Pain and the depression-anxiety connection

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No matter how mentally or physically fit you are, pain is never welcomed. But for people with depression or anxiety, pain can be more intense and harder to treat. This is especially true for those dealing with fibromyalgia, nerve pain, headaches, low back pain, and irritable bowel syndrome.

Healthcare providers have long recognized that both depression and anxiety can cause pain. Anxiety, for example, is often accompanied by chest pain, while back pain and headaches are often the first symptoms of depression.

In addition, chronic pain can lead to both anxiety and depression. Loss of mobility or the inability to engage in once common and simple activities, can lead to worries about employment, and safety and can compromise quality of life.

Over time, that anxiety can turn to depression. Depression, in turn, can lead to lack of energy, sleep problems, loss of appetite, and other issues which can make pain worse.

It can be a vicious cycle.

The challenge for providers and patients is recognizing the separate and concurring conditions at play and treating each individually and properly.

The most common and effective treatments for patients with overlapping pain, anxiety and/or depression include both psychotherapy and drug treatment and, very often, a combination of the two.

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Here are some options you may wish to discuss with your provider:

- Exercise. According to several studies, regular exercise works as well as medication for some people to reduce symptoms of anxiety and depression. Exercise can also help to alleviate pain by building muscle strength and improving physical function in patients with chronic conditions, including fibromyalgia.

- Antidepressant medications. Frequently prescribed for both anxiety and depression, antidepressants are available in many formulas, some of which can also help with nerve pain. However, these double-duty drugs are not without side effects. Ask your doctor which medication, if any, may be right for you.

- Talk therapy. Also known as psychotherapy or cognitive behavioral therapy, talk therapy has been found to be highly effective at treating pain. Recognizing that pain, anxiety, and depression are all related, therapists can help patients develop coping skills to manage their conditions effectively and regain control of their lives.

- Stress-reduction therapies. Often taking the form of yoga, Tai Chi, progressive muscle relaxation, meditation, and even journaling, stress-reduction therapies can help patients relax and reduce the stress response. Frequently, coping skills and strategies covered in these therapies can be use in day-to-day living to manage anxiety and pain.

Finally, we are accustomed to talking with our doctors about pain. But, if you think that you might also have anxiety and/or depression, be sure to discuss that with your doctor as well. The sooner you're able to figure out all the factors contributing to your condition, the sooner you'll be on the path to regaining a sense of overall wellbeing.

Dr. Kim Fodor is an internal medicine physician at Southwestern Vermont Medical Center Internal Medicine.


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