Chronic Pain and Comorbid Depression Treatment

Overview

Chronic pain and depression can be difficult to distinguish from one another. Chronic pain can often cause depression, as constant pain can lead to emotional instability, sadness and anxiety. Depression tends to have physical symptoms as well as emotional symptoms, including aches, pains and fatigue. According to Harvard Medical School, people with one condition are three times as likely to develop the other.

Diagnosing Chronic Pain and Co-morbid Depression

According to the Johns Hopkins Arthritis Center, depression should not only be considered as a comorbid chronic pain condition, but also as one that interacts and influences depression. Diagnosing the two diseases can be difficult because many of the symptoms overlap. These include fatigue, insomnia and musculoskeletal aches and pains. According to Harvard Medical School, the two conditions may also be influenced by similar brain pathways, making distinguishing the two that much harder. Because of this, most pain specialty practices treat the two diagnoses together.

Pain Medications

Sometimes, treating the symptoms of one disease will help the other. Harvard Medical School reports that many pain physicians first prescribe what are termed standard analgesics: NSAIDs (such as ibuprofen and naproxen), acetaminophen or even opioids in cases of severe pain. While they do not directly treat depression, standard analgesics can help get pain to a manageable level, which can decrease the psychological burden on the person with chronic pain. They may be used alone, though more often standard analgesics are combined with other psychological treatments.

Antidepressants

Antidepressants (often tricyclic antidepressants) are effective not only at reducing the psychological symptoms of depression, but its physical symptoms as well. Similar receptors in the brain control both mood and pain perception, and it is thought that tricyclic antidepressants can ease both. Because of this, antidepressants can be useful in treating chronic pain and comorbid depression. The Johns Hopkins Arthritis Center reports that tricyclic antidepressants have consistently relieved pain and depression better than placebos. While other classes of antidepressants may also be used to treat the two diseases, the results have not been as consistent.

Other Psychiatric Medications

Harvard Medical School reports that almost any drug used for psychiatric conditions can relieve pain, not just antidepressants. These include anticonvulsants (seizure medications) and mood stabilizers. The idea behind using these other types of psychiatric medications is that treating anxiety and fatigue associated with depression and chronic pain can relieve both mood and pain symptoms. Some studies even show that electroconvulsive therapy (ECT) can help regulate both depression and pain, though this approach is not used as often as medications.

Other Approaches

Medications are not the only approach to treating chronic pain and comorbid depression. Some other treatments often performed in pain specialty clinics include progressive muscle relaxation, hypnosis and guided imagery, meditation and cognitive behavioral therapy. Teaching clients to relax and to take control of their pain can often relieve the symptoms of both conditions. Physical therapy has also been shown to be effective, according to Harvard Medical School, as it can help to break the cycle of pain caused by immobility.