DoD photo by Staff Sgt. Robert Barnett, U.S. Air Force/Released

Whether a veteran has been wounded in action, has experienced a non-battle injury or is currently working through a recovery, chronic physical pain has the potential to play a significant role in his or her rehabilitation and reintegration process. Managing the psychological and emotional effects of chronic pain, particularly if it stems from a traumatic event, can be just as challenging as the pain itself, but there is hope when it is addressed properly from both a physical and psychological perspective.

What is Chronic Pain and How Does it Relate to Psychological Health?

For pain to be considered “chronic,” it usually must be experienced in one or more areas of the body for a period lasting between three to six months – although it can last longer, sometimes years. Chronic pain can be caused by normal wear and tear on the body, physical injury, accidents, or chronic medical illness. In some cases, it can even be experienced without any known cause.^1,2,3

Although chronic pain may be thought of as solely a physical problem, it can have effects on psychological health as well. Research shows that depression can be a common side effect of chronic pain due to its persistence. Chronic pain can also stem from a traumatic event, such as a physical assault, a motor vehicle accident, or some type of disaster. Under these circumstances, the person may experience both chronic pain and post-traumatic stress disorder (PTSD).2 Approximately 15% to 35% of patients with chronic pain also have PTSD. Research also shows that survivors of physical and psychological abuse can be more at risk for developing certain types of chronic pain later in life.²

How to Successfully Manage Chronic Pain

If you are currently coping with chronic pain, familiarize yourself with how it can affect your psychological health and follow the four tips below to manage your pain and improve your well-being:

#1 - Develop a Comprehensive Treatment Plan with Your Physician
Developing a comprehensive pain management plan with your primary care physician and patient care advocate may not eliminate your pain, but it has the potential to change your attitude, emotional state and outlook on life. When you work to address both the physical and psychological symptoms, you can put yourself in the best position to cope with chronic pain. The Mayo Clinic recommends the following basic guidelines for creating a comprehensive pain management plan with your physician:⁴

• Start with a comprehensive medical evaluation — Ask your primary care physician to review your physical condition, psychological responses, any effects on your occupation and the current status of your medications.
• Manage your medications — Medications prescribed and monitored by your physician can be useful tools in addressing severe pain, however it may be helpful to reduce reliance on – and even eliminate – some medications as treatment progresses. This is especially true for opioid medications (e.g., morphine) which can act as depressants.
• Enroll in physical therapy — Weight gain, loss of strength, reduced stamina and limited activity can commonly occur with chronic pain. Physical therapy can be a great solution to these issues.
• Use stress management techniques— Psychological health care, group therapy, lifestyle management, family counseling and biofeedback – a method of monitoring changes in your body using medical equipment – are all good stress management techniques. Talk with your doctor to find out which one works for you and incorporate it into your pain management plan.

#2 - Participate in the Treatment Process
The following tips will help you cope with the effects of chronic pain and encourage you to actively participate in the pain management process:⁵

• Keep a personal “pain diary” where you can record your experiences with pain and the way it affects your life. American Pain Foundation - a nonprofit organization that educates, supports and advocates for people affected by pain - offers a printable pain notebook for people to track and record their experience with chronic pain. [PDF 1.39 MB]
• Set realistic goals for pain management and remember there will be good days and bad days.
• Educate yourself on your current condition so you can make informed decisions and successfully adapt your lifestyle and habits to your current condition.
• Participate in a support group where you can ask questions, share your experiences and receive support from others in similar situations. The American Pain Foundation's post on our message boards is one good place to start. Visit the Real Warriors Campaign partners page to find other organizations that may offer helpful resources.
• Be prepared for your doctor’s appointments. Bring someone with you to help remember what was said, take a list of questions to help clarify issues you may not understand and take notes.
• Stay physically active with the permission of your primary care physician.

#3 - Understand the Link Between Chronic Pain and Depression and Reach out for Support
There are a number of reasons why scientists believe pain and depression so often occur together:^2,6

• The same area of the brain is affected by both pain and depression
• The brain uses the same chemical messengers to regulate both pain and depression
• Chronic pain may cause issues that can naturally lead to depression, such as stress, trouble sleeping and anxiety.

Although it is common to experience depression along with chronic pain,⁷ not everyone who experiences chronic pain will cope with depression. If chronic pain and depression are experienced together, service members and veterans can maintain a healthy quality of life and promote their own psychological well-being with a comprehensive treatment approach. Reaching out is a sign of strength. If you notice your pain is having a negative effect on the way you relate to others – including family members, children, spouses and friends – your experiences at work or your outlook on life, reach out to one of the following resources:

• Log on to Real Warriors Live Chat where you can speak with a trained health resource consultant who is ready to talk, listen and provide the guidance and resources you’re looking for. Call 866-966-1020 or log on 24/7.
• Read the VA’s “Chronic Pain and PTSD: A Guide for Patients” for valuable information about chronic pain and psychological health issues
• Visit a Vet Center, a community-based center operated by the Department of Veterans Affairs, that offers counseling and outreach services. Find a Vet Center in your region or call 800-905-4675 (EST) or 866-496-8838 (PST) during normal business hours.
• Speak to a patient advocate who can help coordinate your care and make the treatment process easier for you. To speak with a patient advocate, contact your regional VA facility.

#4 - Report All the Effects of Chronic Pain to Your Doctor
Even though you may be experiencing chronic pain, you can be on your way to feeling better about yourself, sleeping better and having better interactions with your family members, friends and coworkers. In order to stay on the right track, record all the effects chronic pain is having on your life and report them to your doctor. This will keep your doctor up-to-date with your symptoms, so he or she can develop an ideal treatment plan.
Begin this process by taking an assessment of your current situation. Consider inviting someone close to you to join in this process and think about the following questions:

• Have issues arisen at work since you started dealing with chronic pain?
• Have you been experiencing stressful family interactions?
• Are you having financial or legal trouble?

After taking this initial assessment, look at the list below of signs and symptoms associated with depression, as reported by chronic pain patients.^8,9 If you can identify with any of these signs of stress, reach out for support and report them to your doctor.

• Irritability or anger
• Anxiety or depression
• Social isolation
• Physical de-conditioning (including weight gain or loss)
• Trouble sleeping
• Fatigue
• Fear of injury
• Reduced sexual activities

Taking steps to proactively manage both the psychological and physical effects of chronic pain will initiate a process of healing and ultimately help you better cope with the effects of chronic pain. If you think chronic pain is affecting you psychologically, talk to your doctor so you can begin treating all of the symptoms and chart a course toward recovery.

Sources

¹NINDS Chronic Pain Information Page.
²Chronic Pain & PTSD: A Guide for Patients.
³Causes of Chronic Pain.
⁴Plumbo, Ginger. "Comprehensive Approach Can Break the Chronic Pain Cycle."Newsroom - Health Information. Mayo Clinic, 11 May 2010. Web. 16 Nov 2010.
⁵"Pain and Depression."Pain and Your Mental Health. National Pain Foundation, n.d. Web. 17 Nov 2010.
⁶Hall-Flavin, Daniel K. "Is there a link between pain and depression? Can depression cause physical pain?."Depression (Major Depression). Mayo Clinic, n.d. Web. 17 Nov 2010.
⁷Bair, MJ, RL Robinson, W Katon, and K Kroenke. "Depression and pain comorbidity: a literature review."Archives of Internal Medicine 163.20 (2003): 2433-45. Web. 17 Nov 2010.
⁸"Pain and Depression." Pain and Your Mental Health. National Pain Foundation, n.d. Web. 17 Nov 2010.
⁹"Depression and Chronic Pain." Depression Guide. WebMD.com, n.d. Web. 16 Nov 2010.