Chronic Pain | Depression | Covid 19

Pain & Depression during Covid 19

Are there any relations between chronic pain with anxiety and/or depression?

There are lots of studies that prove an association between chronic pain and depression. Depression can cause different types of pain called somatization and on the other hand chronic pain can lead to anxiety and depression. In different studies, this association has been found in more than 50% of the situation. Many patients with chronic pain have noticed this association and they frequently complain of increased feelings of pain when they are depressed for any other family or personal reasons.

How are the mental health conditions of patients with chronic pain in Covid time?

The anxiety related to Covid disease, the economic burden, and the social distancing all has produced psychological pressure on the general population and in particular on the vulnerable section of the population. Patients with chronic pain are vulnerable section and they are suffering a lot.

The pandemic caused by COVID-19 has resulted in the need for the general public to isolate and maintain social distancing to stop the spreading of the disease. This has resulted in a negative impact on the mental health of chronic pain patients.

A survey administered by the Spanish Pain Society on 340 participants shows that 91.4% of individuals with chronic pain believe that the lockdown has badly affected their emotional state, and 63% realized that their sleep quality was much better in the pre-Covid period than during covid.

In another study published in Nature revealed that more anxiety and/or depression is associated with more insomnia and pain in Covid time.

Why patients with chronic pain are feeling more pain in Covid time?

There is a vicious cycle. Covid situation is producing more stress resulting in anxiety and depression. Anxiety and depression cause more pain. Pain produces mental stress and worsens mental health. Study shows that there is worsening of physical and emotional health during Covid pandemic more because of isolation and social distancing.

How to break the vicious cycle?

The cycle should be broken at different levels targeting both pain and depression. The following have been proved and reported.

  • Psychological tricks: Stay connected with friends and family members with telephone, video calling, and social media; accept that anxiety is normal; distract yourself by engaging with favorite things like watching a movie, reading books, cooking, etc
  • Pain medicines: The of paracetamols, opioids, non-steroidal anti-inflammatory drugs, and corticosteroids in patients with COVID-19 to take care of pain.
  • Depression medicines: Many antidepressants are used to treat chronic pain particularly neuropathic pain. With proper doses, they can take care of both pain and depression. Among these medicines, the most commonly used medicines are amitriptyline, venlafaxine, and duloxetine. Amitriptyline is a tricyclic antidepressant that may cause dryness of the mouth, constipation, postural hypotension, arrhythmias, etc. Venlafaxine and duloxetine are serotonin and noradrenaline reuptake inhibitors and can also cause arrhythmias, constipation, GI upset, vertigo, dizziness, etc.
  • Physical activities and exercises: Inactivities and rest cause deconditioning of muscles, joints, bone and increases pain. So movements in daily life activities must be done by chronic pain patients. Exercises also reduce depression. Thus movements of daily life activities and simple exercises like walking are encouraged to break the cycle.

What is the take-home message?

Pain and mental illness coexist in more than 50% of situations. Both deteriorations of psychological health and increase of pain are found in patients of chronic pain in Covid time. Physical activities, exercises, staying connected with friends, engaging in favorite hobbies can all help in reducing morbidity. Pain medicines and antidepressant medicines should be taken when needed with the advice of physicians.

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494581/
  2. https://ejnpn.springeropen.com/articles/10.1186/s41983-021-00286-4
  3. https://www.nature.com/articles/s41398-021-01196-y
  4. https://www.unicef.org/serbia/en/how-protect-your-mental-health-during-coronavirus-covid-19-pandemic
  5. Kanchan Sharma, Gautam Das, Samarjit Dey, Emmanuell Q Villano, Sripurna Mandal. Neuropathic pain and depression: A prospective study to find out any association. Journal on Recent Advances in Pain, 2016;  2, 1, 6-10. DOI: 10.5005/jp-journals-10046-0026

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