Tuesday, July 24, 2007

Head Bone Connects To The Body Bone

Do you remember the chorus to the children's song, "Dem Bones?" "The foot bone connected to the leg bone, The leg bone connected to the knee bone, The knee bone connected to the thigh bone, The thigh bone connected to the back bone, The back bone connected to the neck bone, The neck bone connected to the head bone, Oh, hear the word of the Lord!"

For me, bones and pain have been intricately connected. My broken bones include toes, ankle, ribs, sternum, fingers, thumb, wrist, elbow, nose and hip. Dem bones gonna hurt, when dey broke!! Add to that, three major operations (elbow, back and hip), several scars over 4 inches, twenty years worth of migraine headaches, and you can see that pain has long been a companion of mine. Like depression. In my particular case, though, I don't believe that there was always a direct connection. Perhaps some times, but mostly not.

The medical community has pretty much accepted the fact of a connection between the "head bone" and chronic pain. The discussion of this phenomena has caused a division of psychiatrists and pain management professionals into "egg" and "chicken" parties. There seem to be people from both professions in both groups. The major question is, "What comes first? Depression or pain?" The answer appears to be, "Yes."

The more open minded doctors and researchers see that, depending on the particular patient, either pain and depression can be a result of the other. In some cases, chronic pain (lasting more than 3 months) can cause depression to develop in the patient. Makes sense to me. I know that one year when I had daily migraines (5 out of 7 days), the pain alone was depressing. Severe pain that can't be escaped or alleviated just naturally causes a person to become depressed.

What is less obvious, though, is the manner in which depression might cause someone to develop (or feel) chronic pain. In a Newsweek article (10/27/07), James Bakalar writes that "depressed people suffer three times their share of chronic pain (and people in pain are at high risk for depression). Some studies suggest that if physicians tested all pain patients for mood problems, they might discover 60 percent of all undiagnosed depression. If you're struggling with either problem, there's a good chance you're suffering from both of them."

The connection between sensory pain and emotional pain is rooted in the nervous system. Both are governed by the same neurotransmitters (serotonin, norepinephrine, and substance P), and both are processed in the same parts of the brain. When the circuitry is working properly, pain and depression are self-limiting.

Treating chronic pain can often help reduce depression, and treating depression can, to some degree, reduce the magnitude or incidence of pain. The administration of antidepressants can sometimes reduce the pain felt. This is why the medical community is beginning to consider both problems in developing a successful treatment regimen. Dr. Matthew Bair, formerly of the Regenstrief Institute, says, "We believe that a treatment model that incorporates assessment and treatment of both depression and pain is desirable."

That makes sense to me. Even children know that the Head Bone is connected to the Body Bones.

["I'm so low, I could do a ten minute free-fall off the edge of a dime."]


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Ann said...

I was browsing the internet and came across your writing. I pray for your body is free of pain. He bore our infirmity in His body.