Antidepressants and Cognitive Behavior Therapy Help Chronic Pain

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Category: Chronic Pain Articles Published on Monday, 20 May 2013 Written by Yong Tsai, MD
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Patients with fibromyalgia (FMS) suffer with chronic widespread, generalized muscle pain, along with headaches, irritable bowel syndromes and chronic fatigue.  FMS, one of the central hypersensitivity syndrome, occurs when the central nerve system (brain and spinal cord) become hypersensitivity to different stimulus and lead to many different symptoms.

Currently, we have adequate scientific evidences that central hypersensitivity is mainly caused by imbalance of neurotransmitters such as serotonin, norepinephrine, Dopamine or others. Serotonin and norepinephrine are produced and regulated within in our brain and spinal cord to keep everyday pain sensation and mood in sync by balancing pain and other signals. When levels of serotonin or norepinephrine are decreased and unbalanced, which occurs with fibromyalgia or depression, the brain becomes incapable of processing the transmitted pain signals properly. Pain signals can be exaggerated and even disordered. Patients can be also depressed.

Research has shown that by increasing levels of either serotonin or norepinephrine or both in the brain with the use of anti-depressants, pain signals can be decreased. Selective serotonin re-uptake inhibitors (SSRIs) such as Prozac, tricyclic-depressants, and especially serotonin and norepinephrine reuptake inhibitors (SNRIs) such as Effexor, Cymbalta and Savella, which are dual-acting anti-depressants that can increase both serotonin and norepinephrine, have proven capable of decreasing pain while treating both depression and chronic pain.

Our mind, a source of thoughts and feelings, allows us to experience sensations, including those of pain. Even though pain signals are processed by our brain, they are heavily influenced by our mind. Our mind and mood are also influenced by neurotransmitters. Feelings of angry or hopelessness, associated with depression and chronic pain, enhance negative thinking, which can intensify pain signals and increase feelings of distress and despair. It has been widely observed that, those who are optimistic improve more quickly and suffer less than others whose self-talk is filled with "I am worthless," "Nothing ever goes right for me" or "My whole day is ruined."

Scientists have proved we can train our mind and then change our brains (neurotransmitters). Cognitive-behavior therapy (CBT) focuses on altering distorted belief, attitude, and expectation patterns by substituting a new response to a given pain suffering.  CBT also shows individuals how to evaluate things in a more balanced manner. Three principles of CBT are to recognize the problems, to offer retraining of coping skills, and to teach the patient how to apply these skills in everyday life.

Many studies have already proven that combining CBT with anti-depressants can offer relief to sufferers of chronic pain with or without depression.  The key is to realize that some situations cannot be changed, but you can change yourself and the way you react to them.

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