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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
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Pain and Depression

Allan N. Schwartz, LCSW, Ph.D. Updated: Nov 7th 2007

I a recent posting I talked about an illness called Fibromyalgia. One of the reported symptoms of this disorder is chronic pain and depression. There was a time when the medical establishment believed that chronic pain was always a symptom of depression and nothing more. Now, we know that mind and body are not separate and that pain is both physical and mental in nature. How is this so?

David Morris in his book, The Culture of Pain, "Pain only exists as we perceive it." In other words, pain is a signal, a symptom that something is wrong organically. However, the experience of pain is subjective. This is why people have such difficulty describing it and why there is no objective way to measure pain.

Morris states that pain rests on four legs each of which is a contributor to the experience of pain:

Leg one is the physical cause of pain. Morris emphasizes that traditional medicine focuses on this first leg of pain.

Leg two is muscle tension caused by people bracing themselves when they experience pain. Over a long period of time during which chronic pains is experienced this muscle bracing muscle tightening increases the painful sensation. In addition, the pain spreads to the adjoining muscles because of their constantly being tightened.

Leg three is the attention the patient focuses on the pain.

Leg four is the way in which the individual interprets the sensation of pain. In other words, pain is a sensation. The interpretation of pain may include "suffering" and that is open to each individual's interpretation. Interpretations include judgments, emotions, and expectations about the pain. These interpretations of the pain experience can actually worsen the experience. Thoughts such as "I cannot stand this another minute," or, "This must be punishment for something I did," all contribute to increasing the woe that is experienced.

There is also research that shows that pain can and does lead to depression. In fact, the greater number of illnesses a person suffers from such as heart disease and diabetes, the more likely they will experience depression even if they never did so before.

One of the valuable outcomes from understanding the connection between pain, illness and depression is that there are many more ways to treat pain and to gain relief than relying solely on medication. If perception or interpretation of a sensation influences the way we experience the sensation then, if follows that, changing that interpretation will alter the experience.

For example, if pain causes the patient to focus on that sensation then learning ways to distract attention will alleviate pain by creating a distraction. A friend of mine underwent a very serious surgery and was sitting up in bed the next day, with their lap top, focusing on work instead of her discomfort. Some of the ways we can use distraction is to engage in meditation, guided imagery, self hypnosis, etc, as ways of directing attention away from the discomfort.

If depression results from chronic pain because someone is thinking that life is hopeless and they will never feel better then Cognitive-Behavioral Therapy will go a long ways to alter those thoughts and the way an individual feels.

In a similar way, if tightening muscles aggravates pain then things such as deep muscle relaxation, massage, acupuncture and do on, will help reduce the discomfort that is felt.

Pain is a signal that something is wrong. As such, it is a signal and sensation that alerts to organic and/or mental problems. It should never be ignored and medical help should be sought both what is causing the pain and for the underlying or overlying depression. In addition, the treatment of chronic pain should include both medication and non medication methods of handling this sensation.

Your comments are welcome

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at for details.

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