The Link Between Depression and Pain
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NEW YORK—Mind and matter are like the chicken and the egg—and pain, both emotional and physical, is no different. Healers and scientists have long known that mental factors and physical symptoms are inextricably intertwined.
A study published in the journal Psychosomatic Medicine in 2004 found that two-thirds of patients being treated for depression also reported physical pain such as frequent headaches, back pain, joint pain, and abdominal pain.
“Physical pain and depression have a deeper biological connection than simple cause and effect; the neurotransmitters that influence both pain and mood are serotonin and norepinephrine,” reads a 2004 National Institutes of Health report. “Dysregulation of these transmitters is linked to both depression and pain.”
While trouble with neurotransmitters play a huge role in both depression and pain, the story doesn’t end there.
Since the 1950s, doctors and drug companies have touted pillular anti-depressants as the go-to method for treating depression and certain cases of pain. In the process, patients were forced to counter side effects associated with these drugs with more drugs while pharmaceutical companies reaped the profits. Now, patients and health care providers alike are turning to other, lasting, and more intuitive ways to address the psychosomatic factors contributing to the twin distresses of pain and depression.
The Integrated Being
For 5,000 years, Chinese medicine has treated human health holistically. Its foundational philosophy says that a human being exists on the spiritual, emotional, and physical levels simultaneously, and that no one facet of human health can be fully understood without examining the others. Furthermore, people do not exist in a vacuum; they are also members of their community and the universe. Thus, when practiced fully, Chinese medicine integrates concepts from many fields that are today specialized and separate.
Chinese medicine believes that physical symptoms have their root causes in mental and emotional states that manifest in blockages of qi, which can be loosely translated as “life energy.” Likewise, since qi is the conduit for all human functioning, mental, emotional, and physical dysfunction can be treated by manipulating qi. On this framework sprang traditional Chinese healing methods such as acupuncture, herbal medicine, and qigong, just to name a few modalities commonly known to the West.
According to Dr. Jingduan Yang, a Chinese medicine doctor and psychiatrist practicing at Thomas Jefferson University Hospital in Philadelphia, a deficiency in yang qi or an excess in yin qi often manifests as depression. The same qi imbalances will affect other areas of functioning and present itself as pain.
Modern research is coming close to similar understandings of this complex relationship. The Scandinavian Journal of Pain in 2011 attempted to explain the connection this way:
“First, catastrophizing plays a central role in models of both pain and depression and hence might form an important link between them,” researchers wrote. “Second, emotion regulation is important in both depression and pain since they both can be viewed as significant emotional stressors.”
Dual Acting Treatments
Pain and depression often go hand in hand—sometimes the same traumatic experience triggers both, and the two conditions exacerbate each other.
Neuropathic pain, as opposed to common muscular aches and arthritic pain, derives from dysfunctions in the central nervous system or peripheral nervous system. Trauma causes disproportionate electrical activity in the nerves, and sufferers of chronic neuropathic conditions such as complex regional pain syndrome (CRPS) experience normal touch or the slightest heat as pain.
Acupuncture acts on correcting the qi blockages that cause such pain and when used correctly can reduce the hypersensitivity associated with neuropathic pain. Used as a complementary treatment to conventional modalities, it can increase the rate of recovery while reducing stress. Since it works on the person’s qi, and qi regulates emotion, effective acupuncture boosts mood, too.
Another alternative treatment that acts on both the body and the brain is ketamine infusion. Ketamine is an anesthetic drug that, when administered by a qualified physician or anesthesiologist, acts on the nervous system to dampen excessive pain signals.
“It stops the transmission of pain from the body to the spine and to the brain, and gives the system the chance to reboot,” said Dr. Glen Z. Brooks, a New York anesthesiologist who offers ketamine treatments.
In cases of depression, ketamine promotes the growth of the synapses and lets the brain heal itself, reversing the structural causes of depression, according to Brooks.
The ketamine dosage and treatment plan for depression patients and pain patients are different, and must be customized to the person’s body weight, and so should be thought of as separate treatments, but patients with related conditions often see improvements in their symptoms.