Chronic pain is something that millions of people deal with every day in the United States. Often, chronic pain is defined as pain that that continues beyond the time it would take an injury to heal, or pain that lasts longer than three months and is dealt with each day.
While chronic pain is significant on its own, Dr. Shuchita Garg says that it is also a gateway for people to develop depression. According to her, as many as 30-50% of people with chronic pain also experience depression. We were fortunate enough to have Dr. Garg sit down with us to discuss the interaction between chronic pain and depression, along with treatment options that people can seek.
Erich Rüthers: First of all, congratulations on being nominated as one of the Top Doctors of 2020.
Dr. Garg: Thank you so much.
Q: Dr. Garg, thank you for speaking with us today. We wanted to start off by asking: What is chronic pain?
A: Thank you so much. Chronic pain is when you have some form of pain that lasts longer than the typical time it takes for an injury to heal. It is long-lasting. Often, you’ll hear people quote a specific time period for the pain, such as longer than three to six months of discomfort.
Q: You’ve said that there is a significant relationship between chronic pain and depression. Could you elaborate on that for us?
A: Chronic pain doesn’t just make you feel uncomfortable. After a while of waking up with an incessant backache or a neck injury that won’t get better, it begins to affect you mentally. People will often experience a loss in the quality of life with chronic pain since they can’t move around as much or do the things they love.
Even injuries that are not physical can involve chronic pain like diabetes, heart disease, and arthritis. The pain reduces people’s ability to enjoy life and that can result in depression and anxiety. Both of these ailments can make their pain worse and feed into their depression.
Q: You said that depression can feed into the patient’s chronic pain. How does that work?
A: When I see patients at UCMC Downtown, Midtown, and West Chester clinics, I know that you can’t just mark down the physical aspects of their pain. Yes, their pain is significant, but it’s only part of the problem we’re facing as doctors.
People who aren’t able to resume their typical lifestyle can become depressed. That causes them to struggle with their physical health, have unexplained pains, and have a high level of stress. Depression can make people feel worthless or guilty that they aren’t able to undertake their old work or hobbies. Not only are they feeling pain, but they are suffering from depression which creates new problems that will complicate their initial symptoms. Not only is this harder for the patient to deal with, but it’s also difficult for doctors to treat.
Q: What makes this so difficult for doctors to treat?
A: Part of the issue is that half of the people with depression who visit their doctor only talk about their physical symptoms. That makes it difficult to provide meaningful help for patients, which is available to people that are more honest about their symptoms. However, the other possibility is that patients don’t know that they’re suffering from depression.
Q: What are some things that people with chronic pain should look for with regard to the possibility of being depressed?
A: While these aren’t exact indicators that you are definitely depressed, they are several symptoms that people with chronic pain should look for if they think they might be depressed. For example, you might not be interested in the same activities as you once were. You might have feelings of guilt or despair. A lot of people experience a lack of energy and have difficulty concentrating.
You might gain and lose appetite, your sleep pattern could change, and you might have suicidal thoughts and idealization. All of these are signs that you could be experiencing depression.
If they’re feeling these symptoms, especially suicidal thoughts, they need to reach out to get treatment.
Q: Who can treat people that are suffering from chronic pain and depression? They’re two different ailments, right?
A: Treatment for chronic pain that is coupled with depression involves a multidisciplinary team. It’s best to approach all the elements of the problem and solve them together. Typically, a treatment team starts off with a physician that will give you a preliminary examination and evaluation. They provide a diagnosis initially and can prescribe medication.
The pain specialist is another important part that can educate you on the nature of chronic pain and how depression can set in. We’ll help you develop a treatment plan. It’s important to treat you in other ways, too. A therapist can use psychotherapy to help you cope and overcome pain or depression. They’re a great resource for families to use to learn about your condition as well.
Finally, you will probably see a physical therapist who can work to rehabilitate your injured area, give you more mobility and reduce your pain. Together, these team members, with others, can address all the different facets of a person’s pain and depression.
Q: What kinds of treatments are typical for chronic pain and depression? What can patients expect?
A: The treatments will always vary based on the extent of pain and depression. Yet, as a patient, you can expect to see things like talk therapy where you change your thinking and learn skills to help you cope with issues. Medication is also pretty common, usually analgesics for pain and antidepressant to treat mental symptoms.
You’ll also hear a lot of peer support groups helping each other with specific ailments so you can have an outreach in your community without going to a doctor. For severe cases, there are inpatient and outpatient pain programs that will help to manage symptoms, too.
Q: Are you working on any research project to find a relationship between pain and depression?
A: I am glad you asked this. Yes, in fact, we are. The process is underway to determine how patients who come for consultation for chronic pain, react to antidepressants and psychotherapy. We are working on finding correlations and compounding factors that make things better or worse during the course of treatment. I hope we should be ready to publish that soon.
Q: That is great to know. So Dr. Garg, what final thoughts do you have for people that might read this and still be on the fence about making a phone call to their doctor?
A: If you believe that you have depression in addition to chronic pain, you shouldn’t hesitate to be honest with your doctor. Pain, even if it’s invisible, can be treated with the help of the right doctors. You just have to take the first step, often the hardest, to start receiving the help that you need.
Dr. Garg has been a practicing anesthesiologist for 20 years. Presently, she works as an assistant professor in the department for Anesthesiology and Chronic Pain Medicine at the University of Cincinnati College of Medicine (UCCOM), Ohio, USA. She is also the Director of the UCCOM Clifton Pain Clinic where she has garnered a reputation as a very competent doctor. She was also named one of the Top Doctors of 2020 in the area of pain management by Cincinnati Magazine.