People with chronic pain often suffer from depression. In this lesson, you will: - Understand how depression can happen with any chronic medical condition - Learn how your mood can have an effect on physical symptoms - Learn some ways to break the cycle of depression and pain

1. How to deal with depression
Written by: Joanne Zeis
Reviewed by: Synne Wing, MSW, September 2015

2. Learning Goals
People with chronic pain often suffer from depression. In this lesson,
you will:
➢Understand how depression can happen with any chronic medical
condition
➢Learn how your mood can have an effect on physical symptoms
➢Learn some ways to break the cycle of depression and pain

3. Pain and Depression
People who have chronic pain often say that they feel depressed. Since pain causes
stress and can affect every area of a person’s life, it’s natural to feel frustration,
anger, fear, and sadness. These moods are all common reactions to a long-term,
stressful situation.
Over time, though, many people with pain say that they start to feel worse in other
ways, too – they sleep poorly, have low energy levels and sex drives, seem cut off
from others socially, and feel weak and tired. There may also be some difficulties
with memory and concentration. All of these problems can lead to a lack of self-
confidence, constant worrying about what has happened in the past, and fears of
what might happen in the future. Many of these fears center on physical symptoms,
and on the extra pain that the person is feeling. If these thoughts are allowed to
continue, a vicious cycle of pain and depression can develop that is hard to break.

4. The Vicious Cycle
If you have chronic pain, it might seem like depression is unavoidable:
➢Chronic pain can make it hard to do many of the activities that you
used to enjoy, which can cause a loss of self-esteem.
➢If your pain problem has been hard to treat, you may be afraid that
similar bad things will keep happening to you.
➢You may worry how you will keep coping with this pain, if it never
goes away.
➢Some people may even wonder if life is worth living, if their chronic
pain can’t be relieved.

5. The Vicious Cycle
Stopping the pain-and-depression cycle can be hard. The first step is to
understand the two types of depression:
1. Reactive depression is caused by big losses or bad situations in a
person’s life. Most people will deal with reactive depression at
some point.
2. Biological depression is based on a chemical imbalance in the
brain, which can cause depression to develop even if there is no
specific event to set it off. Your chances of depression are higher if
other people in your biological family have a history of depression.

6. Be Informed and Start Slowly
You’re going through a difficult time, but rest assured, other people
have been in your shoes and know how you feel. Depression is a natural
reaction to unpleasant events and situations. It’s possible to learn new
ways to cope with pain and depression, so that your life can improve
again.

7. Be Informed
➢Connect with other people who understand what you’re going
through. This can be done through the Internet and through support
organizations in your area. Many local hospitals also sponsor support
groups for people with chronic conditions.
➢Learn as much as possible about your condition from your doctor, the
Internet, books and support groups.

8. Start slowly
➢Remember, you didn’t get to this point in your life overnight.
Improving your mood and learning how to cope with pain may take a
while.
➢Congratulate yourself for any small improvements that you’ve made
in your situation.
➢Try to avoid thinking about what will happen years from now. Most of
these thoughts can be negative, and will only add to your worry.

9. Stay active
Being active may not make sense to someone who hurts with every attempt
to exercise. But slowly increasing your activity level is important, to keep you
from getting weaker, and to improve your mood.
➢Meet with a physical therapist or exercise physiologist. Each has
experience working with people in chronic pain. They can map out a
regular program to build your strength slowly and increase your self-
confidence.
➢Doing too much in the beginning of an exercise program is not helpful.
Have a gradual walking, stretching and strengthening program to help keep
you fit and to raise your spirits.

10. Keep your mind occupied
Distraction from constant worried thoughts is important. Being alone
with your pain and the four walls is not a good way to cope with a
chronic condition. Make a list of things that will keep you busy each
day, even if you’re experiencing a flare-up of pain. Some options may
include:
➢Visiting with friends
➢Watching sporting events
➢Reading
➢Movies
➢Video games

11. Learn to Relax
➢People who get depressed often say that they feel tense and “tight.”
It’s possible to teach yourself to relax through some of the following
methods:
❖Take slow, deep breaths that use the diaphragm.
❖Try tensing and relaxing different muscle groups in your body, one at a time.
❖Repeat calming phrases to yourself.
❖Use guided imagery – listen to a record that lets you imagine yourself in a
calm, quiet place
❖Close your eyes and think of being at a peaceful vacation spot

12. Change your way of thinking
➢Some counselors who work with depressed people use cognitive
behavioral therapy (CBT) to break problems down into bite-size
pieces and deal with them objectively – without getting upset. This
process teaches people how to feel stronger if they are facing bad
situations.
❖Realize that some things, no matter how much you may worry about them,
will not change. They are out of your control.
❖Recognize the things that you can control, and let go of the things that are
out of your control.

13. Get support
➢Chronic pain is a “hidden” condition. It may not be obvious to other
people that you’re hurting, so you may feel alone in your pain.
❖Get support from others who understand what you’re going through. Chronic
pain support groups are available at some local hospitals or clinics; there are
also groups available on the Internet.
❖Even if you’d rather be alone, sharing your feelings with people who are
honestly concerned and understanding can be very important.

14. Work toward success
➢You might feel that you have to accept your situation as it is, but
that’s not the case. It’s still possible to set goals for your life, and to
work towards them one at a time.
❖Set a realistic plan for what you can do in the future.
❖Consider work options that you might not have considered before.
❖Meet with a career counselor to uncover special interests and skills that you
can use in a new job.

15. Let Specialists Help
➢Coping with depression isn’t easy, and it’s sometime tempting to give
up. Specialists are available to help, though, and can often prescribe
antidepressant medication to improve sleep, pain levels, and mood.
❖If an antidepressant is prescribed for you, learn as much as possible from
your doctor about it. Speak up if you have unwanted side effects.
❖Keep in mind that there’s not a “quick fix” for most pain problems. Your care
provider may have to try a few different medications before finding the best
combination to help you.
❖By doing what you can to improve your situation, you can start to feel better
about yourself – and more confident about managing your chronic pain.

16. Additional Resources:
➢Caudill, M.A. (2002). Managing Pain Before It Manages You, Revised
Version. New York: The Gilford Press.
➢Otis, J.D. (2007). Managing Chronic Pain: A Cognitive-Behavioral
Therapy Approach. Workbook. New York: Oxford University Press.