That’s important because the two conditions often occur together. “Depression commonly occurs in people with chronic pain,” says Kurt Kroenke, MD, of the Indiana University School of Medicine and Regenstrief Institute, who was lead author of the study. In 30 to 50 percent of pain or depression cases, the two conditions coexist. “Some people who have chronic pain develop depression because they’re always in pain and their mood drops,” he says. But there are physiological reasons as well. “Depression heightens your sensitivity to pain,” explains Dr. Kroenke. Also, there are neural pathways in the brain that are common to both pain and depression.
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THE DETAILS: Adults who’d had low-back, knee, or hip pain for more than three months and had at least moderate depression were divided into two groups. The first group was told its members had depressive symptoms and were advised to seek treatment, without the researchers influencing what kind of treatment they received. The second underwent an intervention therapy divided into three stages. During the first stage the patients were given traditional antidepressants, and during the second they were taught pain self-management techniques, such as relaxation, exercise, and psychological tricks for coping with and distracting themselves from their pain. In the third stage, nurses assessed their depressive symptoms and adjusted their antidepressant medication as needed.
More patients in the intervention group saw significant improvements in their depression and pain symptoms: 47.2 percent reported overall improvements in pain, compared with 12.6 percent in the other group. 17.9 percent of the intervention group patients saw significant improvement in their depression symptoms after a year, compared to 4.7 percent of the usual care group, and 26 percent rated their improvement as a 50 percent reduction in depression symptoms and a 30 percent improvement in pain, as opposed to only 7.9 percent of the usual-care patients.
WHAT IT MEANS: Medication helps, but it shouldn’t be the only tool in dealing with depression, especially in cases of depression that are accompanied with physical pain. “Both [medication and drugfree pain-management techniques] are beneficial,” says Dr. Kroenke. “They complement one another. We use medications to treat symptoms as best we can, but since pain tends to be a chronic disorder, people also need to learn strategies to deal with it.” Not only will you decrease your pain by doing so, you may save money, both when it comes to medication and to missed workdays. “Pain and depression are the leading causes of reduced work productivity,” he notes.
Here are a few ways to help manage both pain and depression:
• Talk about it. Many people think that either depression or chronic pain may be all in their heads, says Dr. Kroenke. But both are medical conditions that should be taken seriously. Start by talking to your primary-care doctor and see if a depression test is warranted. This gives you an opportunity to communicate the severity of your pain and discuss options.
• Stay active. Exercise and physical activity not only improve your mood, they help reduce chronic pain. Get a good mix of structured exercise—aerobic activity or weight lifting; just be mindful of your physical limitations—and “lifestyle activity”—walking to the store, gardening, or doing housework. Research has found that endorphins, chemicals released by your body when you exercise, are more powerful painkillers than any medication.
• Be mindful. Studies show mindful meditation, or concentrating on living in the moment, can reduce pain. The Center for Mindfulness in Medicine, Health Care, and Society sells books and CDs that provide tips.
• Relax actively. In addition to mindfulness and meditation, relaxation can be a powerful tool in pain management. Just don’t “relax” by sitting passively on the couch in front of the TV. You can try yoga, deep breathing exercises, or the “tense and relax” technique. For the latter, get into a comfortable position, whether sitting or lying on the floor, and tense the muscles in a major muscle group (for instance, your legs and feet, arms and hands, or face) for two seconds. Take a deep breath when the muscles are tense and then exhale.
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