PAIN PAIN AND AND

DEPRESSIONDEPRESSION

Radu Vrasti, PhDRadu Vrasti, PhD

Pain and depression-old common Pain and depression-old common

experiencesexperiences

When our ancestors faced physical damageWhen our ancestors faced physical damageor failed to understand their surroundings, they or failed to understand their surroundings, they became frustrated, down, fearful, angry, guilty…became frustrated, down, fearful, angry, guilty…and learned to suffer…and learned to suffer…

Physical pain or emotional pain both usePhysical pain or emotional pain both usethe same pathway to our brain…the same pathway to our brain…

Pain and depression has the samePain and depression has the samemeaning for our mind… meaning for our mind… sufferingsuffering!!

Emotional Relationship Emotional Relationship Between Between

Pain and DepressionPain and Depression SUFFERING (FRUSTRATION)SUFFERING (FRUSTRATION)

PAINPAIN

DEPRESSIONDEPRESSION

SUFFERING (REINFORCEMENT)SUFFERING (REINFORCEMENT)

Acute painAcute pain

When pain arises ourWhen pain arises our

mind receives a ring thatmind receives a ring that

something wrong hassomething wrong has

happened in the bodyhappened in the body

Chronic painChronic pain

In cases of chronic painIn cases of chronic pain

there is a “false alarm” there is a “false alarm”

and the bell continues and the bell continues

to ring without apparentto ring without apparent

causecause

Pain: Prevalence in Pain: Prevalence in populationpopulation• 25 to 30 percent of the North-25 to 30 percent of the North-

Americans suffer from chronic painAmericans suffer from chronic pain

• 50-75% of those experiencing 50-75% of those experiencing chronic pain are partially or totally chronic pain are partially or totally disabled for a period of days (i.e. disabled for a period of days (i.e. headache) or weeks and months (i.e. headache) or weeks and months (i.e. back pain, arthritis, fibromyalgia)back pain, arthritis, fibromyalgia)

Pain: Some statisticsPain: Some statistics

• 1 in 3 Canadians suffer from some form of recurring pain1 in 3 Canadians suffer from some form of recurring pain

• 1 of every 3 families contain a person who suffer from 1 of every 3 families contain a person who suffer from chronic painchronic pain

• 4 out of 5 people have one severe headache a year4 out of 5 people have one severe headache a year

• 1 in 5 Canadians experiences migraines or other headaches1 in 5 Canadians experiences migraines or other headaches

• 1 in 7 Canadians is affected by arthritis1 in 7 Canadians is affected by arthritis

Depression: statisticsDepression: statistics

• 7.9-8.6% of adults will have major 7.9-8.6% of adults will have major depression during their lifetime in Canada; depression during their lifetime in Canada;

• 6.5% of women have a major depressive 6.5% of women have a major depressive disorder; disorder;

• 3.3% of men have a major depressive 3.3% of men have a major depressive disorder; disorder;

• lifetime incidence of major depression lifetime incidence of major depression found that 7.9% to 8.6% of adults over 18 found that 7.9% to 8.6% of adults over 18 years of age;years of age;

Pain and depression: Pain and depression: statisticsstatistics• People with chronic pain have three times People with chronic pain have three times

the average risk of developing depression; the average risk of developing depression; • People with depression have three times People with depression have three times

likelihood developing chronic pain;likelihood developing chronic pain;• 75% of patients with clinical depression 75% of patients with clinical depression

present to their doctors because of present to their doctors because of physical symptoms including pain;physical symptoms including pain;

• 40-60% of patients being treated at pain 40-60% of patients being treated at pain clinics report experiencing symptoms of clinics report experiencing symptoms of depression.depression.

Pain and depression: Pain and depression: brain chemistrybrain chemistry

The sameThe same neurotransmitters neurotransmitters (serotonin (serotonin and norepinephrine) and the same and norepinephrine) and the same neural pathways and brain centersneural pathways and brain centers (limbic area) are involved in the (limbic area) are involved in the regulation of mood (depression) and regulation of mood (depression) and pain.pain.

Pain vocabularyPain vocabulary

• throbbing, flashing, shooting, sharp, dull ache, hurt, sore, intense, throbbing, flashing, shooting, sharp, dull ache, hurt, sore, intense, flickering, quivering,flickering, quivering,

• pulsing, beating, pounding, jumping, pricking, boring, drilling, stabbing, pulsing, beating, pounding, jumping, pricking, boring, drilling, stabbing, lacerating, cutting, pinching,lacerating, cutting, pinching,

• pressing, gnawing, cramping, tugging, pulling, wrenching, hot, burning, pressing, gnawing, cramping, tugging, pulling, wrenching, hot, burning, scalding, searing, tingling, itchy,scalding, searing, tingling, itchy,

• smarting, heavy, tender, taut, rasping, splitting, tiring, exhausting, smarting, heavy, tender, taut, rasping, splitting, tiring, exhausting, sickening, suffocating, fearful, frightful,sickening, suffocating, fearful, frightful,

• terrifying, punishing, grueling, cruel, vicious, killing, wretched, blinding, terrifying, punishing, grueling, cruel, vicious, killing, wretched, blinding, annoying, troublesome,annoying, troublesome,

• miserable, intense, unbearable, spreading, radiating, penetrating, piercing, miserable, intense, unbearable, spreading, radiating, penetrating, piercing, tight, numb, drawing,tight, numb, drawing,

• squeezing, tearing, cool, cold, freezing, nagging, nauseating, agonizing, squeezing, tearing, cool, cold, freezing, nagging, nauseating, agonizing, dreadful, torturing, continuous,dreadful, torturing, continuous,

• steady, constant, rhythmic, periodic, intermittent, brief, momentary, steady, constant, rhythmic, periodic, intermittent, brief, momentary, transient, mild, discomforting,transient, mild, discomforting,

• distressingdistressing((Wendy Duggleby, The Language of PainWendy Duggleby, The Language of Pain))

Characteristics of Characteristics of chronic painchronic pain

• Medications taken excessively or Medications taken excessively or inappropriately;inappropriately;

• Inappropriate patterns of accessing the Inappropriate patterns of accessing the medical system;medical system;

• Physical inactivity and weakness;Physical inactivity and weakness;• Depression and other emotional problems;Depression and other emotional problems;• Lack of coping skills to deal with pain and Lack of coping skills to deal with pain and

disability;disability;• Family, work, and community problems Family, work, and community problems

associated with pain.associated with pain.

Characteristics of Characteristics of chronic depressionchronic depression

• Feelings of worthlessness, self-reproach, or Feelings of worthlessness, self-reproach, or excessive or inappropriate guiltexcessive or inappropriate guilt

• Loss of interest of pleasure in usual activities, or Loss of interest of pleasure in usual activities, or decreased sex drivedecreased sex drive

• Complaints or evidence of diminished ability to Complaints or evidence of diminished ability to think or concentratethink or concentrate

• Poor appetite or significant weight loss or weight Poor appetite or significant weight loss or weight gain gain

• Insomnia or hypersomnia Insomnia or hypersomnia • Psychomotor agitation or retardation Psychomotor agitation or retardation

• Loss of energy or fatigue Loss of energy or fatigue • Recurrent thoughts of deathRecurrent thoughts of death

Type of PainType of Pain

• Back pain, neck painBack pain, neck pain 13.9 (%)13.9 (%)

• Joint painJoint pain 13.813.8

• HeadacheHeadache 13.313.3

• Muscle painMuscle pain 9.99.9

• Stomach painStomach pain 4.04.0

• Premenstrual painPremenstrual pain 3.73.7

• Dental painDental pain 1.91.9

• OtherOther 2.02.0

Mental Factors Involved in Mental Factors Involved in PainPain

• ConsciousnessConsciousness

• Focus of attentionFocus of attention

• MemoriesMemories

• ExpectationsExpectations

• Your mental attitudes and Your mental attitudes and beliefsbeliefs

Three ways of Three ways of conceptualizing pain:conceptualizing pain:

•Pain as a teacher or reminderPain as a teacher or reminder

•Pain as an opponentPain as an opponent

•Pain as a survivable eventPain as a survivable event

Ways to Close the Gate of Ways to Close the Gate of PainPain 1.1. Physical self-managementPhysical self-management - Application of heat or cold- Application of heat or cold - Massage- Massage - Exercise, - Exercise, 2.2. Emotional self-managementEmotional self-management - Keeping emotionally stable - Keeping emotionally stable - Managing tension- Managing tension - Experiencing positive emotions- Experiencing positive emotions3.3. Mental self-managementMental self-management - Distracting your attention away - Distracting your attention away - Increasing your involvement in life activities - Increasing your involvement in life activities - Having positive attitudes toward yourself, others, and the future- Having positive attitudes toward yourself, others, and the future4. Actions4. Actions - Maintaining an appropriate level of physical activity- Maintaining an appropriate level of physical activity - Striking a good balance between work, recreational, and social - Striking a good balance between work, recreational, and social

activityactivity - Maintaining good physical health- Maintaining good physical health

12 Steps to Manage Pain12 Steps to Manage Pain 1. Accept the fact of having chronic pain. 1. Accept the fact of having chronic pain. 2. Set specific goals for work, hobbies, and social activities toward which 2. Set specific goals for work, hobbies, and social activities toward which

you will work. you will work. 3. Let yourself get angry at your pain if it seems to be getting the best of 3. Let yourself get angry at your pain if it seems to be getting the best of

you. you. 4. Take your analgesics on a strict time schedule, and then taper off until 4. Take your analgesics on a strict time schedule, and then taper off until

you are no longer taking any. you are no longer taking any. 5. Get in the best physical shape possible, and keep fit. 5. Get in the best physical shape possible, and keep fit. 6. Learn how to relax, and practice relaxation techniques regularly. 6. Learn how to relax, and practice relaxation techniques regularly. 7. Keep yourself busy. 7. Keep yourself busy. 8. Pace your activities. 8. Pace your activities. 9. Have your family and friends support only your healthy behavior, not 9. Have your family and friends support only your healthy behavior, not

your invalidism. your invalidism. 10. Be open and accessible with your doctor. 10. Be open and accessible with your doctor. 11. Practice effective empathy with others having pain problems. 11. Practice effective empathy with others having pain problems. 12. Remain hopeful. 12. Remain hopeful.

Difficult MomentsDifficult Moments

There are many reasons to hold on to a feeling of There are many reasons to hold on to a feeling of hope:hope:

• Your current mental state is natural but Your current mental state is natural but temporary; temporary;

• There are many reasons to remain There are many reasons to remain hopeful; hopeful;

• You'll help yourself if you get up and You'll help yourself if you get up and change what you are doing to something change what you are doing to something different.different.

Benefits of ExerciseBenefits of Exercise

• More muscle strength More muscle strength • Less body fat Less body fat • More energy More energy • Better breathing Better breathing • Less joint pain Less joint pain • More flexibility More flexibility • Less depression Less depression • Better memory Better memory • Increased reasoning Increased reasoning • Increased self-confidence Increased self-confidence • Better sleep Better sleep • Less chance of heart attackLess chance of heart attack

Good NutritionGood Nutrition

• Eat a variety of foods. Eat a variety of foods.

• Maintain an optimum weight. Maintain an optimum weight.

• Avoid excessive fat and cholesterol. Avoid excessive fat and cholesterol.

• Avoid excessive sugar. Avoid excessive sugar.

• Eat foods with adequate starch and fiber. Eat foods with adequate starch and fiber.

• Avoid excessive salt or sodium. Avoid excessive salt or sodium.

• Limit alcohol consumption. Limit alcohol consumption.

More WaterMore Water• Drinking adequate water is crucial to the Drinking adequate water is crucial to the

proper functioning of the body;proper functioning of the body; • The human body is about 60% water, the brain is 75% The human body is about 60% water, the brain is 75%

water, and the blood is 85% water;water, and the blood is 85% water; • Dehydration can contribute to pain and disability;Dehydration can contribute to pain and disability; • Dehydration is a particular problem in older people, who Dehydration is a particular problem in older people, who

generally need more water than younger people;generally need more water than younger people; • Bottled or filtered water, fruit juices, and decaffeinated Bottled or filtered water, fruit juices, and decaffeinated

teas are good sources, as are fruits and vegetables teas are good sources, as are fruits and vegetables which are 75 to 85% water;which are 75 to 85% water;

• For optimum health, sip water frequently throughout the For optimum health, sip water frequently throughout the day, perhaps keeping a small bottle or glass handy in day, perhaps keeping a small bottle or glass handy in areas of the home where you spend the most time, areas of the home where you spend the most time, rather than trying to gulp whole glasses at a time.rather than trying to gulp whole glasses at a time.

Setting GoalsSetting Goals

Goals should be:Goals should be:

• Concrete and specific Concrete and specific

• RealisticRealistic

• AchievableAchievable