26 February 2006

Depression and Chronic Pain

This is just an interesting example of how free-form thought on the Internet can produce surprising results. For instance, in my last post, I was trying to find a web site that spoke about suicidal ideation, and I came across this site:
Understanding Chronic Pain
I knew that there was some sort of a relationship between pain and depression. For instance, people who are depressed often experience headaches, back pain, joint pain, and abdominal pain. Of this list, I would say that the major symptom in my case is the back pain that I have -- nothing else can explain it. In fact, one study states
Up to two-thirds of those with unexplained pain meet the criteria for major depression
Now, take what they have to say about chronic pain and depression:

Consider some of the more devastating psychological effects of chronic pain:

1. Loss of mobility. Chronic pain and suicide ideation have been shown to be strongly related. However, recent research shows that chronic pain is usually a secondary cause of suicide ideation. One of the chief intermediary factors is the severe effect that chronic pain has on limiting mobility. Being unable to move around comfortably, constantly being constrained by pain, being unable to enjoy normal sexual relations with one's spouse or carrying one's children without fear of injury leaves a damaging mark on the sufferer's emotions.

2. Depression. Patients with depression are also heightened in their perception of pain, and will very often be reluctant to carry out treatment modules provided to them for fear of encountering more pain. The combination of immobility and depression leads to irritability, nervousness (or anxiety) and an unhealthy desire for isolation. Marital conflicts develop and escalate. As depression sets in, chronic pain patients tend to become more angry, easily frustrated, often moody, and plagued with feelings of hopelessness.

6. Anxiety. Pain may feature in anxiety disorders because of increased muscle tension or spasms. Tension headaches, post-infarct precordial pain and other pain syndromes affecting the musculoskeletal system may occur. Patients injured in motor-vehicle accidents often suffer from flashbacks of the accident, frequent nightmares, fear of driving or crossing the street, and extreme anxiety when returning to the site of the accident.

I was involved in a fatal automobile accident in January 2002. I don't remember anything about the accident, and have only one flashback: waking up and screaming uncontrollably due to the unbearable pain of being pulled out of my car by rescue workers. Apparently, the accident was a head-on collision on the Napeague stretch of Montauk Highway in Amagansett, New York. I was driving a 1999 Oldsmobile Alero, and I collided, head-on, with an Audi. I wound up in the emergency room; the driver of the Audi wound up in the morgue.

I realize that I have a lot of work to do in terms of dealing with this accident, and its outcome. Some people think that I merely fell asleep at the wheel, because the accident occurred around 8:30 at night. But those who knew me at the time would discount this; I worked nights and maintained a night schedule, even when not working. So 8:30pm was, to me, more like 8:30am to most.

My depression pre-dates my accident. Back in 1999, my friend Val, who is a Spiritual Counselor with a New York State Certification in School Psychology, suspected that I was suffering from chronic depression and a generalized anxiety disorder. She suspected that I've had the depression for quite some time -- probably dating back at least to my teenage years. I've been trying to get treatment for the depression ever since then, but without health insurance, it can be quite expensive, and difficult to obtain.

Currently, I'm not in treatment for my mental health issues, but I'm trying to get back into treatment. I know that my depression is a major cause of things not going right in my life. For instance, the reason I didn't finish law school was because I went into a double-depression while I was in law school, and that basically was the cause of my dismissal, although at the time, I didn't even know that I was depressed or had chronic depression.

So I have all of this chronic pain from the car accident, and that interacts with my depression, which makes the pain feel worse to me, which makes the depression worse, and it gets into this really vicious cycle. I used to be in pain management (after the accident, while my insurance was active for a time) but stopped going because of lack of insurance. Most of what they did was put me on painkillers, and let me tell you right now: the only painkiller I miss is the Celebrex. The side-effects of the other painkillers (mostly the opiates) were horrendous, and I really don't ever want to be put back on opiates for any length of time. Besides, the opiates didn't even fully take away the pain.

So, what should I do? Any suggestions for dealing with chronic pain and chronic depression?