Chronic Pain Series Part 2: Mental Health & Chronic Pain
Mental Health and Chronic Pain:
Mental health and physical health are fundamentally linked; there can be no denying that people in pain, feel stress and it is this cycle of stress that leads us to consider our mental health. People living with chronic physical health conditions experience depression and anxiety at twice the rate of the general population.
Living with chronic pain every day puts a strain on your psychological well-being. Keeping the mind healthy while the body struggles to finds ease is not always easy, but it plays a huge role in coping with day to day pain. It is a perpetual cycle that acts as a feedback loop in both the brain and the body.
On the flip side, it also goes without saying that people living with a serious mental illness are at higher risk of experiencing a wide range of chronic physical conditions.
It is no secret that there is a link between chronic pain and certain mental health concerns, like depression. This can be extremely frustrating during the diagnosis stage, because of the dual diagnosis of chronic pain. In fact, depression is often one of the first conditions that doctors try to rule out when diagnosing chronic pain. As many as 50% of people who suffer from chronic pain also have recurrent clinical depression. Billions have been spent on healthcare per year, yet chronic pain is still not high on the medical agenda.
So what is Clinical Depression? Clinical depression is more than a feeling of sadness or low, down and out mood. It is a psychological state that causes fatigue, lack of motivation, appetite changes, slowed response time and feelings of helplessness, inability to partake in the things you love, which is doubled by the pain of……pain. Depression has physical symptoms as well, including aches, pains and difficulty sleeping. Does this not sound familiar? Does this not sound a lot like many of the same symptoms of chronic pain? YES.
Depression is more than a side effect of chronic pain: the two diagnoses are often so interwoven, that they can be difficult to separate the two for proper treatment and resources. Chronic pain can keep people from doing the things they love. Pain changes how our body’s move, and how we relate to the world. It changes our mood; therefore, it’s safe to say that people who have chronic pain tend to be less active than those who are healthy, because their minds and bodies cause them to slow down and the anticipation of pain receptors leave little room for getting excited to move around and be merry. Again, we see this constant cycle of anxiety around pain. Not feeling happy with your quality of life is often an emotional drain. With few outlets available for stress relief, it is easy to fall into a downward spiral that leads to depression.
In the Vancouver Sun on April 15, 2013 there was an article “Chronic pain: Managing it, living with it: Health system lags in chronic pain treatment,” outlining the need for chronic pain to be higher up on our medical systems agenda.
“Depression can make people’s pain feel more intense as it can potentially stop them from feeling hopeful and they can lose motivation to do the work of recovery, which adds up to more pain, she says.
Diagnoses related to chronic pain are therefore difficult. Complex pain is a biopsychosocial issue as opposed to acute pain,” says Squire. “So that means we’re never just assessing the painful part, we’re assessing somebody’s mood, usually their sleep. It has cognitive effects, so they’re quite complicated assessments.”
We still do not have enough data metrics and research to support the proper pathways to treat people with chronic pain, but there are many organizations that are coming together to change this. Two of those organizations are PainBC and Change Pain Clinic, located right here in VancouverBC, but we will get to them in just a mere moment. Let’s look at the cycle of stress.
The Cycle of Stress:
Pain activates the areas of the brain that respond to stress; through pain receptors. This is one of the body’s coping strategies for dealing with acute pain and for protecting us from harm. It is a survival mechanism that’s been encoded in our DNA since the dawn of time. When the brain gets the signal, the brain reacts by sending the body into high sensory overload and overdrive, to prepare for fight or flight. When the pain goes away the signals are supposed to stop.
However, we see with chronic pain, the fight or flight signals don’t turn off, and the nervous system stays in a constant state of high alert, like an alarm in the morning that won’t shut off. You can imagine how annoying and frustrating that would sound like; at some point all you want to do is throw the freakin’ alarm clock against the wall and drop “F”bombs right, left and center.
Now imagine that constant alarm in your body 24/7. It can feel debilitating, maddening and deafening. The body does not get a break from the brain’s stress chemicals and too much stress without time off eventually wears the body down, which can leave you vulnerable to depression.
Stress management can be complicated and confusing because there are different types of stress, each with its own characteristics, symptoms, duration, and treatment approaches.
Now, not all stress is bad, but when we do not know how to cope or adapt to the changing landscape, it can do more harm to us, then we realize. In most psychology journals, psychologists describe four types of stress – hyopstress, eustress, episodic acute/ hyerpsress and chronic/ distress:
- Hypostress: insufficiently low stress
- Eustress: sufficient, adaptable stress, positive stressors
- Episodic Acute /Hyperstress: recoverable, high stress, “A” type stress
- Distress: excessive, unadaptable stress, inability to recover or cope
The emotional trigger and response is critical in establishing greater levels of resilience, in hopes of instigating more positive coping strategies that can greatly improve ones ability to cope under stress. These include options such as; gentle and restorative yoga, breathing classes, meditation, music therapy, light movement classes, even brain entrainment. All of which have shown to be successful when applied to their treatment and personal coping strategy. Of course, none of these alone will do the trick, but an integrated system designed for YOU – can offer you renewed HOPE.
The Biopsychosocial Model:
The biopsychosocial model (abbreviated “BPS”) is a general model or approach positing that biological, psychological (which entails thoughts, emotions, and behaviors), and social factors, all play a significant role in human functioning in the context of disease or illness. Indeed, health is best understood in terms of a combination of biological, psychological, and social factors rather than purely in biological terms The biological component of the biopsychosocial model seeks to understand how the cause of the illness stems from the functioning of the individual’s body. The psychological component of the biopsychosocial model looks for potential psychological causes for a health problem such as lack of self-control, emotional turmoil, and negative thinking. (Wikipedia)
Rather than offer you a full synopsis on this model, it can be best viewed in this riveting presentation featured in April via Pain BC:
For those of you interested in the cross pollination of these fields, I highly recommend you take the time to view this presentation.
Our community mental health sector, as well as our community in chronnic pain management, is undergoing a province-wide transformation. Many organizations, including local branches of the Canadian Mental Health Association, grassroots organizations in pain specialties have received new funding for service enhancements over the past several years; however it is not enough. Policy making and governance are high on the agenda to support long term, sustainable change at the higher levels. With new policy and adequate funding this can offer those patients with pain who may not be able to afford services and programs new hope in optimizing their health and wellness.
PainBC and teams like Change Pain Clinic are two pioneers in the areas of chronic pain who are paving the way for a renewed sense of dignity and hope for those who live with chronic pain and dual diagnosis in mental illness.
Last week we looked at PainBC, but I wanted to draw your attention to the previous “Empowering Self Management of Pain” webinar series. A series of webinars that aired in May brought forth the power of how innovation and technology can bring people with pain together to better understand their conditions and the power they have to take charge and manage their own personal health and wellness. In case you missed them please watch them all here – http://www.painbc.ca/sessions/past
Change Pain Clinic:
A passionate team about leading health care system change for everyone burdened by pain. Since it’s fruition in 2009, founders Brenda Lau, Greg Siren and Judy Pryce have been collaborating on ideas on how to improve the lives of pain patients and pain practitioners. An integrated team of clinicians and health practitioners brings together the necessary skill sets to truly revolutionize how we look at, deal with and treat people in pain.
More importantly, a team readily open to put themselves on the line to change agenda, governance and policy within our medical system. Word on the street is Fit to Train Human Performance Systems may just be combining forces and joining this revolution. I feel honored to be part of this team and part of this revolution.
Not Myself Today: Partners in Mental Health
In January, a major step forward was taken with the launch of a National Standard for Psychological Health and Safety, which promotes good mental health and prevents psychological harm in the workplace. This is an important start.
The Not Myself Today campaign was created to proactively deal with our mental health. Every one of us has had a day when we don’t feel like ourselves. Now, imagine living with those feelings not just one day, but many days – and the shame, discrimination and lack of treatment and support that goes with it. This is especially critical at work – where so many of us spend so many hours a day. This campaign is designed to better understand and break the stigma around mental illness. As we know much like chronic pain, the stigma is the same. If you can’t “see” it…how do we tell others about how we “feel.” This campaign aims to change that and to bring people who feel miss understood…together to join forces… so they CAN and WILL be understood.
The moral of this story, is that there are those of us who understand, who are here to help and offer support. There is hope and dignity in this struggle and as we continue to forge forward, more and more options are available to those who live with chronic pain and mental illness. I would like to close by offering you a fan-freakin-tastic quote, by one of my mentors, who has undergone his own transformation with chronic pain, injury, being stigmatized with labels; a man who is a fighter and has come out on the other side stronger and more resilient. This is quote from one of his blogs titled “Strive but do not Identify with the Struggle.” Enjoy….
“What you fight for, and what you refuse to struggle against, defines who you are. Fight for your values, but do not live in strife. You can do a thing, without becoming a thing, just like you can face defeat, but not be defeated. Stop keeping track of the mistakes you’ve made, the fights you’ve faced and the defeats you’ve suffered. You will again, but you will not become them by doing do; only by thinking you are.
Focus your attention on the right decisions you’ve chosen, the flow you’ve facilitated and the triumphs you’ve allowed. Steel against the negative until you no longer need to direct your mind, and you have trained yourself to be free of judgment at all. Judging a person doesn’t define who they are, but who you are; judging yourself is the same. The process of judgment limits us by the boundaries of its definitions.
Do not identify with the discord, even when life surrounds you with a cacophony. Remain in harmony with the melody of your soul despite the noisy world, and you give everyone with whom you harmonize, a chance to tune in to their own melody as well.”
– Scott Sonnon
Next week we look at chronic pain and PTSD in our military forces. Serving those who serve and protect.
- PainBC: www.painbc.ca
- The Biopsychosocial model: http://www.youtube.com
- Change Pain Clinic (CPC): http://www.changepain.ca/
- Not Myself Today: http://www.notmyselftoday.ca/home
- The Vancouver Sun: http://www.vancouversun.com/Health/Empowered-Health/What+your+pain+never+stopped/8244723/story.html
- Scott Sonnon “Flow Coach” Blog: May 30th, 2013 “Strive but do not Identify with the Struggle” http://www.rmaxinternational.com/flowcoach/