More than 45 million people in America suffer from chronic pain and depression. However, the experience of each person is so unique and the field is so broad it is hard to adequately cover such a topic. Chronic pain issues cover each part of the body, every nerve pathway, even unidentifiable pain sensations. Depression comes on quickly or slowly, stays for days or months. The two together create a vicious cycle- each one causing the other to increase. A person who experiences chronic pain often develops depression, and thus the "cycle of pain" begins.

Chronic pain differs from acute pain in that it is continual. Chronic pain often does not have an easily treated cause, or the cause may be unknown. Chronic pain does not respond to treatment. For example, acute pain may be a headache, or an occasional migraine. Chronic pain is frequent debilitating migraines that do not respond to medication and significantly impair one's life. Or, acute pain is a back injury that responds to medical intervention. Chronic pain is a back injury that does not respond to treatment and the patient has no relief from the pain. Acute pain temporarily affects physical abilities; chronic pain indefinitely affects physical abilities. Chronic pain causes worry, fear, anxiety, and often leads to depression. Chronic pain can be perpetuated by the brain, whereas acute pain is generally not perpetuated by the brain.¹

People with chronic pain suffer from a high incidence of major depressive disorder. This is most likely because being in pain for a long time results in psychological pain. Depression then alters the person's perception of the pain and the depression worsens.² This psychological pain can be due to incorrect diagnoses, untreated pain, disability, financial problems, and spiritual difficulties. Symptoms of depression that may then appear on top of the pain can be lack of physical activity, lack of sleep, poor nutrition, fear, anxiety, relying on medication, and mental exhaustion.

Chronic pain and depression severely affects one's ability to work, maintain independence, friendships, and family relationships. Years of living with pain and depression can lead to personality changes, poverty, divorce, even suicide. People often loose important parts of their lives, important relationships, and become absorbed in their pain and depression. It is invaluable if they have family and friends who are willing to understand some of the complexities of this condition.

Chronic pain and depression is isolating. If you love someone with these, know he will often be unable to be in relationship with you in ways he usually is or has been in the past. The nature of the condition prohibits him from having the ability to "muscle" through it. Yes, there will be days when he can deal more successfully with the pain and depression. So, be careful to not use these days as evidence that he can once again get up and go like he did last time. As a family member, you can benefit from understanding what makes pain and depression worse or better and what his experience is of pain and depression. This allows you to help him watch for and monitor triggers. Family and friends can be helpful in reminding him to use coping strategies or take any prescribed medicine as needed.

Chronic pain and depression can be triggered at any moment and render someone incapable of performing even minor tasks. Even those who suffer from the condition do not fully understand why they cannot feel better, why they suffer or what help is available. When one is suffering, getting active enough to find help often seems impossible. There is help, though. Encourage your loved one to call their doctor, make a counseling appointment, talk to a pastor or friend. (If you feel your loved one is suicidal, act immediately and call for help or get him to an emergency room.)

Help for Chronic pain and depression is often talked of as "pain management techniques". Pain management techniques are available through pain management doctors (see your doctor for a referral), pain centers and/or counselors. A combination of techniques are generally used to help the patient learn to manage and begin alleviating pain. Treatment can include medication, physical therapy, nutrition, massage, exercise, bio-feedback and counseling. Counseling helps address issues of sleep habits, exercise, lifestyle issues, and thinking patterns that address the pain/depression cycle. Counseling has been used successfully to deal with the emotional and environmental factors contributing to the cycle of pain. Once your doctor or your pain specialist makes a treatment plan, the root causes of the pain and depression can be explored medically and behaviorally. However, in dealing with chronic pain and depression one should be careful to avoid fragmented treatment. Once a treatment plan and counseling has begun, one needs to stay the course. Remembering that pain causes depression and depression causes perceived pain, counseling can often be seen as something that can be easily skipped. Counseling in conjunction with medical treatments for chronic pain and depression is a key component for successful management.³

If you or someone you know is suffering from chronic pain and depression, there is help. See your doctor and seek support from friends, family, your church, and counseling if you so desire. People think that pain has to be suffered or cured. While looking for a cure, one can actively work on managing the pain. While waiting to be well, one can actively work on being better. Pain management techniques take time to work and require ongoing practice. Find the right support team for you, there is help.

Join us on Wednesday nights at 6:30 pm at First Baptist Church in Melissa, TX. The counselors at CBC will be presenting various Parenting topics. Topics on adolescent issues, communication, ADHD, and other prevalent topics on parenting will be presented. The church is located at 2600 State Highway 121. For more information, you can email us at newsletter@cbcmckinney.com. It's FREE and no reservations are required. We'd love to see you there!

What to Do When Limit Setting Doesn't Work

You have been careful several times to calmly and empathically use A-C-T and Choice-Giving. Your child continues to deliberately disobey. What do you do?

1. Look for natural causes for rebellion: Fatigue, sickness, hunger, stress, and so forth. Take care of physical needs and crises before expecting cooperation.
   
   
2. Remain in control, respecting yourself and the child: You are not a failure if your child rebels, and your child is not bad. All kids need to "practice" rebelling. Remember: At this very moment, nothing is more important than your relationship with your child, so respond in a way that respects your child and yourself. If you find yourself feeling angry at your child and losing control, walk outside or to another room.
   
   
3. Set reasonable consequences for disobedience: Let your child choose to obey or disobey, but set a reasonable consequence for disobedience. Example: "If you choose to watch TV instead of going to bed, then you choose to give up TV all day tomorrow" (or whatever is a meaningful consequence for child).
   
   
4. Never tolerate violence: Physically restrain the child who becomes violent, without becoming aggressive yourself. Empathically and calmly REFLECT the child's anger and loneliness; provide compassionate control and alternatives as child begins to regain control.
   
   
5. If the child refuses to choose, you choose for him: The child's refusal to choose is also a choice. Set the consequences. Example: "If you choose not to (choice A or B), then you have chosen for me to choose for you."
   
   
6. ENFORCE THE CONSEQUENCES: Don't state consequences that you cannot enforce. If you crumble under your child's anger or tears, you have abdicated your role as parent and lost your power. GET TOUGH! When you don't follow through, you lose credibility and harm your relationship with your child.
   
   
7. Recognize signs of more serious problems: Depression, trauma (abuse/neglect/extreme grief/stress). The chronically angry or rebellious child is in emotional trouble and may need professional help. Share your concern with the child. Example: "John, I've noticed that you seem to be angry and unhappy most of the time. I love you, and I'm worried about you. We're going to get help so we can all be happier."

COMMUNICATION

Ways to Reject Feelings:

1. Defend/explain-"The reason I said that . . . " or "What I meant was . . ."
2. Apologize-(refers to a "too quick" apology that doesn't really own the harm, or done before hearing the other's feelings)-"I'm really sorry that . . ." or "I shouldn't have said that . . ."
3. Attack-"I admit what I did was wrong, but you . . . " or "Well, maybe you're right, but what I can't understand is why you . . . "
4. Advise-"Maybe you should . . . " or "It seems to me that if you . . . "
5. Disdain-"I don't really see why you feel . . . " or "Gee, honey, there's no need to feel . . ."
6. Correct-"What I think you really mean is . . ." or "I don't think you feel . . ."

Ways to Accept Feelings:

1. Reflect-"It sounds as if you feel . . ." or "Guess you really felt . . . when . . ."
2. Clarify-"Are you saying that . . .?" or "I wonder if you feel . . .?"
3. Explore-"I'm not sure what you mean . . ." or "When else do you feel like that? I don't quite understand how you feel about . . ."
4. Extend-"You really felt . . .? Did you also feel . . . ?" or "I can see that you feel . . . If I were in your shoes I might also feel . . . Do you feel like that?"

(The Marriage Builder, pp.83-84; Larry Crabb)

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