The Link Between Anxiety, Depression, and Pain

pain and depressionAccording the International Association for the Study of Pain, pain is defined as:

“an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

This is one of the best descriptions of what pain is and is used worldwide to explain the experience of pain.

Pain and Emotion

Pain is an emotional experience.  Emotions such as happiness, sadness, and anxiety are generated in the brain.  Thus, pain and anxiety are intimately linked in the brain in terms of the locations that generate these perceptions.  As noted in the definition, pain has unpleasant emotional components, which most people perceive as anxiety.

The link between pain and anxiety is, in reality, more than just theoretical.  Sensation that is interpreted as pain is processed in several areas of the brain.  Some of the main regions of pain sensation are in very close proximity to the regions that process emotions of anxiety and depression.  When there is prolonged activity in the areas that process pain sensation, the areas nearby that process depression can be activated.  The areas then can spontaneously interact, pain sensations can be interpreted as anxious emotions, and anxiety can be misinterpreted as pain.

Anxiety and Chronic Pain

Those who have chronic pain often become depressed and anxious.  The two sensations become intermingled, and often the pain is greatly amplified by the depression.  Treating the emotional consequences of pain is often as important as treating the physical causes of pain.  If the depression and anxiety are not controlled, the pain is not controlled.  Once the depression and anxiety are controlled, insight into pain can occur and pain often becomes manageable.  There may be a physical cause to the pain, but if the emotional components are not controlled, then the pain is not controlled.

Comprehensive Treatment

Since pain, anxiety, and depression are intimately linked in the brain, comprehensive pain care involves treatment that is aimed at all aspects.  A comprehensive pain program looks at both physical control of pain and emotional control of the consequences of pain.  These programs link psychological approaches to pain, with physical methods.  A pain psychologist is often involved in patient treatment.  Medications for chronic pain that affect both physical signals of pain and emotional components then become understandable in their effectiveness.

Pain is a complex medical issue.  It has both physical and emotional components.  The physical side is the tissue damage and perception of signals.  The emotional side is the anxiety and depression that is linked to the chronic pain signals.  Treating chronic pain, due to its emotional components has long involved a multidisciplinary approach that includes psychological management.

How to Prepare for an MRI Scan

MRIMagnetic Resonance Imaging (MRI) scans are one of the newer technologies that allow us to view the inner structures of the body.  The scanners use extremely powerful magnetics that align the hydrogen proton spins, which are present in water and most tissue, and create signals that can be detected and interpreted by computers into pictures of the body and its contents.

There is no radiation used, just a powerful magnet that forms a detailed picture of the tissues in the body.  The most common magnet used today is 1.5 Telsa, and that can give excellent detail of most body structures. However, the most sophisticated and experimental scanners are 5 times stronger and give us even more detailed information about the body.

Bodily Structures

MRI scans are used to give us detailed information about the tissues in the body.  They are commonly used to study all of the following structures:

  • The brain and nervous system
  • The spine
  • Muscles
  • Joints

It is a tool to give a physician more information to help define what is wrong and guide future treatment choices.  Since it only shows the structures, it still requires a physician to examine a patient to determine if what is seen correlates to symptoms presented by the patient.

Risk Factors

The risks of MRI scans are very low in general.  Since there is no radiation, they are often considered completely safe without any side effects.  MRI scans use very powerful magnets, therefore any magnetic metal can not be in close proximity of the scanner.  Since the early 1990’s, all metal objects used for implants have usually been made to be compatible for a MRI.  A few notable exceptions include:

  • Most pacemakers
  • Some ear implants
  • Heart valves
  • Implantable stimulators

If you have had surgery and an implant, notify the scanner personnel and they can check whether you may have problems.  Other metal such as bullets or metal fragments near the eye (from metal grinding work) may also be an issue.  The other main problem is if the noisy, closed space of the scanner can cause severe anxiety of people, preventing them from tolerating the scan, and support by the MRI staff or medication may help with the problem.

Preparing for a MRI Scan

There is very little preparation necessary for a MRI scan.  Know if you have any metal in your body, so the scanner radiologist can determine if a scan can be performed, and leave all metal jewelry outside the scanner room when changing for the scan.  A scan can often take an hour of time, and keeping still and relaxing during the scan will allow the best pictures to be obtained.   The results will be given to the ordering physicians usually within a day, and they will help you interpret the results.

Read our previous article on the differences between MRI scans, CT scans, and X-rays.

How to Identify & Treat Abdominal Pain

abdominal painMost everyone has had abdominal pain at some point in his or her lives.   Thankfully, the most common causes of abdominal pain are not serious. Every structure in the abdomen can cause pain. The organs and structures in the abdomen include:

  • Stomach
  • Intestines
  • Liver
  • Spleen
  • Kidneys
  • Bladder
  • Appendix
  • Sexual organs
  • Blood vessels and muscles

Since each of these structures tends to have some type of sensory innervation, they can all be a source for pain.

Almost everyone has had pain from the stomach and intestines.  From overeating, to acid reflux and indigestion, to constipation or diarrhea, the problems are not unusual.  Most of the problems are short-lived, inconvenient, and not serious.  When they are intense and not resolving, sometimes they do require medical intervention.

When to Seek Medical Attention

The main concern with abdominal pain is when to seek medical attention to help determine the cause.  Signs that indicate a need for further medical attention include:

  • Fever
  • Inability to eat or drink fluids for over a day
  • Ongoing vomiting
  • Vomiting blood
  • Severely painful abdomen and not being able to touch it
  • Painful urination
  • Passing blood in urine or stools
  • Difficulty breathing due to pain
  • Acute traumatic injury

Since there are so many different organs and structures linked to the abdomen, the diagnosis of the cause of pain may be difficult.  The starting point is always the history and story provided by the patient. After the history, a physical exam gives the next set of information.  With the basic information, the clinician then can determine the best tests to help find the answers to the cause of the pain.  Tests may include blood and urine analysis, X-rays, CT scans, ultrasounds, and sometimes invasive scopes of various systems and possibly surgery.

Treatment for Abdominal Pain

Treatment of abdominal pain is as variable as the causes.  Since the vast majority of causes are not life threatening, treatment is often simple.  Serious problems often require the intervention of medical specialists to guide the evaluation and treatment.  Self-diagnosis and treatment for minor problems is fine.  When the problems are more serious, find a medical specialist who you work well with and can trust.  If looking up information on the internet, stick to respected medical sites, including WebMD, Mayo Clinic, and the NIH (National Institutes of Health).  Do not panic about information on the Internet but use it to discuss concerns with your provider.

How to Relieve Pain from Rheumatoid Arthritis

joint painRheumatoid Arthritis (RA) is an autoimmune inflammatory disorder that affects the joints.  It can cause painful swelling and deterioration of the joints.  It is often symmetrical, starting in the smaller joints and moving to larger joints as the disease progresses. RA impacts the synovium, the lining of the joints and eventually the cartilage, causing thickening and destroying the joint structure and alignment.  The damage is caused by inflammation, which is triggered by the body fighting and destroying the joint tissues.

Inflammation & Pain

RA is an inflammatory process.  Inflammation itself is painful.  Whenever a person has an injury, inflammation occurs.  In injury cases, this is a limited process, as the damaged tissue heals, the inflammation disappears, and the pain resolves.  In rheumatoid arthritis, the joint inflammation is an ongoing process.  Therefore, as long as joints become inflamed, pain can be a problem.

The diagnosis of rheumatoid arthritis is made based on exam and the findings of inflammatory markers in the blood being elevated as well as the finding of specific blood markers for rheumatoid factors.  The disease can be followed by the extent of inflammation, and whether the markers in the blood for inflammation are controlled.

Controlling Pain from Rheumatoid Arthritis

In the past, controlling rheumatoid arthritis was very difficult. Originally the main medications were steroids that had many side effects, especially when used long term.  Pain medications could control symptoms, but had no effect on the disease.  About 30 years ago, some cancer drugs were being used to control the immune system and these decreased the activity and severity of the disease.  In the last ten years, a number of drugs have been developed that specifically suppress the immune system.  These drugs, when they are effective, do a remarkable job at stopping inflammation, and markedly slow or eliminate the joint destruction.  When inflammation is stopped, minimal pain is present and there is no need for additional pain medications.

Controlling the disease process with the appropriate medications is the key to management of rheumatoid arthritis.  If you have RA, the disease should be managed by a Rheumatologist, a doctor specializing in the management of these types of conditions.  Pain is a characteristic of inflammation. If pain is present, this usually means that medications need to be adjusted to better control the disease.  Rarely, when RA is well managed, will a patient need any additional pain medication.