¶ … chronic pain and resulting depression. Specifically, it will show the connection between chronic pain and depression, how it affects the person and the ones around them, what treatments are available, and ways to break the cycle. BREAKING THE CYCLE OF CHRONIC PAIN AND DEPRESSION

There is always hope. Depression blinds us to that fact. If we can somehow hold on to our hope, just maybe we can find a way to get through"(Feinberg, 2002).

Depression - "Depression results when individuals forfeit their personal power. To overcome guilt, insecurity, and anxiety is to conquer frustration and to regain personal power" (Miletich, 1995, p. 1). "Depression is derived from 'deprimere,' a Latin word which means 'to press down'" (Miletich 1995, p. 26).

Chronic Pain - is defined as pain that lasts six or more months. Pain is any type of feeling or hurt that is annoying, hurtful, or causes discomfort. Chronic pain is suffered by approximately 30% of the U.S. population. These individuals wake up, function during the day, and go to sleep trying to keep pain at a minimum while, at the same time, maintaining some quality of life. They may be frequent visitors to the doctor and the pharmacy. When they find relief it is usually short-lived and comes at a cost, such as dependence on narcotic medications or complete limitation of activity. Pain often becomes the central point of their existence (Block, 1996, p. 1).

What causes depression? For thousands of years, depression was thought to simply be a weakness of the mind, often called "melancholia. "Depression is caused, in part, by certain life goals which become unfeasible, but which a person cannot abandon, this resulting in reflection upon lost goals. To gradually abandon these goals and to work towards other goals is to overcome the depression" (Miletich, 1995, p. 11). Today, we know depression is a treatable disease, and often physicians and therapists treat it with a variety of anti-depressive drugs, gaining very positive results. However, there is another kind of depression that is much more difficult to treat, because it is linked to a physical ailment, chronic pain.

For instance, the co-occurrence of depression and chronic pain is well documented. Prevalence rates vary considerably but are typically substantially above those reported for the general population (ranging from 31% to 100% in chronic pain vs. from 13% to 20% in general population samples) (Nelson & Novy, 1997, p. 393).

Often, depressed people say the feel alone, are hiding from the world, or have feelings of despair and suicide. One wrote, "I wonder if you would understand / if I told you I was hiding / within myself / private and safe" and another wrote, "What can I say / that would help you understand, / my days are numbered / like an hourglass without sand" (Feinberg, 2002). Clearly, depression is a serious disease that can often lead to suicide if not treated. Mixed with chronic pain, the situation can be too much for some people to bear, and as expected, it can be equally hard on family members.

As pain increases, the patient may be increasingly difficult to deal with. They become angry and demanding, making it more difficult for health care professionals and family members to deal with them. "Reciprocally, chronic pain patients are the b te noire of many health professionals, who come to find them excessively demanding, hostile, and undermining of care" (Kleinman 57).

Unfortunately, the more pain the patient has, the more they tend to fall into depression. "Moreover, a traditional view of the evolution of acute to chronic pain states has held anxiety to predominate in early stages, yielding to more overtly pronounced depression as the duration of pain persists" (Nelson & Novy, 1997, p. 393).

In addition, it may be increasingly difficult for the patient to fully explain their pain, so others, like family members may not really understand the severity of the pain, or understand the sufferer's reaction to it. This can help lead to more depression. The sufferer is unable to perform normal tasks, or participate in activities they used to enjoy, so they become frustrated and even more depressed. "Her children avoid her because of her irritable temper. She and her husband rarely go out now, never have guests over, because she simply doesn't feel up to it" (Sternbach, 1987, p. 21). It is easy to see how the cycle of depression and chronic pain are intertwined, when the changes in everyday life become so overpowering. It becomes even worse...

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To make matters worse, often in chronic pain treatment, the pain's source is identified, but there is little that can be done to alleviate the pain, such as in the case of arthritis, cancer, and diabetes. The sufferer literally has no hope of returning to their "normal" life. They may be able to take drugs that will help lessen the pain, but it will never go away. This hopelessness is a common feeling in depressed patients, and again, it is easy to see how chronic pain, with its own hopelessness, can lead to depression.

The cycle of chronic pain and depression is like a whirlpool, continually revolving, and sucking in anything it can. It is nearly impossible to reverse, once in motion, unless there is some type of family or professional intervention.

As Emily Dickinson (herself a pain patient) wrote: Pain - has an Element of Blank - /

It cannot recollect / When it began - or if there were / A time when it was not - / It has no Future - but itself - / Its Infinite realms contain / Its Past - enlightened to perceive / New Periods - of Pain (Kleinman, 1988, p. 60).

However, not all chronic pain patients fall into depression. Alternatively, if they do, they have the ability to drag themselves out of the whirlpool. What is the difference in these patients? Dr. Richard A. Sternbach, author of "Mastering Pain: A Twelve-Step Program for Coping with Chronic Pain," has studied chronic pain for decades. He believes there are several factors that contribute to the mastery of chronic pain, while avoiding depression. One is anger. He has noted in several of his patients that their anger has kept them from sinking into a bottomless pit. "How? They angrily refuse to be kept down" (Sternbach, 1987, p. 54). They become angry at their pain, but angrier at the attitude of "poor me," and will simply not allow the pain to get in the way of what they want to accomplish. One woman admits, "It's a mental thing. The higher the pain goes, the higher my mind goes to surmount it" (Sternbach, 1987, p. 56).

Another factor is faith. Some chronic pain sufferers feel their pain is a message from God, and a test of their own faith and strength. They use their religion to help them deal with the pain and for the comfort of the rituals it provides, like praying and church services. "They find that their faith gives them strength. There must be an inner difference, then" (Sternbach, 1987, p. 58). These two factors can also aid in depression and its treatment. Anger, rather than helplessness can help pull a person out of depression, as can faith.

Of course, there are other treatments available for managing pain, and many more studies are looking into the relationship between chronic pain and depression. The field has long been ignored, but more scientists and physicians are looking into the connection between depression and chronic pain, and trying to find answers to help their patients.

Many chronic pain treatment programs now include explicit training in cognitive pain control techniques. Such techniques include hypnosis, rational-emotive therapy, reframing, and many others. Further, studies have shown that improvements in the status of chronic pain patients are associated with the development of positive cognitive changes (Block, 1996, p. 22).

New medications are being developed to combat chronic pain and depression all the time. Unfortunately, many of the pain medications are addicting, or bring on other serious side effects. One man, desperate for relief, reported to his doctor, "He has also taken, by his reckoning, almost fifty pain medications, including powerful narcotics, to several of which he became addicted. There have been other serious side effects of these drugs: most notably, anemia and allergic rashes" (Kleinman, 1988, p. 62). Depression can also be treated with a variety of anti-depressants; the most notable until a few years ago was Prozac, a drug developed specifically for depression. Today, there are many other drugs available for the treatment of depression, and some can treat pain, too.

Dr. Sternbach…