When the Mind Causes Pain

By Marion Scher

For most people pain is sorted out with a pill, but for many their agony goes much deeper.

By the time Angie* (34) had seen her fourth specialist even she was beginning to think her stomach aches were a product of her imagination. They'd run every test of her from scans to swallowing barium and being X-rayed. The tests all proved negative and her family were convinced she was a hypochondriac. "There were days when I'd get up and could barely walk from the pain. I'd take painkillers which would ease the pain that day, but a few days later they would be back again. I even tried changing my diet, but apart from losing even more weight this didn't help either," explains Angie.

After suffering severe injuries to her leg from an accident, a knee replacement and a back operation, it wasn't long before Vonnie Ooostuizen (54) found herself relying more and more on tranquilisers. "At the beginning the painkillers worked, but I was having to take six at a time to really make a difference. I even found myself going from chemist to chemist trying to get more pills. Eventually I was taking around 50 pills a day. I was also sinking deeper and deeper into depression and my family life was really suffering. My children didn't understand what was going on and all the things I'd enjoyed before suddenly became secondary to my pain.

"I started making the rounds with different doctors to seek help – anything to stop the way I was feeling. It got so bad I really started to think and talk about suicide," explains Vonnie, choking with emotion at the memory. This was when Vonnie's husband decided to step in and seek psychiatric help for her. "The psychiatrist immediately asked to see what medication I was taking," she continues. "When he explained that the tablets I was taking contained, amongst other things, morphine, everything suddenly started making sense. He also explained that these strong analgesics in my case would never take away all the pain – that my depression had to be treated also."

What both these women had in common was that they were suffering not only from physical symptoms, but also from stress and depression. It was only after they'd been properly diagnosed and prescribed that right type of anti-depressant that dealt with not only the physical but mental symptoms, that their lives became normal again.

The Link Between Depression and Pain

These stories and many others like them are not new to psychiatrist Dr. Eugene Allers, who recently conducted local research as part of a global study examining the link between depression and painful physical symptoms. His research showed that of the patients studied, 66 percent suffered chronic pain symptoms, including headaches and backache. The global study by the World Federation for Mental Health found nearly 72 percent of people with acute depression did not believe, prior to their diagnosis, that painful symptoms such as unexplained headaches, backache, gastrointestinal problems and vague pains were in fact common symptoms of depression.

"If cases like these go undiagnosed the results can be very serious. We now know that the longer a person with depression goes untreated, the worse the condition will become, and what that less chance of full recovery," explains Allers.

For most people their GP is their first port of call, but unfortunately not all doctors are aware of the physical symptoms of depression and will automatically prescribe analgesic pain killers. "What many people don't realise is that so many pain tablets available over the counter contain codeine, which in many other countries is heavily regulated and has in fact been made illegal in Greece," says Allers. "Doctors need to make sure their patients don't abuse pain killers, or develop a dependence on them."

Getting the Right Diagnosis

But for Angie, suffering from pain was easier to admit to than telling people she was suffering from depression. "When I look back not I know it was stupid, but somehow I'd always associated depression with the words 'nervous breakdown' and I was scared of losing my job. I kept telling myself that I was obviously a bit down because of my back pain, but I didn't think this was a big problem."

According to psychiatrist Dr. Frans Korb, an expert in this field, the problem is that very few people link the psychical pain with the depression, which is part of the whole thing. "All they have to do is consult a depression check list to see if their symptoms fit the condition. Depression rarely presents itself as just a psychological condition – there are always some psychical symptoms and to treat depression properly you need to treat both symptoms."

Getting a correct diagnosis is the difficult part. Once someone has been correctly diagnosed the right type of anti-depressant that will work on both the symptoms can be prescribed, and in many cases psychotherapy is also recommended.

"It was just such a relief to be finally properly diagnosed," explains Vonnie. "I'd got to the point where I really thought I didn't want to live with the pain anymore and, as no one seemed to understand what was happening to me, I was starting to think I was going crazy. It was sheer hell."

But it wasn't just medication that her doctor prescribed – psychotherapy was needed to deal with what was actually contributing to the depression. This is where psychologists can often pinpoint the problems behind the depression.

"The best way of treating depression is generally a combination of both cognitive behavioural therapy and medication," explains psychologist Kevin Bolon. "Most people will see a difference within six weeks of treatment. Apart from their moods lifting, suddenly problems that seemed insurmountable will be solved and what seemed a catastrophe one day will seem manageable the next. Depending on the patient, some may only need a short period of treatment and others longer. What a person need to discover and correct is what caused the irrational patterns of thinking which led to the depression in the first place."

Why the Mind and Body Reacts This Way

Simply put, in the brain are chemical messengers called neurotransmitters. These chemicals control and regulate our bodily functions. Two of these chemicals, noradrenaline and serotonin, are responsible for the control and regulation of mood. Depression occurs because there may be a decreased amount of these two chemicals released from nerve calls in the brain. Normally when these chemicals are released from nerve calls they lighten moods, but when they're reabsorbed into the nerve calls they no longer have an effect on mood.

"There are different anti-depressants," explains Korb. Some work on the neurotransmitter, noradrenaline, and some work on the serotonin levels. A patient suffering from both pain and depression needs one that works on both. Where serotonin works for just mood it won't have any effect on the physical symptoms, so often the patient will continue with the pain killers, which is a vicious circle, worsening their condition."

According to Allers, the last decade has seen huge advances in psychiatric medication and treatment. "It's simply a case of making people aware of the link between their pain and depression and making certain they get help for it."

"I didn't even realise that I had depression, or maybe I didn't want to admit it, I'm not sure," says Angie. "Looking back a lot of my problems started after the break-up of my marriage, which had left me not only emotionally drained, but in financial trouble. I was stressed most of the time, just worrying how I was going to come out at the end of each month. I didn't associate my stomach aches and headaches with any kind of depression.

"It was after watching a talk show on television that I started to realise that maybe my problems were linked with depression. When I discussed it with my doctor he gave me anti-depressants, which helped my stress, but still left me with the stomach pains. When a friend suggested I see a psychiatrist I was sceptical – wasn't that for people who had serious mental problems? That wasn't me. But two weeks after taking the new medication I literally felt like a new women. Looking back I can't believe the years of agony I suffered."

The Case for Ongoing Treatment

But it's more than just getting the right diagnosis explains Allers. "It's vital that once someone is correctly diagnosed and put on the right medication that they don't stop the medication when they start feeling better. Often people will stop after say three months and the result is a relapse. They normally have to keep taking their anti-depressants for at least a year after their symptoms have gone."

With stress and pressure becoming a part of daily life, it stands to reason that depression is becoming one of the world's most common illnesses. Statistics show that 330-million people worldwide suffer from depression and that 90 percent won't get adequate treatment.

"I've got my life back," exclaims Vonnie. "When I look back now I can't believe how close I came to the edge. No one has to suffer like that.

Copyright 2006, Used with permission from Marion Scher.