Pain serves an important function in our lives. When you suffer an acute injury, pain warns you to stop the activity that is causing the injury and tells you to take care of the affected body part. Chronic pain, on the other hand, persists for weeks, or even years. Some people, often older adults, suffer from chronic pain without any definable past injury or signs of body damage. Common chronic pain can be caused by headaches, the low back, and arthritis. Unfortunately, there is scant objective evidence or physical findings to explain such pain.
Psychological and social issues often amplify the effects of chronic pain. For example, people with chronic pain frequently report a wide range of limitations in family and social roles, such as the inability to perform household or workplace chores, take care of children, or engage in leisure activities. In turn, spouses, children, and co-workers often have to take over these responsibilities. Such changes often lead to depression, agitation, resentment, and anger for the pain sufferer. Family and other social relationships are effected by the strains.
Depression is the most common emotion associated with chronic pain. It is thought to be 3 to 4 times more common in people with chronic pain than in the general population. In addition, 30 to 80% of people with chronic pain will have some type of depression. The combination of chronic pain and depression is often associated with greater disability than either depression or chronic pain alone.
People with chronic pain and depression suffer dramatic changes in their physical, mental, and social well-being and in their quality of life. Such people often find it difficult to sleep, are easily agitated, cannot perform their normal activities, cannot concentrate, and are often unable to perform their duties at work. This constellation of disabilities starts a vicious cycle. Pain leads to more depression, which leads to more chronic pain. In some cases, the depression occurs before the pain.
Until recently, we believed that bed rest after an injury was important for recovery. This has likely resulted in many chronic pain syndromes. Avoiding performing activities that a person believes will cause pain only makes his or her condition worse in many cases. Depression associated with pain is powerful enough to have a substantial negative impact on the outcome of the treatment, including surgery. It is important doctors to take into consideration not only biological, but also psychological and social issues that pain brings.
The first step in coping with chronic pain is to determine its cause, if possible. Addressing the problem will help the pain subside. In other cases, especially when the pain is chronic, you should try to keep the chronic pain from being the entire focus of your life. Some of the techniques to help alleviate chronic depression may include staying active, relaxation training, cognitive therapy, distraction, and involving your family in your recovery process.
Some of the common signs and symptoms of chronic pain may include:
- Pain beyond six months after an injury
- Pain from stimuli should not normally be painful
- Exuberant pain from stimuli that should be moderately painful
- Being overly sensitive to pain
Signs of major clinical depression will occur daily for 2 weeks or more, and often include many of the following:
- A predominant feeling of sadness, feeling blue, hopeless, or irritable.
- Changes in appetite or weight loss, or weight gain.
- Poor concentration or memory
- Feeling restless or fatigued
- Loss of interest or pleasure in usual activities
- Feeling of worthlessness and/or guilt.