#58 The profound effects of long term chronic pain.

Mental health and Chronic pain are both topics that are little talked about. They seem to be brushed under the carpet, people seem to be almost ashamed to admit it might affect them, let alone seek help for it. But what exactly does chronic pain do to you, physically and emotionally?

The pain monster

When you live with chronic pain, it is all that you can think about. From morning, to night, it is there. You cannot escape it. Whether you think it or not, if affects your every being. Whether you are smiling or frowning, you wear this pain on the outside like an invisible mask. This mask might not necessarily be noticeable while you are wearing it, but the moment you put it down for a second, its absence becomes VERY noticeable to almost everyone around you.

You begin to look inwards instead of outwards. All your energy goes into just surviving the day. Once you have managed that, you then focus on surviving the night. Sometimes this can be much more emotionally traumatic than day time hours.

Pain never leaves you alone. not for a second. It eats away at you.. wipes your cheerful smiles away slowly one by one. Once they are all gone, it begins to eat away at your thought processes, memory and even your ability to perform basic tasks. Once that’s all done, it starts on your nearest and dearest. Leave pain too long and it will leave you in total isolation, both physically and mentally.

I almost see it as a form of cancer, quietly gnawing away in the background, with devastating long term effects if left untreated.

 A review of recent literature examining the neurobiology and pathophysiology of chronic pain reveals that this highly prevalent condition negatively impacts multiple aspects of patient health, including sleep, cognitive processes and brain function, mood/mental health, cardiovascular health, sexual function, and overall quality of life. 

P Fine, Pain Medicine, Pub 2011

How to break the cycle

Recognising the signs of pain related depression

• Depressed mood for most of the day, nearly every day
• Poor appetite or significant weight loss or increased appetite or weight gain
• Loss of interest or pleasure in usual activities
• Disrupted sleep: too much or too little
• Agitation or restlessness
• Low energy or fatigue
• Feelings of worthlessness and/or guilt
• Lessened ability to think, concentrate, or make decisions
• Frequent thoughts of death, suicide, or wishing to be dead

If you think about it, it makes sense that depression might occur in people with chronic pain. Pain can make it difficult to sleep, causing fatigue and daytime irritability. Limited physical activity can result in fewer social events, more isolation, and the loss of pleasurable activities. There may be financial problems. Pain medications can cause fatigue or mental dullness. Pain can be distracting, cause memory loss, and increase difficulty doing normal activities, especially work. Interest in sex may decrease leading to stress or unhappiness in an important relationship.

Pain also affects the family as roles and responsibilities may change. Pain may limit someone from doing household chores, participating in family activities, or caring for children. Domestic partners and children often take on responsibilities that were once performed by the person with pain. These adjustments can cause stress and strain in family relationships.

pain and depression are closely correlated from the perspectives of both brain regions and the neurological function system

Jiyao Sheng, Shui Liu, Yicun Wang, Ranji Cui, Xuewen Zhang, “The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain”, Neural Plasticity, vol. 2017

What can you do about it?

• Talk to health care providers early in treatment if there are symptoms or a history of depression. The more the provider knows about the patient, the better he/she can care for the patient.
• Advise your health care provider if any of these common symptoms of depression occur:
  1. Changes in sleep patterns,
  2. Changes in appetite
  3. Feelings of anxiety or stress.
• Both pain and depression can become worse without enough physical activity. Participating in an appropriate exercise plan can lessen or prevent symptoms
• Identify and avoid stresses that can increase pain and depression
• Obtain health care from a physician and a mental health professional.
• Pain-related depression is common. It can result in more problems and a worsening of pain symptoms. Many negative consequences result from not managing the depression that may come with pain. Aggressive treatment of depression can improve the outcome of pain treatment and reduce pain-related disability.

Conclusion

That pain monster won’t rest till it has destroyed everything and everyone. Don’t let it. Life is too short to be miserable. Life is too short to waste valuable time NOT doing things that make you happy.

The only person that can change things is YOU.