One of the realities about depression is that it seldom occurs in a vacuum. Many people with chronic medical conditions such as multiple sclerosis, rheumatoid arthritis, osteoarthritis, fibromyalgia,, or chronic fatigue syndrome may also experience depression. One thing all these medical conditions have in common is that patients with these disorders may frequently experience pain. It seems that there can be a strong correlation between physical pain and the emotional pain of depression.
September is pain awareness month and to help us explore the connection between chronic pain and depression we have called upon the expertise and personal experience of Karen Lee Richards. Karen Richards is the lead writer and community leader for Health Central’s ChronicPainConnection. Karen is also the co-founder of the National Fibromyalgia Foundation (NFA). Karen has used her personal experience as a patient having both fibromyalgia and chronic fatigue syndrome to help others who are facing similar medical challenges.
It is both a pleasure and an honor to have Karen with us to answer some questions.
Q: How many people are currently affected by chronic pain issues in the U.S.?
Karen: According to the Institute of Medicine report released recently, “Chronic pain affects at least 116 million American adults—more than the total affected by heart disease, cancer, and diabetes combined.” That's a really staggering number. It means that one out of every three people in the U.S. lives with some type of chronic pain.
Q: Are there any statistics on how many people dealing with chronic pain are also coping with depression?
Karen: The estimates tend to range somewhere between 25 and 60 percent. I suspect it varies depending on the cause of the pain as well as its severity. I've also read that on average, 65 percent of people with depression also complain of pain. In some cases, living with chronic pain can result in depression, while at other times, depression can lead to chronic pain problems.
Q: What are some of the emotional reactions to being diagnosed with an illness which causes chronic pain?
I've found that for most of us, our emotional reaction to being diagnosed with a chronic pain illness tends to be very similar to our response to any major life crisis, such as a divorce or the death of a loved one. We generally go through many of the emotions involved in the grieving process – fear, disbelief, denial, anger, guilt, depression, and eventually acceptance. My article “After the Diagnosis: Facing Life With Fibromyalgia” explains this process in more detail. For me, facing the fact that I was probably always going to have some degree of pain was difficult; but what was even harder to deal with was the realization that my life was not going to be what I had expected and hoped it would be. I had to grieve the loss of my old life before I was ready to accept and begin to build my new life. What I couldn't have imagined at the time was that in many ways, my new life is better than anything I ever dreamed possible before chronic pain came into my life.
I read your candid post on “Dealing with Suicidal Thoughts” and it reminded me of the interview I conducted with Lene Andersen of our Rheumatoid Arthritis site. Lene shared a dark time where she confided: “I reached a point where I could get up each morning only by promising myself that if a solution hadn't been found by the summer, it would be OK to give up. To kill myself.” In your post you relate that: “And I have asked God to take me home when there seemed to be no hope that I would ever get any relief from the pain and fatigue. (Now I can say I am thankful that was one prayer He answered with a “No.”)” We are very grateful that both you and Lene managed to survive these times of crisis.
Q: Would you say that suicidal thoughts are common for those dealing with chronic pain?
Karen: Yes, it's not at all unusual for people who live in chronic pain to have entertained suicidal thoughts at some point. The idea of living the rest of your life in pain can lead to feelings of hopelessness and despair . . . especially if it seems like there are no good pain relief options available to you. Some people are actively suicidal and think about taking steps to end their life. Others, like me, are more passively suicidal. For spiritual reasons, I didn't consider taking my own life an option, however, I did think about not seeking treatment if I were diagnosed with a potentially terminal illness like cancer. And I did ask God to end my life here and take me home.
Q: Can you tell us how you personally pulled through this difficult time?
Karen: For me, it was a combination of spiritual commitment and a complete re-evaluation of my life that eventually pulled me through. I thought that if God had chosen to keep me here, He must have a purpose for me. And I felt pretty certain His purpose for me was more than just existing and being miserable. So with much prayer, I began to re-evaluate my life. Basically, I compared what in life was most important to me with how I was actually spending my time and very limited energy. The results were eye-opening. Without realizing it, I had been spending most of my time doing what was least important to me. That was the motivation I needed to start making changes in my life. I finally had some real hope for my future.
If you'd like to know more about the re-evaluation process I went through, please read “Learning to Live With Chronic Pain: Re-evaluating Your Priorities.”
Q: Do you find that others are understanding and empathic about chronic pain?
Karen: I am fortunate that my family, close friends and work associates are all very understanding about my pain and the limitations it causes. Sadly, that's not true for everyone. Because chronic pain is often an invisible illness, it can be hard for some people to realize how much we are suffering. Sometimes that can lead to criticism, accusations of laziness and even cruelty.
Q: Where did you find your greatest support?
Karen: I find that I need two different, but equally important, types of support. I need the loving support of my family and close friends who will be there for me no matter what. But I also need the kind of understanding and support that can only come from other people with chronic pain. No matter how much my family loves me and tries to understand, only someone who has experienced what it's like to live with pain day in an day out, month in and month out, can truly relate to what I'm going through. The latter support I get from the community members at ChronicPainConnection and my local fibromyalgia support group.
Q: What can loved ones or caregivers do to provide emotional support to family members and friends who suffer from chronic pain?
Karen: First and foremost, believe them when they say they are in pain. The emotional pain of not being believed can be as bad or worse than the physical pain. And the stress of feeling like no one believes you can actually make the physical pain worse. Don't make them feel guilty when they're not able to go somewhere or do something you want them to do. Trust me, they already feel enough guilt on their own. Instead, tell them you understand that they don't feel up to it and offer to do something that would help them. Keep them in the loop. It can be easy to ignore or forget about someone who can no longer be as active and involved as they once were. Stay in touch, let them know you're thinking of them, share the latest news (or gossip) – anything that helps them feel included.
Q: What do you advise or suggest to patients who suspect that they are depressed in addition to having chronic pain issues?
Karen: First, talk to your primary care physician. There's a good chance that what you're experiencing is more than just being down because of your pain problems. You may have a clinical depression caused by a chemical imbalance that can accompany chronic pain issues. If so, your doctor may want to prescribe an antidepressant, which incidentally can also be effective as a pain reliever. Second, seriously consider talking with a therapist who has experience treating chronic pain patients. There are a number of therapies that can help you learn to ways to cope with both the depression and the pain.
Q: What do you tell people who want to give up?
Karen: Giving up is never a good option. When you're in pain and depressed, it's hard to see beyond what you're experiencing right now. It's like a horse with blinders on. You can't see all the possibilities around you. You don't realize what good and positive things may be just around the next corner. Little did I know when I wanted to give up that a couple of months later I would find a new medication which would significantly reduce my pain level. If I had given up then, I never would have experienced the joy of having grandchildren. And I never would have realized my lifelong dream of being a writer. Life is always the best choice.
Q: Do you have a special mantra or philosophy which has helped you to overcome depressive thoughts?
Karen: Whenever depressive thoughts begin to creep in, I try to follow the instructions from Philippians 4:8 in the Bible, “...whatever things are true, whatever things are noble, whatever things are just, whatever things are pure, whatever things are lovely, whatever things are of good report, if there is any virtue and if there is anything praiseworthy—meditate on these things.”
Q: Can you share any special coping strategies?
Karen: For me, overcoming depressive thoughts is all about controlling my mind. It can be so easy to start dwelling on the negatives of life. If I realize that my mind is drifting into those negative or feel-sorry-for-myself thoughts, I actively try to occupy my mind with something positive that I enjoy. I may work on a crossword puzzle, read one of my “Cat Who...” books, play a computer game, or watch a comedy show on TV. I've also learned to pay attention to how different types of music, movies, TV programs and people make me feel and I avoid those that cause me to feel melancholy or stir up bad memories. In a nutshell, I try to block out negative thoughts and focus on the positive.
Thank you Karen for sharing your experience and insights with us here on MyDepressionConnection!
Depression can be a co-morbid illness of many chronic mental health and medical disorders. The following is a list of Health Central articles about health related conditions associated with depression.
Published On: September 29, 2011