Depression and chronic pain

[jago45]

I've suffered all my life from chronic daily headaches and have had three episodes of depression. To make matters worse, I also take medication for reflux and hypertension. The depression seems to be controlled by Zoloft and diazepam (Valium), though I still feel a sense of malaise.

My primary care physician prescribed Ultram for pain. It usually works. I saw a neurologist but he was of no help. I know that depression and pain are closely related. I was wondering about the advisability of seeing a neurologist who specializes in headaches or going to a pain management center or doctor (or something else). I understand that some antidepressants are useful for chronic pain and low doses of anti-seizure drugs are being tried.

Anyone have any knowledge or experience in these areas?

Jim

[Guest ASchwartz]

Hi Jago45,

In my opinion you need to see a psychiatrist. There is an antidepressant that helps relieve pain and I am not sure why you are not on it. I am NOT a psychiatrist or an MD but I am a psychotherapist and have lots of experience. Primary care doctors are excellent but psychiatry is a speciality and that is why one of them could best help you. My guess is that a neurologist is also not the right doctor. In fact, a psychiatrist can let you know if you need to see a neurologist.

Allan

[LogDork]

Hi Jim, I'm 45 and have a lot of pain associated depression issues too. For me, what I do for fun- shop stuff, welding, mechanicing, now blacksmithing, and work- construction, and woods work is really hard on my body, I'm in pain nightly.

Does what you do cause more pain? I'm trying to take it easier on my bod, but when I get going, I tend to go at it like I'm 20 or 30 some, but I regret it at night.

[Luna-]

Hi Jago45, are you still here? I have also struggled with untold headaches and have some suggestions but will need to get back on you on this. Would you put up your hand if you're still checking this thread?

[Luna-]

I sympathise about the daily headaches – I had them too. Sometimes people would say to me “Oh, I never get headaches”. A nice, slow, strangulation would come to mind!

I get both tension headaches and classic migraines with aura. (The migraines would sometimes require morphine injections from the doc, in the past.) I seem to be “outgrowing” the migraines now after some 30 years, but I still get tension headaches. I have a number of ways of dealing with them now and I would definitely recommend you go to a headache clinic or specialist where they can assess all possible factors. I had very good help at a clinic with a multi-disciplinary approach.

I saw a neurologist who did neurological function tests first. I had no problems neurologically. They then checked my jaw tension with a machine that measures muscle tension and it was very high. I saw a physiotherapist who said my neck muscles were terribly tense (I knew that!) and did a very painful massage (OW!) Lastly, I saw a dentist who took impressions of my teeth and made me a little plate to wear in the roof of my mouth to keep my tongue from pushing too hard upwards, adding to the jaw tension. It worked very well. I no longer wear the plate but have learnt to consciously slacken my jaw and not clench so hard and especially relax my tongue and not press it against the roof of my mouth (The tongue is actually the strongest muscle in the body.)

Now when I get headaches I see a chiropractor who crunches my neck (not really, but he does what chiropractors do; my neck tension sometimes pulls my vertebrae out of alignment) and then massages the tense muscles, pressing deeply into the “trigger points”. It is occasionally painful but this almost always works to make the headaches go away and I go when the headache is continuous over some 3 days and I get to the Tylenol-with-codeine stage. I can sometimes get my kids to press the trigger points too, when they’re feeling patient.

A word of caution about painkillers: they actually CAUSE headaches if used too much. This is called MOH (Medication Overuse Headache) and can happen with continuous use of even straight Tylenol or aspirin, no narcotics. MOH is a documented phenomenon. If you're using a lot of painkillers, wean off them slowly and then take them only for the bad ones.

Some time ago I was on a very low dose of Amitryptiline (I think you call it Elavil in the US?) which also helped very much. The usual AD dose is from 75mg upwards; I was on 10mg; some people only need 5mg. (It lost efficacy with time, though). It helps with chronic pain management in general. The AD Cymbalta can also help with some forms of pain – I don’t know exactly which forms they are, though. Ask a doctor about these meds. I don’t know much anti-seizure drugs but I am on Lamictin for bipolar, perhaps it is helping too? I know Topamax is effective against migraines for many people, perhaps it works for other headaches too.

And yes, when I’m in a depressive episode I have all sorts of aches and pains in my body, my headaches are worse and my pain perception is more acute. They ease off some, when I come out of the episode.

I can sometimes go a month or two without a severe headache now, which is heaven. Sorry about the wall of info, but I SO know how awful it is. I hope something in the above helps you.

[jago45]

Hi Jago45, are you still here? I have also struggled with untold headaches and have some suggestions but will need to get back on you on this. Would you put up your hand if you're still checking this thread?

Yes, I'm still here. I've tried massage, meditation, herbs, just about everything in addition to prescription and OTC drugs. The problem with drugs is that you build up a tolerance to them so they no longer work. The other therapies help a bit but don't solve the problem.

Jim

[Luna-]

Jim

As I understand it, there isn't always a single causative factor, at least there wasn't for me. Certain foods give me headaches. Alcohol gives me headaches. Intense emotions give me headaches (just peachey for a bipolar!) For me, it has been a case of noting every little cause and addressing it. But there isn't one thing that helps for me, there are times when the chiropractic treatment and massage fail too. Over time, I have identified the foods, identified the times of the month, stopped drinking alcohol (it simply wasn't worth the pain), learned to relax my tongue and jaw, learned where 'trigger points' are in my neck muscles ... you get the idea. It's been one thing at a time, over time. I was looking for a single cause, but I didn't find one.

If you cannot find a headache clinic, can you try to get assessment from the various disciplines independently? Each may have some input they can give and what to do about it and together they may help?

[Desperate]

Hi Jago45,

I don't know if this is any help to you but when I have a headache now and I have had tension and migraine headache, including being in hospital once with one, I find if I can get moving and drinking as much as I can not alcohol it help to ease the headache as though it opens the blood vessels and helps the blood to flow better.

I also have a chronic pain and it does make the depression worse when you cannot control it.