What has been consistently observed is that chronic pain and depression have been associated: that is, where there is chronic pain, there is depression; and where there is depression, there is usually chronic pain.
Here are some observations:
Pain is a sensory, as well as, emotional perception of discomfort that may be associated with actual or potential tissue damage. In layman’s terms, pain is something you feel in your body, your mind or your emotions in the face of injury, illness or everyday stresses.
Pain that is chronic is one that persists for three months or more. When pain persists, it doesn’t mean that it escalates in intensity, it may be low key one day and intense on some other days. It means that it doesn’t go away or that it keeps coming back.
The first reaction to pain is withdrawal. When you put your finger on a hot stove, you immediately withdraw your finger from the thing that causes the painful sensation. When the cause of the pain is obvious or known, it is easy to withdraw and the pain will stop. What is more difficult is when the cause of the pain is unknown or when the cause of pain is not one single factor, but, several factors coming together.
The second reaction to pain is immobility. In the example about putting a finger on the hot stove, people will hold the hurting finger to protect it. If they pull a muscle when lifting a heavy object, they will immediately drop the heavy object, sit down or lay down to protect the strained muscle. This is easy to do when there is a specific event, stimulus or cause for the pain.
The third reaction is finding a remedy for the pain. In the example about the finger on a hot stove, we run to the sink and put the finger under running cold water under the tap. In the example about the pulled muscle, we often get an ice pack and put it on that particular part of the body that is experiencing pain.
The fourth reaction is, we take medication for the pain, either to numb the area or to inhibit neurotransmitters from signaling pain in the brain. In acute pain, this often works. As the wound or injury heals, the intensity of the pain decreases until it is gone.
In chronic pain, people have exhausted the initial reactions and pain intensifies or continues. The next step that they do is try to find a diagnosis for the pain. This is a very frustrating time as some people have experienced professional dismissal of their experience of pain: doctors think that it’s all in their head. Sometimes the pain is in the head (it may have psychological causes) but it does not make the pain less real. Ignoring the pain or living in denial of the pain is not possible.
If and when the cause for the pain is finally diagnosed, there is the period when a person feels like a deflated balloon – especially when the diagnosis is of some rare disease or condition and there may be no known cure.
It is also a time when a person is sucked into a low mood: first, the pain is present, there is very little that can be done to shoo away the pain, any relief would be short and too far in between to enable them to bounce back to their former selves. The low mood comes with a feeling of helplessness, hopelessness and futility.
Depression feeds on the pain and the pain feeds on the depression sometimes. The presence of pain is all that defines life as people try to manage and cope with the pain; avoid it getting worse and avoid it intensifying. It is a battle a person faces alone; fights alone; and often, loses alone.
Even when there is a family or social support group around the person, the pain is not experienced or perceived by anyone else but the person suffering from it. This makes the person feel all alone, vulnerable and small.
As pain persists, the depression often persists until the person defines his worth and value in terms of the pain. They wear their pain, they talk about their pain, they eat their pain, they drink their pain and breathe their pain. A life without pain is something so far in the remote past that it becomes impossible to ever go back to that kind of life.
The good news is that most people, when they reach this stage, re-define their sense of self-worth and self-value. They re-define their life’s goals, they re-define their concept of recovery, of good health and of wellbeing. They no longer define recovery as the absence of pain: they define recovery as successfully coping and managing the pain.
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