How Is Stressful Pain Associated With Depression, And What Can I Do About It?

— -- Question: How Is Stressful Pain Associated With Depression, And What Can I Do About It?

Answer: Well, there are really three important objectives in treating chronic pain. Traditionally, pain scores have been used as the first objective, followed by improving function, and also improving mood and depression.

But many pain experts, myself included, believe that addressing mood and function, are more important than addressing pain scores. And in fact, patients lead us to believe that we're correct in this. They do not expect complete abolition of their pain. And in fact, on a pain scale of 10, if their pain was 9 or 10, they only want to get down to a score of 4 or 5 so that they can function. So function is really the primary outcome of interest.

When patients present to us, obviously, we do not get to see them performing their usual activities of daily living. And what's most apparent to us is their severe mood disturbance. And we've shown that in our patients, about two-thirds of them have depression, and at least 50 percent of them have severe depression. And it's really impossible to make a positive impact on their pain, unless you address their mood simultaneously.

So when we treat painful conditions, we focus on interventions that are going to improve their mood, and also improve their function. So when my patients come to me, I ask them, "Why do you want relief their pain?" And if they say, "So that I can feed my goats," as one of my patients did, or "that I can clip my roses," then we have real tangible objectives to work towards rather than kind of an abstract pain score that really does not measure what's important to a patient in terms of usual activities of living, and experiencing the usual joy that they derive from their home environment, their work environment, and their leisure environment.

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