Whenever you experience pain, it is always important to ask: “What is my pain trying to tell me?” Remember, pain is trying to tell you that something is wrong, that you should find out exactly what it is, and find a way to address it—not mask it.

Our pain system is a crucial component of our makeup and essential to our ongoing survival.  Could you imagine how bad it could get if we didn’t have pain receptors and kept putting ourselves in situations that could seriously damage our body?  Imagine that you’re in the kitchen talking on the phone and you put your hand down on a hot burner.  Without pain receptors your first indication that something was wrong would be your flesh burning.

Impaired Pain System Can Lead to Chronic Pain

As with any sensory system, pain receptors and circuits can become impaired, resulting in chronic pain that cannot be attributed to any identifiable physical problem. The greatest challenge with regard to understanding the biological aspects of pain is not knowing why the pain sometimes continues even after a painful stimulus has been removed.

Recurrent Acute Pain

There is also another classification of pain that is called acute recurrent pain which is when the individual suffers from pain episodes with pain free periods in between. The pain episodes are usually brief (e.g., lasting from minutes to an hour or so) and are often associated with an identifiable physical process (such as migraine headaches, sickle cell anemia, back sprain, etc).

Anticipatory Pain

When you live with chronic pain you hurt.  Doing certain things can make you hurt worse. So you come to believe that these things will always cause you to hurt. In other words, you associate those things with your pain. You believe that every time you do those things, you will have pain. 

Because you believe that you are going to hurt, you can activate the physiological pain system just by thinking about doing something that you believe will cause you to hurt. This is called anticipatory pain.  You anticipate that something will make you hurt, which in turn activates your physiological pain system. You often start hurting even before you begin doing whatever it is that you believe will cause you to hurt. All you have to do is to start thinking about doing that thing. This process is what often leads to suffering.

Pain versus Suffering

The psychological meaning that you assign to a physical pain signal will determine whether you simply feel pain (“Ouch, this hurts!”) or experience suffering (“Because I hurt, something awful or terrible is happening!”). Although pain and suffering are often used interchangeably, there is an important distinction that needs to be made. Pain is an unpleasant signal telling you that something is wrong with your body. Suffering results from the meaning or interpretation your brain assigns to the pain signal.

Many people irrationally believe that: “I shouldn’t have pain!” or “Because I have pain and I’m having trouble managing my pain, there must be something wrong with me.” A big step toward effective pain management occurs when you can reduce your level of suffering by identifying and changing your irrational thinking and beliefs about the pain, which in turn decreases your stress and overall suffering.

Because of these two components—pain and suffering—pain management must also have two components: physical and psychological. The way people sense or experience pain—its intensity and duration—will affect how well they are able to manage it. It may be an unrealistic goal to become totally pain free but I can promise that if you are willing to follow through and complete the work required—you will never have to “suffer” with your chronic pain again. 

To learn more about pain and suffering for more effectivce chronic pain management please check out my article Pain versus Suffering that you can download for free on our Article page. In addition, please take a look at a more recent article along similar lines Moving Beyond Anticipatory Pain for Effective Chronic Pain Management that you can also download for free.

If you’d like to receive training for helping people with relapse prevention, I’m very excited to announce that the Gorski-CENAPS Corporation is presenting The Relapse Prevention Therapy44 Hour Certification Training in Ft. Lauderdale October 18-22, 2010. To learn more about this 5 day 44 hour training you can check out our Calendar page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you or a loved one is undergoing chronic pain management, especially if you’re in recovery or believe you may have a medication or other mental health problem and you want to learn more effective chronic pain management tools, please go to our Publications page and check out my books; especially the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please click here. If you want to sign up for the newsletter, please click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Many people living with chronic pain frequently become depressed due to living with under treated or mistreated pain symptoms. When a person’s thinking and emotions become problematic they become irrational or dysfunctional and mismanage their feelings. As a result, they have urges to indulge in self-defeating, impulsive or compulsive behaviors to cope with their depression, which affects all their relationships.

Things People with Chronic Pain Should Do When They’re Depressed

• Eliminate the use of alcohol and other drugs (other than appropriate prescriptions)
• Exercise or engage in some form of physical activity every day, such as walking, or whatever is possible given your physical limitations
• Eat a proper, well-balanced diet—also, use a good multivitamin daily
• Obtain an adequate amount of sleep—if sleep is a problem discuss this with your doctor/therapist
• Reach out for emotional support from friends and family
• Focus on the positive aspects of your life
• Pace yourself, modify your schedule and set realistic goals
• Eliminate or reduce unnecessary tasks so that your schedule is more manageable
• Reduce or eliminate the use of nicotine, caffeine, and sugar
• Consult with a physician if you are experiencing any medical problems 
• Seek early intervention which may modify the severity of your depression

Things People with Chronic Pain Should Avoid When They’re Depressed

• Isolating behavior
• Making long-term commitments or important decisions, unless absolutely necessary
• Over-committing to activities which are stressful or overwhelming
• Assuming that things are hopeless—they’re not!
• Engaging in “emotional reasoning” (e.g., “because I feel awful, my life is terrible”)
• Assuming responsibility for events which are outside of your control
• Avoiding treatment as a way of coping so you don’t have to change

To learn more about the role of depression in chronic pain management please check out my article Depression Management with the Chronic Pain Patient that you can download for free on our Article page.

If you’d like to receive training for helping people with relapse prevention, I’m very excited to announce that the Gorski-CENAPS Corporation is presenting The Relapse Prevention Therapy44 Hour Certification Training in Ft. Lauderdale October 18-22, 2010. To learn more about this 5 day 44 hour training you can check out our Calendar page.

You can learn about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders; including depression, addiction and other coexisting psychological disorders effectively; please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please click here. If you want to sign up for the newsletter, please click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.
 

Not everyone with chronic pain and depression will need antidepressant medications.  However, this class of medication may be indicated for several reasons; one is that many people living with chronic pain disorders become clinically depressed.  The Addiction-Free Pain Management® System suggests a full biopsychosocial evaluation to determine the severity of the problem before any medications are prescribed.

Situational depression responds best to cognitive behavioral therapy and in those cases medications are not necessary.  Other types (bipolar) may need a medical intervention in addition to psychotherapy.  There are many different types or classifications of antidepressants to choose from, therefore a specialist should be consulted to determine the most effective medication for each person.

Pain reduction is another key factor to consider using an antidepressant.  For example the use of tricyclic antidepressants has been an effective tool in pain management for years.  The tricyclic medication Elavil (amitriptyline) is frequently used to treat and help prevent migraine headaches.  These antidepressants have been able to provide relief for nerve pain and often result in lowering the dose of opiate medications.  Since sleep disturbances often accompany both chronic pain and depression some healthcare providers use this type of medication as a sleep aid.

Another class of newer antidepressants is the SSRIs (selective serotonin reuptake inhibitors). Many pain management specialists utilize this type of medication for chronic pain treatment particularly for people who live with constant debilitating chronic pain, as their serotonin system becomes depleted.  This type of medication is good for both depression as well as improving pain management.

SSRIs like Prozac, Effexor, Lexapro, or Celexa, improve mood as well as help relieve pain, reduce fatigue and improve sleep problems.  There have been reports about SSRIs being helpful for some types of neuropathic pain symptoms.  Some studies also suggest that using an SSRI and a tricyclic antidepressant (such as amitriptyline) together may be more successful at breaking the cycle of pain, depression, and sleep problems caused by fibromyalgia than using just either one alone.

In addition, these three antidepressant medications can also be very helpful; Cymbalta and Effexor, which block the reuptake of serotonin and norepenepherine and Wellbutrin, which alters the levels of norepenepherine and dopamine.  Cymbalta is a versatile medication that is FDA approved to treat depression and certain types of neuropathic pain. Norepenepherine, serotonin, and dopamine are neurotransmitters that not only affect depression but also pain management. Many pain management specialists recognize that combining different medications creates a synergistic effect for both pain management and improving depression.

The good news is that there are many different management and treatment options for depression.  Try to remember that overcoming depression can take time and someone living with chronic pain and depression will need to stay strong and focused when faced with tough pain days.  They will also need to reach out for support to keep them from becoming isolated.  The important thing to remember is that overcoming depression is achievable with the right team and the right plan!

To learn more about the importance of identifying and treating depression for more effectivce chronic pain management please check out my article Depression Management with the Chronic Pain Patient that you can download for free on our Article page.

If you’d like to receive training for helping people with relapse prevention, I’m very excited to announce that the Gorski-CENAPS Corporation is presenting The Relapse Prevention Therapy44 Hour Certification Training in Ft. Lauderdale October 18-22, 2010. To learn more about this 5 day 44 hour training you can check out our Calendar page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you or a loved one is undergoing chronic pain management, especially if you’re in recovery or believe you may have a medication or other mental health problem and you want to learn more effective chronic pain management tools, please go to our Publications page and check out my books; especially the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please click here. If you want to sign up for the newsletter, please click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.