Pain

Pain and mood are incredibly interconnected.

In part 1 of the pain-mood connection, we discussed a few factors including connected brain pathways that result in pain from physical and mental conditions. Additionally, these pathways appear to light up even more in patients with mental health conditions, like depression, making pain tolerance all the worse. We also briefly looked at inflammation, a difficult-to-appreciate factor of chronic illness that can over time, bring damage to your body and immune system.

Today, what steps are there to take to help with both the physical and mental aspects of pain and mood. 

Pain And Mood: Simple habits to integrate into your life:

1. Consider seeing a psychiatrist. Seeking psychiatric evaluation if you are dealing with mood disorders, seems pretty straight forward. But if you have chronic pain, and are unsure if your mood symptoms are interfering, finding a consult liaison psychiatrist (formerly psychosomatic medicine) can really help to better understand this connection and determine if you might be helped with therapy and or medications.
2. Progressive Muscle Relaxation. Progressive Muscle Relaxation or PMR, has been studied in insomnia and was developed in the 1920s to assist patients who suffered from various illnesses. It was developed by Edmund Jacobson who felt there was a common overlap in patients with chronic illness that they all had muscle tension and pain, worsening whatever else they were dealing with. Utilizing PMR can help create a feedback loop to your brain that you are in a relaxed state, control your anxiety and stress, and decrease tension that worsens pain. It can also help you better understand what it feels like to be in a relaxed state so that you can better intervene when you are stressed. 
3. Meditation. There is a lot out in pop culture about meditation today, including specific meditation studios in big cities. But, meditation has been around for thousands of years, and has been show to help calm both pain and mood symptoms. There are tons of free apps for meditation, so it can be cost effective as well. 
4. 4-7-8 breathing. My patients must by now think I’m a broken record, because one of my favorite techniques for stress, anxiety, and tolerating pain is a breathing exercise. In using 4-7-8 breathing, you are inhaling a deep breath into your belly to a count of 4, holding your breath for a count of 7 and exhaling as deeply as you can to a count of 8. It takes some getting used to, and if you have any lung issues, this may not be for you. Again, it can feedback to your brain that you have taken control of your “fight of flight” response and you can regain focus or push through whatever stressful event is going on.
5. Positive psychology. A quick intervention I like to talk about is the idea of identifying “3 good things” everyday. They don’t have to be profound. It could be that your train came on time or that you enjoyed your coffee this morning. It could be that you got a promotion or that you got outside for 5 minutes of sunshine. Keep up listing these good things to remind your brain that even in the setting of struggling with mental health or physical illness, including pain, there are good things to keep looking out for. 

As always, speak with your doctor before undergoing interventions, but I hope these can be helpful ideas to integrate into your life, no matter what you’re going through. 

**This blog is not to be treated as medical advice, please discuss with your physician if you have any concerns.**

Lady Gaga presented us with a wonderful statement at the 2019 Grammy Awards, “If you see somebody that’s hurting, don’t look away, and if you’re hurting, even though it might be hard, try to find that bravery within yourself to dive deep and go tell somebody…”

Her quote speaks to what we often seen used in colloquial language, depression and other mood symptoms can be painful. But then why do we so often associate pain with only the physical? Realizing the profound and reciprocal mental and emotional impact on pain can be freeing and help to decrease the stigma to get treatment for mental health conditions associated with physical illness. 

What happens when the body interprets emotional signals as pain? Mental health diagnoses such as depression, anxiety, somatic symptoms, and PTSD can significantly overlap with pain signaling in the brain and research looking at brain scans have found that in certain diagnoses, areas in the brain associated with pain light up more in patients that also suffer from mood disorders. Thankfully, even without great assessment tools to quantify pain, gone are the days of chalking it up to being “all in your head.” Physical conditions can stand alone without an interference from mental health, but, it doesn’t mean that having an untreated or under-treated mood disorder can’t worsen your physical conditions.

In fact, as a consult liaison psychiatrist, my specialty training is focused on this exact intersection of the physical and mental and how our bodies respond to various stressors, including pain. Although many conditions can be included, some of the most prominent and debilitating include headache disorders, neuropathy, inflammatory bowel disease, fibromyalgia, and chronic fatigue. In working with these patients, under medical care for their diagnosis, we can tackle many aspects of how to decrease pain by utilizing psychotherapy and medications.

The Pain-Mood Connection

Another interesting aspect of the intersection of pain and mental health is the idea of inflammation in the body. Many chronic illnesses, including chronic pain (whether it is isolated or due to another illness) can result in signs of physical inflammation, including elevated cortisol levels, elevated white blood cell counts, and decreased immune functioning. Depression and anxiety can do the same, and make other chronic physical illnesses worse! It is so important to treat these conditions for overall health and wellbeing and to decrease stress on your body. Often patients with mood disorders express feeling shame that they cannot just “deal with it.”

Let’s think of a different example. No one suggests that a patient diagnosed with cancer simply “walk it off”. Mental health conditions that result in inflammation are just as important to treat, to prevent long term damage to our bodies. They deserve to be thought of as chronic illness and as disorders that can get better, with the right treatment. The first step to stopping the hurt is reaching out and better understanding your condition and treatment options, ideally with a psychiatrist that is trained in consult liaison psychiatry to help you understand how your mental and physical conditions are intersecting and what to do next. 

Check out the blog on Thursday for tips to intervene on both mood and pain in your everyday life. 

**This blog is not to be treated as medical advice, please discuss with your physician if you have any concerns.**