KIDNEY CITIZEN Issue 11
The Kidney Citizen is a quarterly informational magazine that provides articles, Q & A’s, dedicated topic supplements, and patient profiles. You can download the latest issue on https://www.dpcedcenter.org/news-events/the-kidney-citizen/ The Kidney Citizen is a quarterly informational magazine that provides articles, Q & A’s, dedicated topic supplements, and patient profiles. You can download the latest issue on https://www.dpcedcenter.org/news-events/the-kidney-citizen/
How Chronic PainCan Lead to DepressionFirst, it may be helpful to understandhow chronic pain and depression areconnected. Psychologist Ravi Prasad,PhD, says the same areas of the brainare involved in regulating both pain andemotion, which is one reason why the twoconditions can overlap. But there are otherfactors at play, he says.When people living with chronic pain areunable to do the things they want to do,they may pull away from activities that givetheir lives meaning. Their sleep may beaffected. Their motivation may diminish,says Prasad, who is a clinical professor anddirector of behavioral health in the divisionof pain medicine at the University ofCalifornia Davis School of Medicine.10UnderstandingChronic Painand DepressionHow Chronic Pain Can Impact Your MentalHealth When You Have Kidney DiseaseBy Hannah CalkinsChronic pain and depression are closelylinked and because as many as 60percent of hemodialysis patientsreport moderate to severe chronic pain, it’slikely that many of them have experienceddepression—or are at risk for it. But itmay not look or feel the way you expect,according to psychologist Robert Kerns, PhD.“Depression among people with chronicpain may not be experienced as profoundsadness,” says Kerns, a professor ofpsychiatry, neurology and psychology atYale University. “Other symptoms may bemore likely to be present, including lossof interest or engagement in activitiesyou normally enjoy, as well as sleep andappetite dysfunction.”Together, chronic pain and depressioncan impact management of your kidneydisease and take a toll on your quality oflife. Fortunately, effective treatments areavailable, and with the help of medicaland mental health professionals, there aresteps you can take to feel better.As the pain condition evolves, thedepression does too, he says, leading to a“vicious cycle.”It makes sense, then, that peoplewith depression are less likely to besuccessfully engaged in pain care, whichcan lead to less effective treatment fortheir depression, says Kerns.At the same time, other biological,psychological and social factors mayincrease your likelihood of developingdepression if you have chronic pain, saysKerns. These factors include a family historyor genetic predisposition to depression, priorexperience of trauma, or economic stressors.“Some people may also engage in what isknown as ‘catastrophizing,’ or pervasivenegative thinking that may magnifythe experience of pain and increase thelikelihood of depression,” says Kerns.Examples of such thoughts are “my painis horrible”; “it will never get better”; and“I’m helpless,” he says.Treatments That WorkChronic pain and depression arecomplicated to treat. However, evidencebasedapproaches can alleviate thesuffering caused by both conditions—aslong as both conditions are addressed.A major challenge is that people withchronic pain often believe that if their painwere treated effectively, their experiences ofdepression would also go away, says Kerns.“Evidence suggests this is not the case.”
Prasad agrees. That’s why both chronicpain and depression need to be treatedconcurrently, he says. Your doctor and amental health professional can help determinewhich treatment will work best for you.Treatment for depression may consistof medication, psychotherapy or both.Cognitive behavioral therapy (CBT) maybe especially helpful, says Prasad.“CBT helps people become more aware ofthe thought processes that influence theiremotional and behavioral health outcomes,”says Prasad. “You can apply these strategiesto coping with pain and with depression.”If you’re able to engage in some physicalactivity, that may help too, says Prasad.“Exercise won’t fix the problem, but it canhelp you manage your symptoms,” he says.“If you’re active, you may get better rest,which gives you more energy, and thatmay motivate you to participate more inthe activities you care about. Which, inturn, can improve your mood.”How to Get HelpYour physician or nephrologist may notrecognize the signs of depression, so it’simportant that you speak up if you thinkyou might need help. Let your doctor knowif you are feeling sad, anxious, hopelessor guilty; are persistently restless, listlessor irritable; are experiencing disturbancesin your sleep or appetite; or have lostpleasure in activities you normally enjoy.If you aren’t able to access treatment rightaway, or if you’re interested in learning moreabout managing pain and depression on yourown, Kerns says there are other resourcesavailable. The Centers for Medicare andMedicaid Services (CMS) requires annualdepression screenings for patients ondialysis. Your dialysis social worker is trainedto provide supportive counseling and canhelp you cope with your feelings.“There are great books available tosupport people with both of theseconditions, as well as a growing numberof evidence-based self-managementprograms available on the web or for useon smartphones,” he says. It’s importantto note that a self-help book does not andshould not take the place of receiving carefrom a behavioral health professional.Your nephrologist or physician can helpyou find the right provider.If you have chronic pain and areconcerned about depression, you aren’talone, and help is available. But at thesame time, Kerns says, people with chronicpain should understand that depression isnot an inevitable consequence of pain.“Even though rates of depressive disorderare high among people with chronic pain,most people with chronic pain—even thosewith moderate to severe pain—do notbecome depressed,” he says.For more information, visit the AmericanChronic Pain Association’s website orcheck out the resources available from theAmerican Psychological Association. Ifyou are in distress and need to someoneto talk to immediately about yourmental health, call the National SuicidePrevention Lifeline at 1-800-273-8255.This article was developed jointly bythe American Psychological Associationand Dialysis Patient Citizens EducationCenter as part of a partnership to educatedialysis patients and their families on thepsychological and emotional aspects ofmanaging kidney disease.NEW ONLINEPain ManagementCourseThe DPC Education Center isnow offering an online, freeto-useresource center tolearn more about chronic painand effective ways to livewith it. In the program,you will explore theconcept of pain,learn ways to talkabout it, and discovermethods of managingpain including medication,alternative medicine,nutrition and exercise, selfmanagement,and laughterand humor. You will also havethe opportunity to tell yourstory and hear from othersabout their experiences 11Check out the course at: dpcedcenter.org/paincourse
- Page 1 and 2: issue number 11Reflectionsfrom 45 Y
- Page 3 and 4: Advancing CareCoordination forDialy
- Page 5 and 6: A First Step TowardIntegrated Care:
- Page 7 and 8: to make sure everyone got treatment
- Page 9: (or prescription drugs for unintend
- Page 13 and 14: By Gloria Rohrer,DPC Patient Ambass
- Page 15 and 16: while the other does not. Sepsis ca
- Page 17 and 18: BranlayerEndosperm1. BulgurIs wheat
- Page 19 and 20: Capa desalvadoEndosperma1. BulgurEs
- Page 21 and 22: make sure not to schedule multiplee
- Page 23 and 24: There are multiple injection therap
Prasad agrees. That’s why both chronic
pain and depression need to be treated
concurrently, he says. Your doctor and a
mental health professional can help determine
which treatment will work best for you.
Treatment for depression may consist
of medication, psychotherapy or both.
Cognitive behavioral therapy (CBT) may
be especially helpful, says Prasad.
“CBT helps people become more aware of
the thought processes that influence their
emotional and behavioral health outcomes,”
says Prasad. “You can apply these strategies
to coping with pain and with depression.”
If you’re able to engage in some physical
activity, that may help too, says Prasad.
“Exercise won’t fix the problem, but it can
help you manage your symptoms,” he says.
“If you’re active, you may get better rest,
which gives you more energy, and that
may motivate you to participate more in
the activities you care about. Which, in
turn, can improve your mood.”
How to Get Help
Your physician or nephrologist may not
recognize the signs of depression, so it’s
important that you speak up if you think
you might need help. Let your doctor know
if you are feeling sad, anxious, hopeless
or guilty; are persistently restless, listless
or irritable; are experiencing disturbances
in your sleep or appetite; or have lost
pleasure in activities you normally enjoy.
If you aren’t able to access treatment right
away, or if you’re interested in learning more
about managing pain and depression on your
own, Kerns says there are other resources
available. The Centers for Medicare and
Medicaid Services (CMS) requires annual
depression screenings for patients on
dialysis. Your dialysis social worker is trained
to provide supportive counseling and can
help you cope with your feelings.
“There are great books available to
support people with both of these
conditions, as well as a growing number
of evidence-based self-management
programs available on the web or for use
on smartphones,” he says. It’s important
to note that a self-help book does not and
should not take the place of receiving care
from a behavioral health professional.
Your nephrologist or physician can help
you find the right provider.
If you have chronic pain and are
concerned about depression, you aren’t
alone, and help is available. But at the
same time, Kerns says, people with chronic
pain should understand that depression is
not an inevitable consequence of pain.
“Even though rates of depressive disorder
are high among people with chronic pain,
most people with chronic pain—even those
with moderate to severe pain—do not
become depressed,” he says.
For more information, visit the American
Chronic Pain Association’s website or
check out the resources available from the
American Psychological Association. If
you are in distress and need to someone
to talk to immediately about your
mental health, call the National Suicide
Prevention Lifeline at 1-800-273-8255.
This article was developed jointly by
the American Psychological Association
and Dialysis Patient Citizens Education
Center as part of a partnership to educate
dialysis patients and their families on the
psychological and emotional aspects of
managing kidney disease.
NEW ONLINE
Pain Management
Course
The DPC Education Center is
now offering an online, freeto-use
resource center to
learn more about chronic pain
and effective ways to live
with it. In the program,
you will explore the
concept of pain,
learn ways to talk
about it, and discover
methods of managing
pain including medication,
alternative medicine,
nutrition and exercise, selfmanagement,
and laughter
and humor. You will also have
the opportunity to tell your
story and hear from others
about their experiences 11
Check out the course at: dpcedcenter.org/paincourse
Change language