Chronic Pain Go Hands in Hands with Depression

Pain, especially chronic pain, is an emotional condition as well as a physical sensation. It is a complex experience that affects thought, mood, and behavior and can lead to isolation, immobility, and drug dependence. In those ways, it resembles depression, and the relationship is intimate. Pain is depressing, and depression causes and intensifies pain. People with chronic pain have three times the average risk of developing psychiatric symptoms — usually mood or anxiety disorders — and depressed patients have three times the average risk of developing chronic pain. Almost every drug used in psychiatry can also serve as a pain medication. The most versatile of all psychiatric drugs, the antidepressants have an analgesic effect that may be at least partly independent of their effect on depression since it seems to occur at a lower dose. The two major types of antidepressants, tricyclics and selective serotonin reuptake inhibitors (SSRIs), may have different roles in the treatment of pain. Amitriptyline (Elavil), a tricyclic, is one of the antidepressants most often recommended as an analgesic, partly because its sedative qualities can be helpful for people in pain. SSRIs such as fluoxetine (Prozac) and sertraline (Zoloft) may not be quite so effective as pain relievers, but their side effects are usually better tolerated, and they are less risky than tricyclic drugs. The association of depression with migraine headaches, which affect more than 10% of Americans, is especially close. One study found that over a two-year period, a person with a history of major depression was three times more likely than average to have a first migraine attack, and a person with a history of migraine was five times more likely than average to have a first episode of depression. Very often, when low energy, insomnia, and hopelessness resulting from depression and anxiety perpetuate and aggravate physical pain, it becomes almost impossible to tell which came first or where one leaves off and the other begins.

Modern Pain, Ancient Solutions

One of the most important aspects of Traditional Chinese Medicine is its rich source of historic medical texts. Jin Gui Yao Lue (Essentials of the Golden Cabinet) is perhaps one of the most important of these texts. Far from being an antiquated resource, the following case studies reveal how an ancient formula from this important historic text is still able to provide powerful healing solutions to modern dilemmas. Case #1 The patient was a 42-year-old Caucasian female suffering from chronic shoulder pain. She described her pain as mild chronic aching with generalized numbness and tingling, which radiated from the shoulder into the finger tips. The pain would be temporarily improved by movement, however, would often transform into sharp stabbing pain directly in the shoulder joint. The application of ice would eventually cause a deep aching while the application of heat would provide a temporary sense of relief. The patient had sought both acupuncture and chiropractic therapy with minimal relief which would last for only 1-2 days. The patient's tongue was pale and flabby with extremely swollen/engorged purple sublingual veins, normal coating. The pulse was deep and choppy. No other symptoms were present. The TCM diagnosis was Blood Stasis with Yang Qi Vacuity. The following formula from the Jin Gui Yao Lue was used: Modified Huang Qi Gui Zhi Wu Wu Tang: Huang Qi 30 gr, Gui Zhi 15 gr, Bai Shao 30 gr, Dang Gui 20 gr, Ji Xue Teng 15 gr, Jiang Huang 15 gr, Sheng Jiang 10 gr, Da Zao 5 gr, gan cao 3 grams. The dose was two cups daily. After two weeks on the above formula, the patient experienced a 50 percent reduction in tingling and numbness with no radiating sensations as well as a significant reduction in perception of pain. Her tongue was less pale and the sublingual veins were dramatically less purple and swollen. The following modification was administered: Huang Qi 30 gr, Gui Zhi 15 gr, Bai Shao 30 gr, Chi Shao 20 gr, Dang Gui 10 gr, Dang Gui Wei 5 gr, Ji Xue Teng 10 gr, Jiang Huang 15 gr, Sheng Jiang 5 gr, Da Zao 5 Gr, Gan Cao 3 Grams. The dose was two cups daily. After two more weeks on the initial formula modification, the patient experienced a complete reduction in chronic shoulder pain only experiencing pain 1-2 days a week for 1-2 hours at a time. Her tongue was normal red color with good body and the sublingual veins were no longer swollen purple and engorged. At this point I rotated the patient onto a tablet form of the formula Shen Tong Zhu Yu Tang dosed at three tablets BID. Upon a follow up two weeks later, the patient was experiencing no shoulder pain and no tingling or numbness in the arm. At this point TCM medicinals were discontinued. Case #2 Patient was a 35-year-old Caucasian male who was suffering from painful sciatica for approximately four months. The patient had pursued weekly acupuncture session for two months with minimal relief and had been taking the patent medicine Du Huo Ji Sheng Tang for one month with no change in sciatic pain. The patient's tongue was pale and flabby with teeth marks and the sublingual veins were engorged and swollen. The patient's pulse was deep and choppy. The patient was not experiencing back pain, only radiating sciatic pain down his right leg into the foot with tingling and numbness in the toes as well. The pain would improve when he walked and would worsen in the evening during sleep and during long periods of sitting. No other symptoms were present. The following formula was administered at two cups BID. Modified Huang Qi Gui Zhi Wu Wu Tang: Huang Qi 30 gr, Gui Zhi 15gr, Bai Shao 30 gr, Ji Xue Teng 15 gr, Du Huo 10 gr, Mu Gua 10 gr , Sang Ji Sheng 10 gr , Dang Gui Wei 10 gr, Sheng Jiang 6 gr, Da Zao 3 gr. After two weeks on the above formula, the patient experienced a complete cessation of sciatic pain, however still experienced tingling and numbness in right foot during sleep. The formula was continued for two more weeks after which the patient experienced complete cessation of all pain, tingling and numbness in right leg. The interesting facet of both of the above case studies is that each patient had used acupuncture treatments with minimal relief yet experienced significant results upon administration of herbal medicine. This factor is discussed in the chapter on "Blood Impediment" in the Jin Gui Yao Lue, which states that mild cases of blood stasis and qi stagnation can be effectively treated with acupuncture, however complex chronic cases will require administration of medicinal treatment. If an acupuncturist is not experiencing effective clinical results, it is important to keep in mind that herbal medicine should be brought into the clinical equation. Both of the above patients experienced life changing results from simple modifications to ancient TCM formulas reminding clinicians to not forget the goldmine of resources in the ancient Chinese medical texts. --------------------------------------------------------------------------------