Listen to the pain
Chronic suffering may be pointing to deeper mental health issues
During my years as a professional counsellor, I have met many people who live with a chronic pain condition. When they wonder why their physician would refer them for talk therapy, they are often dismayed to learn that depression and pain are interconnected.
Most people suspect that long-term pain can lead to depression but are surprised that the converse is also often true; depression can lead to pain symptoms. Sometimes pain and depression spiral into a vicious cycle in which depression aggravates pain levels, which in turn further increases depression.
Patrick (a composite of several clients) is a case in point. His long-ignored depression eventually triggered severe unexplained headaches. For some people such pain might be the only sign of depression. The pain and its related problems wore Patrick down over time and affected his mood. He handled normal stresses poorly and developed difficulty sleeping. Eventually his disabling headaches led to low self-esteem as he missed too much work, fell behind on his monthly payments and bills, and found he was arguing almost daily with his wife.
As Patrick and I talked about his life and his current situation, he sounded defeated and admitted to feeling hopeless, doubtful that his circumstances could ever change for the better. His difficult childhood and several life-altering events in later adolescence had left him feeling that “life is out to get me” and that he had no control over his future wellbeing.
Because Patrick didn’t know the classic signs of depression such as persistent low mood or feelings of sadness, feelings of hopelessness and helplessness, changes in sleep or eating patterns, and loss of interest in once pleasurable activities, he had never considered that he might be depressed. Therefore he was unaware that depression might be causing his ever-present headaches.
To achieve control of symptoms of pain and depression, each condition might need separate treatment or, as in Patrick’s case, one treatment was able to improve both. Antidepressant medication helped relieve his pain and depression because of shared chemical messengers in the brain. Our sessions spent talking together taught him stress-reduction strategies, the importance of regular exercise and other healthy living habits, relaxation exercises such as meditation and visualization, and self-directed thinking changes to help him gradually change his negative outlook on life to a more positive one.
The last time Patrick and I met, he reported that his headaches were much milder and occurred less often. He had participated in a local support group, which helped him solidify his new self-care strategies and gave him a sense of camaraderie, as he realized that he was not alone in his situation; others were also learning to navigate the experience of chronic pain and depression.
Patrick is glad now that he got help before his symptoms became even worse. “I didn’t know how depressed I had become,” he shares, “but medication, counselling, and the changes I chose made it possible for me to feel like myself and actually enjoy life again.”
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