Mental Health & Chronic Pain
Today is World Mental Health Day. It is the perfect time to talk about how having chronic pain can affect every aspect of your life, including mental health. Most times, physicians and patients are so focused on alleviating physical issues that they miss the need to address the psychological effects of chronic pain.
“[In one] study, 77% of people who suffered from chronic pain reported feeling depressed. Over 85% of chronic pain patients said that they had difficulty sleeping.”
Ignoring how chronic pain affects your patients mentally is a mistake. And, if a physician ignores the mental and emotional status of patients too long, and the patient is suffering from the added psychological effects of extended pain, the cycle becomes even more defeating for the individual. This stress can then exacerbate the aspects of the physical pain, making the chronic pain even more difficult to treat an/or manage.
What are the potential symptoms?
Depression
If you can’t sleep, socialize or work, it is natural you would feel depressed. And, some people who endure chronic pain can also experience major depressive disorder: symptoms, include persistent feelings of sadness and loss, including a loss of interest, inability to concentrate, sleep disturbances, appetite changes, self-isolation, low self-worth, and more.
Long-term chronic pain can trigger a depressive episode. And, when chronic pain is involved, this can be true for individuals who have never experienced of been diagnosed with depression before. Add in insomnia that can be caused by chronic pain, it can wreak havoc on patient mood, prompting a patient to frequently nap, instead of engaging with others. Pain issues can also cause chronic pain patients to withdraw from activities, isolating themselves from loved ones. Depression is quite common among individuals suffering from chronic pain.
Insomnia
Insomnia is a separate diagnosis in its own right. And, while a symptom of many mental and physical disorders, when chronic pain is involved, it is different. You need quality sleep to function. A patient in constant pain cannot experience this. And, in today’s hectic world, while getting a good night’s sleep is sometimes inconvenient and difficult, adults still require seven to nine hours of sleep.
Chronic pain makes sleeping difficult, sometimes impossible. This can be due in part to the pain as much as it can be a part of possible medication side effects needed to cope with the pain. Insomnia adversely impacts every aspect of life: concentration, digestion, memory, fitness, relationships, etc. What is worse is insomnia can exacerbate any psychological disorders, like depression or anxiety.
Anxiety
When you have chronic pain and you worry, most of those worries are tied to the chronic pain. You worry about why you’re in pain, how long the pain will last and how bad it will get. You go over-and-over in your head about how you’ll pay your bills, when you’ll see your doctor, if you’ll keep your job. And that pain, and these worries, keep you up at night. You find yourself obsessing over all the what-if scenarios. You become fearful, wondering if you will ever sleep. This makes the pain worse. Then you worry about whether or not the pain will ever go away, or if it is a symptom of some other illness.
Patients sometimes then second guess themselves, wondering if they are overreacting, or if the pain they are experiencing is psychosomatic. At this point, the chronic pain causes increased anxiety and even panic attacks.
Fatigue
Fatigue is not just being tired. Feeling tired can be fixed by resting. Being fatigued isn’t resolved by resting. If anything, resting might actually make the fatigue worse. Just walking around the block feels like you ran a marathon. And our patients are so focused on appearing “normal” that they mentally exhaust themselves.
“Studies indicate that arthritis can physically increase fatigue; the body [then] fights the inflammation by releasing chemicals, which can in turn cause fatigue.”
Guilt
Everyday events can elicit feelings of guilt, such as being unable to play with your child, or work for more than a few hours a day, if that. And, while not considered a mental health disorder in itself, these feelings of guilt can be overwhelming.
A patient’s chronic pain can prevent them from participating in activities that most people take for granted — socializing, working, exercising. Patients can feel angry at themselves, or blame themselves for no longer being able to engage with the world. Guilt, that voice in the head of the patient, is one of the most insidious side effects of chronic pain.
How Do You Manage?
Reduce fear of the unknown by educating yourself about your chronic pain condition.
Try mindfulness, yoga or meditation. Focus on the here and now.
Exercise if possible (as much as you are able, and with the permission of your doctor). Exercise produces chemicals within the body to reduce anxiety, worry and depression.
Consider seeing a counselor to talk about your worries, fears and guilt, especially how your chronic pain makes you feel.
Some people may need medication to treat insomnia, depression, or anxiety. You should ask your pain doctor if this should be explored. S/he can refer you to a specialist they trust.
Do not self-medicate. This isn’t a long term solution.