $16.99. Kaplan describes how to break the cycle of pain and depression, drawing on his years of practicing integrative medicine at Georgetown University.
– Staying Sane with Chronic Pain, by Niall Finn, Amazon e-book, 2013, $3.49. The author lives with chronic pain and offers practical advice on how to cope with pain, anxiety, and depression.
– The Mindfulness Toolbox: 50 Practical Tips, Tools & Handouts for Anxiety, Depression, Stress & Pain, by Donald Altman, PESI Publishing, 2014, $29.99. This book highlights mindfulness exercises to address anxiety, depression, stress, and pain.