(W)holy, (W)holy, (W)holy: Health, Healing and Wholeness Article for March 2010
“How long, O Lord? Will you forget me forever? How long will you hide your face from me? How long must I bear pain in my soul, and have sorrow in my heart all day long?” (Psalm 13:1-2a, NRSV)
Salt and pepper; peanut butter and jelly; tea and honey; coffee and cream; chronic pain and depression. Some things just seem to go hand-in-hand. Pain – especially the chronic/on-going kind, can wear down even the hardiest of souls, and is often closely linked to depression. It can trigger a wide range of negative emotions: irritability, anger, fear, anxiety, and despair. It is estimated that 30-80% of people with chronic pain also suffer from clinical depression. Chronic pain stresses all aspects of our well being – it certainly threatens our physical, but also our emotional, spiritual, even sometimes our financial health. People with chronic pain have three times the average risk of developing psychological symptoms, and depressed people have three times the average risk of developing chronic pain. Roughly 32 million people report having had pain lasting longer than one year. Those whose pain limits their independence are especially likely to become depressed.
Why? Depression and chronic pain share some of the same neurotransmitters – brain chemicals – as well as some of the same neural (nerve) pathways in the limbic region of the brain – the area that serves as the seat of our emotions. Yet depression associated with chronic pain often goes untreated – the pain often takes center stage during a typical 15-20 minute office visit. As the depression magnifies pain, it reduces our coping skills. Chronic pain may be difficult to eliminate, but almost always can be managed. Treatment often takes a multi-dimensional approach, which may include your regular healthcare provider, pain or palliative care specialist, psychiatrist and/or a therapist.
Medications are now available which work by affecting brain chemicals that are responsible for both mood and pain. Talk or cognitive-behavioral therapy can also help the individual deal with depression by exploring the mind-set or attitudes of the sufferer in regard to his/her pain, by sometimes uncovering long-standing emotional conflicts or negative thoughts that contributed to suffering, and by exploring some of the losses that may have been triggered by the chronic pain. Often a combination of both treatments will need to be utilized in order to lead to an improved sense of well-being. Once initiated, it is important to understand that treatments may take time to become effective, and because we all experience pain and depression differently, may require changes/adjustment to accommodate the needs of the individual.
Physical exercise also can be an important aspect of treatment. Exercise releases some of the same brain chemicals as anti-depressants. It is crucial that the individual work with his/her doctor to design an exercise plan that is safe and effective, and does not worsen the pain.
Chronic pain and depression may lead to spiritual crisis, resulting in a feeling of hopelessness, a sense of abandonment, questioning the meaning of life, and in severe cases, even consideration of suicide. An important aspect of being with those who suffer is listening with one’s whole being without judgment of feelings that may be expressed. Gently assist them in exploring additional pain management techniques. A daily prayer ritual may bring some relief or at least a diversion from pain. Learning meditative prayer and/or relaxation techniques can also be very beneficial. Finally, assist the individual in maintaining ties with his/her congregation – through visits, providing the Eucharist, cards, flowers, taped worship services. Being a part of a compassionate, praying community is a vital means of social, emotional, and spiritual support. (Resources: http://www.webmd.com/depression/guide/depression-chronic-pain; http://www.johnshopkinshealthalerts.com/reports/healthy_living/3034-1.html?type=pf; and http://www.health.harvard.edu/newsweek/Depression_and_pain.htm)
“I trusted in your steadfast love; my heart shall rejoice in your salvation.” (Psalm 13:5)
Debbie Best
Diakon Family Life Services
