Leslie Durr, PhD, RN, PMHCNS-BC is an advanced practice psychiatric-mental health nurse with a private practice in Charlottesville, Virginia.
While she has always seen a connection between physical pain and depressive symptoms in her patients, her own bout with chronic pain has helped her to understand the connection between body and mind more clearly…. in herself and her patients.
The following is a portion of a blog she recently wrote detailing her own experience:
For a little over a year, I’ve been plagued off and on with pain from sciatica. Until recently, it hadn’t been too bad and did not stop me from doing everything I was used to doing.
Then about two months ago, the pain became really bad. The pain was constant and started shooting down both legs; it was painful to change position in bed at night and that affected my sleep. I had to be careful because even a slight movement, which I could not predict would leave me breathless in pain.
Fortunately, sitting in a chair was completely comfortable, so I kept seeing patients and continued to write. The rest of my world grew smaller and smaller. I became fearful of moving too much, and my disturbed sleep at night meant I was even more tired the next day. Things I used to enjoy doing, like sewing, were abandoned. Food didn’t even taste as good as usual.
It dawned on me: Oh, my gosh, am I depressed? I knew that pain and the problems it causes can wear you down over time and can affect your mood. Chronic pain causes a number of problems that can lead to depression, such as interrupted sleep and stress.
Scientists don’t yet know how depression and chronic pain are linked, but the illnesses are known to occur together. Just as chronic pain can worsen depression symptoms in someone already depressed, it can also be the precipitant of depressive symptoms. There is communication between body and brain that goes both ways. Brain pathways that handle the reception of pain signals, including the seat of emotions in the limbic region, use some of the same neurotransmitters involved in the regulation of mood, especially serotonin and norepinephrine. And chronic pain, similar to chronic depression, can alter the functioning of the nervous system and perpetuate itself.
In my case, an MRI revealed something was bulging and pressing on nerve roots in the lumbar area of my back. Ouch. A minor procedure was performed in hopes of eliminating the pain. Double ouch.
Of course, with pain comes the issue of control. As a nurse, I am among those who find being in control of one’s life very important. This relentless pain has led to a decreased ability to engage in a variety of activities such as work, recreational pursuits, and interaction with family members and friends. And we were just making preliminary plans to go on a safari next fall. The uncertainty is as depressing as the pain.
After some relief, I am back to square one. I am counseling myself as I would a patient to do other therapeutic things such as making time for mindfulness and I’m reminding myself not to catastrophize or deal in black-or-white thinking. And, in two days, I’m starting physical therapy, which can help me become mobilized, as surely there is an element of deconditioning added after this amount of time.
In nursing practice, we now recognize assessing for pain as “the fifth vital sign” after temperature, pulse, respiration, and blood pressure. I don’t know how much assessing for pain has made it into mental health practice, but you can be sure that when patients present with depressive symptoms, I will be asking them about long-standing pain in their life….. Psych Congress 12/20/13