Mental health and Hormones

Cortisol levels are also influenced by chronic pain and mental health problems. Cortisol is a hormone in your body that addresses stress. It can cause or decrease inflammation and it can weaken the immune system. Chronic pain is altered by our emotions and mental health, for better or for worse.

Over time, the number of areas in the brain affected by chronic pain will expand and mental health problems will increase. Signs and symptoms of depression include feeling sad, hopeless, worthless, guilty, a lost of interest in hobbies, gaining or losing weight, insomnia, too much sleep, unexplained physical feelings, and thoughts of death and suicide. Signs and symptoms of anxiety include feeling tense, restless, irritated, trouble focusing, not being able to sleep, an increase in heart rate and blood pressure, loss of food cravings, and feeling their heart pounding in their chest. Anxiety can cause people to catastrophize their pain and to constantly focus on the pain. Magnification, the feeling of the pain and other problems being overwhelming, may occur. Then there is rumination, being able to only think about the pain all the time. And then constantly feeling a lack of control over this very stressful situation.

When a person develops chronic pain, they eventually discover that they are no longer capable of doing all the activities they used to enjoy. Especially activities that require physical strengths and abilities such as playing sports, going on runs and walks, and playing with their kids. This can lead to low self-esteem. It is also common to develop sleep disturbances, fatigue, trouble focusing, decreased appetite, and mood changes. Chronic pain can also lead to activity restrictions, opioid dependency, anxiety and depression, and a reduced quality of life. Staying home all the time leads to social isolation. Your chances of developing depression are increased by 4 times if you have chronic pain. Your chances of having suicidal thoughts and following through on committing suicide are increased by 2 times if you have chronic pain. High impact chronic pain is known to cause more mental health problems than low impact chronic pain. With high impact chronic pain has major activity restrictions like not being able to work or drive. A cycle of depression and pain develops, each one making the other worse.

Different types of chronic pain increase the risk for different mental health problems. Fibromyalgia affects mental health, social life, energy, and overall health. It is most common in women and increases your chances of developing an anxiety disorder by 5 times. It has also been known to lead to obsessive-compulsive disorder, but there are also increased risks for borderline personality disorder and PTSD. Multiple sclerosis can lead to depression, anxiety, and something known as the pseudobulbar effect. The pseudobulbar affect is pathological laughing or crying in situations that are neither funny or sad. With multiple sclerosis there is a disruption of social support and family systems. There are increased risks for developing generalized anxiety disorder, panic disorder, and an obsessive-compulsive disorder. Major depressive disorder increases the risk of developing chronic migraines. People with idiopathic pain (cause of pain is unknown) often have higher levels of depression because they may assume that without a diagnosis, there is not a specific treatment. Doctors may also assume these patients are lying or that they are opioid seeking. They are less likely to be given medications and specific treatments. This can be incredibly discouraging, but there are still treatments out there. Some people may go through several doctors before they find someone who believes them and is ready to work with them.

Another form of mental health problems that may actually lead to chronic pain are somatoform disorders. This is when the pain symptoms are linked to psychological factors. I’d like to make clear that regardless of what is causing the pain, that person is still in pain and in need of a solution. Their pain is not any less real because a specific physical cause cannot be identified. Examples of somatoform disorders include hypochondriasis, conversion disorder, psychogenic pain disorder, and somatization disorder. With these disorders, the symptoms are not under conscious control and can occur in the absence of underlying feelings. People who develop somatoform disorders tend to have a family history of depression and alcoholism, and they may have been considered a “workaholic” before the onset of pain. They may have family members who are disabled or afflicted with chronic pain. When they come into the ER or go to the primary physician, they usually demand surgery. It’s important to remember that there is a very long list of ways to treat chronic pain and that in most cases surgery should not be the first option.

Treating Mental Health and Chronic Pain

Good news!! All of these problems can be treated, especially if you’re willing to put in the time and effort, because truly healing your physical and mental health takes work. Before diving into this, I highly recommend checking out my pages on exercise, sleep, diet, and lifestyle. People are different, physically and mentally, and just because a treatment worked for one person, that doesn’t mean it will work for you. The first step to treating mental health and chronic pain is finding a good provider that believes in you, even if they don’t know why you have pain. Then find a pain psychologist who will help you have more control over your emotions and how you feel pain.

Different types of therapies have been known to successfully treat mental health problems and/or chronic pain. Interpersonal therapy is based on the assumption that depression results from difficulties in interpersonal relationships. Therapists teach people alternative ways of interacting with others. Ideally, this type of therapy will lead to improved relationships and an elevated mood. An improved social life and positive moods can be beneficial for mental health and chronic pain. Cognitive behavioral therapy is based on the assumption that depression results from dysfunctional cognition about self and others and beliefs about the future. This can lead to improved affective and behavioral responses. Cognitive behavioral therapy is known to be helpful in treating chronic pain regardless of existing mental health problems. Acceptance and commitment therapy helps you to accept yourself, be present, put an end to negative thoughts, and figure out what is meaningful to you. There are other options such as mindfulness training (breathwork and meditation), clinical hypnosis, and supportive therapy.

Ideally people should be treated with pharmacological methods and psychotherapies. Sometimes people refuse all forms of psychotherapies. This may be due to stigmas surrounding therapy and mental health. Antidepressants and benzodiazepines may be given. These will have their own side effects so use with caution.

Chronic Pain and Suicide

Chronic pain increases the risk of committing suicide by 2 times. When my pain was at its worst, I would have suicidal thoughts, especially if my insomnia was keeping me awake all night. I would lie in bed at 3 AM, feeling insanely alone, and wanting to die. Luckily, I was in therapy and I eventually started seeing improvements in my pain. The suicidal thoughts are gone and so is the depression. Risk factors for suicidal thoughts include unemployed, disabled, depressive symptoms, anger problems, harmful habits (smoking, drinking), family history of depression or suicide, sleep problems, having more than one chronic pain diagnosis, mental defeat, hopelessness, and feeling like a burden to others. The most effective way to diminish these risk factors is to treat the pain itself. There are therapies and medications for this and there are also support groups. If you are struggling with suicidal thoughts, please let others know, and know that it isn’t worth it because you are still capable of living a beautiful life. The National Suicide Prevention Hotline is 800-273-8255.

Sources

Chronic pain and Mental Health. Mental Health America. (n.d.). Retrieved November 3, 2021, from https://www.mhanational.org/chronic-pain-and-mental-health.

Osterweis, M., & Kleinman, A. (1987, January 1). Psychiatric aspects of chronic pain. Pain and Disability: Clinical, Behavioral, and Public Policy Perspectives. Retrieved November 3, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK219250/.

Murez, C. R. (2021, March 30). Mental health and chronic pain: The Empowered Patient’s Guide. Practical Pain Management. Retrieved November 3, 2021, from https://www.practicalpainmanagement.com/patient/conditions/chronic-pain-mental-health-guide.

Racine, M. (2017, August 26). Chronic pain and suicide risk: A comprehensive review. Progress in Neuro-Psychopharmacology and Biological Psychiatry. Retrieved November 3, 2021, from https://www.sciencedirect.com/science/article/abs/pii/S0278584617304670?via%3Dihub.