Smerte/angst/depresjon

[Nils Håvard Dahl, psykiater]

Denne kom på mail fra Harvard i kveld. Jeg synes den er verdt å lese:

The pain-anxiety-depression connection.

Everyone experiences pain at some point, but for those with depression or anxiety, pain can become particularly intense and hard to treat. People suffering from depression, for example, tend to experience more severe and long-lasting pain than other people.

The overlap of anxiety, depression, and pain is particularly evident in chronic and sometimes disabling pain syndromes such as fibromyalgia, irritable bowel syndrome, low back pain, headaches, and nerve pain. Psychiatric disorders not only contribute to pain intensity but also to increased risk of disability.

Researchers once thought the relationship between pain, anxiety, and depression resulted mainly from psychological rather than biological factors. Chronic pain is depressing, and likewise major depression may feel physically painful. But as researchers have learned more about how the brain works, and how the nervous system interacts with other parts of the body, they have discovered that pain shares some biological mechanisms with anxiety and depression.

Treatment is challenging when pain overlaps with anxiety or depression. Focus on pain can mask both the clinician’s and patient’s awareness that a psychiatric disorder is also present. Even when both types of problems are correctly diagnosed, they can be difficult to treat.

Treatment options when pain and anxiety or depression intersect

In patients with depression or anxiety, various psychotherapies can be used on their own to treat pain or may be combined with drug treatment.

Cognitive behavioral therapy. Pain is demoralizing as well as hurtful. Cognitive behavioral therapy (CBT) is not only an established treatment for anxiety and depression, it is also the best studied psychotherapy for treating pain. CBT is based on the premise that thoughts, feelings, and sensations are all related. Therapists use CBT to help patients learn coping skills so that they can manage, rather than be victimized by, their pain.

Relaxation training. Various techniques can help people to relax and reduce the stress response. Stress tends to exacerbate pain as well as symptoms of anxiety and depression. Techniques include progressive muscle relaxation, yoga, and mindfulness training.

Hypnosis. During this therapy, a clinician helps a patient achieve a trance-like state and then provides positive suggestions — for instance, that pain will improve. Some patients can also learn self-hypnosis. One study showed that hypnosis training reduced both gastrointestinal distress and levels of depression and anxiety in 71% of those studied.

Exercise. There’s an abundance of research that regular physical activity boosts mood and alleviates anxiety, but less evidence about its impact on pain.

The Cochrane Collaboration reviewed 34 studies that compared exercise interventions with various control conditions in the treatment of fibromyalgia. The reviewers concluded that aerobic exercise, performed at the intensity recommended for maintaining heart and respiratory fitness, improved overall well-being and physical function in patients with fibromyalgia, and might alleviate pain. More limited evidence suggests that exercises designed to build muscle strength, such as lifting weights, might also improve pain, overall functioning, and mood.

Patients with anxiety or depression sometimes find that combining psychotherapy with medication offers the most complete relief. A randomized controlled trial, the Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study, suggests that a combination approach might also work for people suffering pain in addition to a psychiatric disorder.

Double-duty medications

Some psychiatric medications also work as pain relievers, thereby addressing two problems at once. Just remember that pharmaceutical companies have a financial interest in promoting as many uses as possible for their products — so it is wise to check that evidence exists to support any “off label” (not FDA approved) uses for medications.

Patients may prefer to take one medication for the psychiatric disorder and another for pain. In this case, it’s important to avoid drug interactions that can increase side effects or reduce the effectiveness of either drug. Talk to your doctor if you are taking multiple medications.

Antidepressants. A variety of antidepressants are prescribed for both anxiety and depression. Some of these also help alleviate nerve pain. The research most strongly supports the use of serotonin and norepinephrine reuptake inhibitors (SNRIs) or tricyclic antidepressants (TCAs) as double-duty drugs that can treat both psychiatric disorders and pain. The findings are more mixed about the ability of selective serotonin reuptake inhibitors (SSRIs) to alleviate pain.

[bibben]

...som et lite apropos anbefales "Mindfulness - Treningsredskap for hjernen" skrevet av psykiateren Åsa Nilsonne...

Løp og kjøp )

[RedakTom]

Nå vet jeg ikke om dette har noe som helst med saken å gjøre, men jeg har merket at min smerteterskel er betydelig lavere nå som jeg har 3 år bak meg på SSRI enn før jeg begynte med tablettene. Det plager meg ikke, bare at jeg trenger litt mer bedøvelse hos tannlegen og oftere "kjenner" smertene bedre. På en måte.

[marlenexxx27]

Jepp, Immanuel Kant var en dust.

[Gjest solfryd]

Hurra for SSRI!

[cathlin]

Jeg kunne tenkt meg yoga på blå resept.

[Gjest datter av en mor...]

Her var det jo mye å lese! Og ikke alt er like lett å forstå for den "menige" mann.

Selv er jeg heldigvis velsignet med relativt god psykisk og fysisk helse.

Jeg har derimot en mor som kunne hatt svært godt av en annen type behandling enn den hun får ved å utelukkende knaske piller og synes synd på seg selv. Hun blir bare verre og verre med årene.

Hun har fybromyalgi kombinert med store, til tider blødende sår på sjelen etter vold og diverse sorter misbruk da hun var barn.

Depresjon og smerte går hånd i hånd og det er blitt en kjempestor ond sirkel som hun selv har innbefattet seg med at er umulig å komme ut av, så hun har forberedt sine nærmeste på at hun har lov til å sutre bestandig og alltid være i sentrum av alles oppmerksomhet. Hun spiller denne herskerrollen med stor stil, ettersom hun med jevne mellomrom trer inn i martyrrollen.

Hva i all verden kan vi gjøre for å hjelpe henne? Og hvordan bevare vår egen helse midt oppe i denne situasjonen? Hun nekter å ta imot velmenende råd, og da jeg tilbød meg å betale for et opphold for henne på senter for fibromyalgi, begynte hun å gråte og sa at hun på ingen måte kunne takle å være flere uker på et sted der andre mennesker hadde vondt (les: der hun ikke kan være i sentrum for oppmerksomheten, fordi flere enn henne har plager).

Kan legge til at hun har hatt tre hofteoperasjoner, mener selv at knær og ankler er ødelagt så ho snart ikke kan bevege seg en meter, skal anskaffe seg rullestol på egen regning og har kronisk migrene og bihulebetennelse.

Som datter opplever jeg å befinne meg i en håpløs situasjon. Er det noen som har råd til meg?