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Team approach to pain, depression

Physical therapist Lesley Toser, left, works with patient Chava at the University of New Mexico Pain Center. Chava, 56, is seeking relief from pain associated with a congenital reversed cervical spine. (Adolphe Pierre-Louis/Albuquerque Journal)

Physical therapist Lesley Toser, left, works with patient Chava at the University of New Mexico Pain Center. Chava, 56, is seeking relief from pain associated with a congenital reversed cervical spine. (Adolphe Pierre-Louis/Albuquerque Journal)

ALBUQUERQUE, N.M. — Like love and marriage or peanut butter and jelly, some things just seem to go together, albeit not always so pleasantly.

Take chronic pain and depression, for instance.

If you’re unlucky enough to suffer from that double whammy, you are hardly alone.

According to the American Pain Foundation, an average of 65 percent of depressed people complain of pain. Conversely, from one-quarter to more than half of the people who complain of pain also tell their doctors they are depressed.

Are you starting to see an unpleasant cycle?

“There is a huge relationship between chronic pain and depression,” says neurologist Joanna Katzman, director of the University of New Mexico’s two-year-old Pain Center, the interdisciplinary Pain Consultation and Treatment Center. “And anxiety has just as big an association with chronic pain. Both depression and anxiety can magnify pain.”

Start adding in some common factors of aging – osteoarthritis, low back pain, neuropathy and the general aches of myofascial pain – and even the thought of growing old can be frightening.

“Fear got me here. I did not want neck surgery,” admits UNM pain clinic patient Chava, a local musician and Realtor who professionally uses her first name only.

Chava, now regularly working with UNM physical therapist Lesley Toser, is learning how exercise and movement can relieve some of the pain associated with a congenital reversed cervical spine.

After eight manual therapy sessions, the two have managed to bring a shoulder back into a useable position for Chava to continue singing and drumming in two bands.

Yet another professional at the UNM Pain Clinic provides occasional Facet injections to lessen Chava’s headaches and neck pain.

“I’m hoping to avoid taking a high number of pills, especially highly addictive opiates,” says Chava, who watched a close relative on a number of different pills sleep away 16 to 20 hours daily before she eventually died.

A new approach

The very fact that Chava is seeing a variety of medical professionals at the pain clinic highlights one of the biggest changes in recent years in the treatment of chronic pain and depression, according to Katzman.

The interdisciplinary medical approach is a fairly new phenomenon in the American medical world.

In the not-too-distant past, the physician likely would send a patient first to a psychologist to treat depression – or vice versa. The patient often bounced back and forth receiving inadequate care from both (or more) professionals.

Today, the UNM team alone is made up of a neurologist, specialized physicians and nurses, physical therapists, psychologists, psychiatrists, pharmacists and chiropractors.

They work in concert as a team, and their treatments often overlap.

Other pain intervention specialists on these collaborative teams might be health educators, acupuncturists, occupational therapists and others.

“We realize that chronic pain cannot be treated if the anxiety and depression is not treated,” says Katzman. “There’s a common denominator between pain and depression. And often, the elderly have an extensive medication list with side effects of their own.”

Neurologist Joanna Katzman says, “There is a huge relationship between chronic pain and depression.”

Neurologist Joanna Katzman says, “There is a huge relationship between chronic pain and depression.”

Magnifying pain

Depression and anxiety can magnify chronic pain, according to Paul Wilson, a clinical/health psychologist at Presbyterian Healthcare Services. “There is some good evidence that the same areas of the brain that process physical pain signals are activated when processing emotional pain,” he says.

“Talk” therapy is often part of the team approach to treating chronic pain and depression.

” ‘Talk therapy’ is a little bit of a misnomer,” says Wilson, “because there is a lot more to ‘talk therapy’ than simply talking, especially with complex conditions like chronic pain. You don’t want someone who just talks and listens well, although that can help.

“What you really want is someone who is also knowledgeable about the potential physiological mechanisms behind the pain condition and who can apply scientific knowledge about thoughts, emotions and behaviors to help the affected person create an action plan to improve their quality of life. This could include improving social or family interactions, improving ways the brain processes pain information, learning to pace activities, decreasing unhealthy behaviors (e.g., substance use problems) that may contribute to pain, and learning ways to decrease stress and tension when related to pain.”

Chava, a musician and Realtor, is learning from physical therapist Lesley Toser, left, how exercise and movement can relieve her chronic pain. “I’ve been in pain since I’ve been on this planet,” says Chava. “I just thought everybody had it.” (Adolphe Pierre-Louis/Albuquerque Journal)

Chava, a musician and Realtor, is learning from physical therapist Lesley Toser, left, how exercise and movement can relieve her chronic pain. “I’ve been in pain since I’ve been on this planet,” says Chava. “I just thought everybody had it.” (Adolphe Pierre-Louis/Albuquerque Journal)

Cognitive therapy

Cognitive therapy, says Wilson, focuses the role of thoughts or self-talk on our emotions and behavior. It seeks to find new ways to process information.

“For instance, when experiencing more pain, it’s not uncommon to have a thought like ‘This is never going to end,’ ” says Wilson. “Having this thought can contribute to more pain. Being able to change that thought into a more realistic and reassuring one can be helpful, such as, ‘This pain will eventually subside and there are things I can do that can help (e.g., relaxation).’ ”

“I’ve been in pain since I’ve been on this planet,” says Chava, 56. “I just thought everybody had it.”

Under the close watch of Toser, her physical therapist, Chava works on a floor mat, grimacing as she slowly rotates her shoulder, a joint that wouldn’t even move a few months ago.

Movement, says Toser, can put patients back in the driver’s seat, easing pain and depression to some degree. Even an initial exam, one which involves a gentle touch between patient and medical professional, can help start the healing process.

“What looks simple can be a big deal,” Toser says.

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