Chronic Pain, Depression, and Quality of Life:

Have you recently sustained an injury or been diagnosed with a medical condition? Are you a victim in an accident or surgery gone wrong which has left you with physical difficulties or pain? Have you been enduring a disease or illness for a while now such as migraines, arthritis or multiple sclerosis? More people are coping with some type of physical issue or medical condition than you could ever imagine.  

In fact, it’s hard to believe that chronic pain affects more people than cancer, diabetes, and heart diseases combined. According to The Institute of Medicine, it’s estimated that chronic pain costs the nation as much as $635 billion a year in medical treatments and loss of productivity and affects more than 100 million people in the United States. WOW!

Chronic pain is a beast of its own kind. It can be devastating and demoralizing and a real challenge to manage and treat. As a mental health counselor, I have seen this beast ruin lives, break down families, and tear apart relationships. I have seen the most successful engineers, corporate leaders, high school students, doctors, athletes and mothers fall to their knees in desperation for help and relief.

Pain sufferers, unfortunately, are often misdiagnosed and improperly cared for. They are misunderstood and miserable. Friends become tired and annoyed with hearing complaints. Sufferers cannot engage in the events and activities they once enjoyed and identities become drastically altered.

Pain sufferers tend to give up hope and it’s no surprise considering doctors get frustrated with chronic pain patients and particularly with the inability to provide a cure. By the time I see a client who suffers with chronic pain they are hopeless and desperate, isolated and demoralized, believing their life is meaningless.

When clients come to me after suffering with chronic pain for years, they are typically heavily medicated with useless drugs. Sadly, most are unaware that the drugs make things worse; certain medications worsen pain, affect judgment, and drastically alter one’s mind and mood. But, being improperly or over medicated is unacceptably understandable, as most doctors simply do not know how else to help pain sufferers expect to prescribe benzodiazepines, opiates and other types medications.

Thankfully there is good news, chronic pain is manageable and treatable with the correct combination of approaches. Unlike the traditional model of medication and rest, there are eclectic methods which work with chronic pain clients and enable sufferers to build resilience, lower pain, rebuild themselves, and achieve a better quality of life.

With a combination of physical therapy, counseling, and the correct medications, clients are able to play with their kids again, generate income, go to social events, take a walk around the neighborhood, and/or cook a good meal. They regain their desire to get out of bed in the morning and life regains meaning and purpose.

So what gives? How does chronic pain become such a beast to begin with? What is chronic pain? Typically, when people sustain an injury or illness they feel “acute pain”. This acute pain is a protective response to allow you to know that something is wrong so you can address the injury or illness and tend to it in order to help yourself heal. Also, pain signals you to avoid any stimuli that could cause further injury or illness. When pain lasts longer than the time it takes to heal or longer than 3 months, it is called chronic pain.

I’ve had the fortune of learning from Dr. Michael Clark, a psychiatrist who specializes in chronic pain and the director of the chronic pain treatment program at Johns Hopkins Hospital. According to Clark, who does a wonderful job explaining chronic pain, the nervous systems’ reaction to pain becomes distorted, subsequently even the slightest touch can be perceived as painful. In essence, our bodies’ natural pain sensors and blockers malfunction and reestablishing correct functioning is necessary in order to decrease the pain. Though this seems daunting, it is very possible.

People often fail to discuss the most important partner in crime to chronic pain and that is depression. Depression is frequently experienced by those who suffer from chronic pain; it seems as if you cannot have one without the other. Sleep disruption, anxiety, chronic fatigue, mood instability, and appetite disturbance are co-occurring issues. And as a result, quality of life for pain sufferers are reported to be the lowest among people who endure chronic illnesses such as chronic pain. According to Dr. Clark, “approximately one-third to three-quarters of people with chronic pain experience moderate to severe depression”.

When clients experience depression, it exacerbates their chronic pain, and in-turn the pain worsens the depression; this leads us into the cycle of pain and depression. The two systems, mood regulation and pain reception, overlap and share some of the same nerve pathways and neurotransmitters. This has been evident in clients who begin antidepressants and experience a significant increase in quality of life and lessoning of pain and depression, which is ultimately the goal. Not to say this is an effective approach for everyone, but it exemplifies that if we effectively interrupt the cycle, those who endure chronic pain and depression can increase their quality of life and overall well-being. If we manage the depression, many clients simultaneously feel a reduction in their pain levels.

Multidisciplinary approaches to chronic pain and depression are the way to go. Physicians, physical therapists, counselors/psychotherapists, and support groups can lead to a better quality of life for those enduring depression and chronic pain. Incorporating purpose and meaning in life also helps in establishing resiliency, an overall better sense of well-being, and is an effective manner in which to cope with chronic pain.

Working as a research assistant and consultant at Johns Hopkins University, working at Broward Health, from personal experience and from those of my clients, these are the findings I’ve witnessed first hand and from research. When chronic pain is addressed from a holistic approach, correct medications are implemented, and when focus is on harmonizing body and mind, chronic pain and depression decrease and well-being and happiness increase. Learning different coping mechanisms, finding purpose and meaning and engaging in life, and learning to live more mindfully, greatly lessen chronic pain and depression. Life becomes more than just tolerable, it becomes enjoyable. Though it takes work, it’s possible to cope and ultimately worth the better quality of life and happiness. 

Written by: Katie Sandler