Chronic pain and depression

Chronic pain and depression
May 3, 2006
By: Peter F. Ullrich, Jr., MD

Chronic pain most often takes a substantial psychological toll on patients. There can be a reinforcing cycle in which chronic pain commonly leads to depression, and patients who are clinically depressed often suffer from chronic pain. Therefore, both the depression and the chronic pain often need to be treated before the patient will feel any significant and lasting pain relief.

Medications for depression

The depression can often be effectively treated with medication, and there are several very effective antidepressants that can be useful. The newer antidepressants do not have as many unwanted side effects as many of the older antidepressants. Exercise that elevates the heart rate can also help relieve some symptoms of depression.

Antidepressants and sleep problems

With depression and chronic pain, sleep problems can complicate matters and make it more difficult for the patient to heal. If patients are not sleeping regularly, it makes it much more difficult to cope with the stress that chronic pain can create, which in turn can lead to more depression.

A number of classes of older-generation antidepressants (e.g. Amytriptiline, Nortriptiline, and Imipramine) are now used to treat sleep disorders, and when used at night in lower doses (that are a fraction of the dose that would be prescribed for treating depression), they are usually well tolerated by patients. These anti-depressants are not addictive and do not change a patientÌs sleep cycles. The most pronounced side effect is that many patients report an initial "hangover" effect that tends to recede over time. The anti-depressant medications also seem to have an anti-pain quality to them and many patients report a reduction in low back pain with these medications. They seem to be especially good for reducing nerve root pain (e.g. radiculopathy or neuropathy) that is sometimes a symptom of degenerative disc disease.

Treating depression along with chronic pain

It often takes a very comprehensive approach to assist patients in returning to their former level of functioning, with a team that consists of a physical rehabilitation physician (physiatrist), physical therapist, psychologist or psychiatrist, occupational therapist, and a nurse case manager who helps coordinate the care needed to treat depression and chronic pain.
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