people living with pain cope with depression. I've read the pain
can cause a change in body chemistry. What comes first, the chicken
or the egg? Physical or emotional pain? What pattern of treatment
seems to be most effective?
-Patricia, Virginia Beach, VA
is estimated that more than half of all patients with chronic pain
also have clinical depression. On the chemical level, these ailments
are closely inter-related, and they might even be seen as two sides
of the same coin.
There is a lot
of research these days looking at the "HPA axis," a group
of glands that helps our bodies react to physical stress and external
danger. Stress causes these glands to pump out hormones such as
cortisol (steroid hormone) and adrenaline (fight-or-flight hormone).
When stress becomes chronic, as it does in the physical stress of
chronic pain, the constant flow of these hormones causes depletion
of the brain's reserves of two important chemicals, serotonin and
norepinephrine. Low levels of these brain chemicals can cause depression.
Additionally, the low levels of serotonin and norepinephrine that
are found in depression change the way the brain senses pain. Normally,
these brain chemicals decrease the intensity of pain. When they
are in short supply, the brain might interpret mild pain as being
severe, and could even sense pain that has no external cause!
So chronic pain can cause depression, and depression can increase
the intensity of pain. The HPA axis glands seem to be a link in
this vicious cycle of events. Dysfunction of these glands may be
a factor in fibromyalgia, an illness causing abnormal pain sensation
and emotional distress.
Understanding that depression and pain are linked can help you cope
with both. Strategies to reduce stress, proper sleep habits, and
serotonin-boosting medications should help.
Chai, MD, MS, is an Internal Medicine Specialist with additional
training in the area of medical research methods. Her experiences
as a patient helped to redirect her priorities to home life and