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    having a rough week
    BrenBren30813 posted:
    Why do so many "well" people say, "if you concentrate on your pain, then it'll worsen"...then they always seem to follow up with: "if you are in pain, then you must be depressed, you should get treatment for that". Which statement here is more of a NO BRAINER!?! My pain is signals that I get from parts of my body that aren't functioning correctly, trying to get my yes, I will pay attention to my pain but not obsess over it. Many people, like myself, live with pain 24/7 and have no choice but to judge a day on pain levels, not whether the pain was present or not. Do you honestly think that us chronic pain patients sit there and say over and over in our heads "OH, it's bad, really bad, now it's worse, really bad, oh now it's bad..."etc. Nope, for me it's more like ouch, what needs to be done now that I can accomplish with a tolerable pain level...oops, did too much, now I need to rest. I live minute to minute, folks, and I don't CONCENTRATE on my pain, I pay attention. Unfortunately, for some of us, our pain levels dictate what we can accomplish; therefore, we get to know our body's, and what it can tolerate, then act accordingly.

    As for the "depression", I would not get treated for a secondary or tertiary symptom if the first weren't addressed. So, if a patient's pain is treated appropriately, wouldn't they most likely need minimal interference from a psychologist/psychiatrist? How is it that we all end up in some shrink's office stating our main problem = chronic pain, then they want to follow up with us in 6 weeks to find out if the new anti-depressant they've prescribed has worked. I'm a firm believer in the chronic pain patient's med "cocktail" that usually involves: anti-convulsant, anti-depressant, long acting opiod, short acting opiod, and occasional muscle relaxant. These all work well together to fight the awful nerve/muscle pain that we have to deal with, but why just focus on one of these and not all of them together? I just don't understand why the anti-depressants are so quick to be prescribed these days, and the rest of the therapies are minimalized.

    Just had to vent, so thanks for reading. You are welcome to share your thoughts (i.e.disagree/agree). I'm just getting so tired of playing their game...I want therapies that are going to work for ME, not the doctor's resume!

    I hope my 3 members are doing well out there. Be blessed people, and bitch here anytime, Peace, B
    annette030 responded:
    I have met people that only ever talk about their pain, and those people are hard to deal with. Most folks opt not to at some point. Who wants to be around someone who is always obsessing about their pain. You are truly lucky not to have met them. I was an ER nurse for many years and dealt with them regularly there, and in the rest of my life also.

    Some people can have pain 24/7 and not obsess over it. You and I are thankfully in that group.

    Depression is common in folks with chronic pain, I went through that years ago, and was frankly suicidal for awhile. I just could not find a time that would not effect my family adversely. My parents died of cancer just before two of my brothers' birthdays. Thank goodness, I got help meanwhile and got well before I could find the right time to die, lol. I found CBT worked for me. Suicide is often the permanent solution for temporary problems. Antidepressants made my depression worse, and did not help my pain either.

    Depression does makes pain worse and can cause pain in some patients. I don't mind a doctor referring me to a shrink anymore than I mind him referring me to a neurologist if he feels that will help. To me a shrink is just another medical specialist. Antidepressants often take 4-6 weeks to get the optimum blood level for them to be effective, that is why the shrinks want to see us again in that time frame. Most doctors want to see their patients after they start on new drugs to see if they are working.

    Antidepressant drugs are commonly prescribed for chronic pain because they mediate the neurotransmitters that carry pain signals to the brain. It is a secondary effect that they have besides treating depression, like many of the antiseizure drugs also often work for chronic pain. They are not always prescribed because the doctor feels we are depressed or it is all in our heads. The doses are commonly smaller in pain management than in depression for some of the antidepressant drugs.

    It is like using some high blood pressure meds for migraines, I never had high blood pressure but I have had migraines, and used a lot of those meds over the years. But there seems to be a stigma attached to antidepressants that is not attached to high blood pressure meds, I think we need to change that as patients and relatives and friends. Let people know it is okay to try these kinds of drugs.

    I have not experienced a lack of trying when doctors give out drug cocktails for pain. I think it is best to try one drug at a time so you know what is working and what is causing a side effect. It takes time to get up to using several drugs at a time. I agree that trying the drugs that do not cause tolerance and have to be increased over the years is better than going straight to opiates, especially in the younger patient.

    I have the perspective of a nurse in addition to a chronic pain patient, so I may be a bit different in outlook. But, that is a good thing. The more different types of people post about their experiences, the better off we all are.

    Take care, Annette
    davedsel57 responded:
    Hello, B and everone.

    I'm sorry you are having such a bad week, Bren. I pray you are doing better today.

    I am hesitant to share too many details with anyone about my conditions and chronic pain. I usually just say I have a really bad back or serious spine problems or get fancy sometimes and say that I have "multiple degenerative spinal conditions." You have to try and judge how interested a person is in you and your problems before knowing how much too share.

    Annette gave an excellent reply, as always. Depression and chronic pain are absolutely linked so it all needs to be treated to get relief. People who do not experience chronic pain have a hard time understanding what we go through each day.

    Cloudy with a few sprinkles but 75 degrees here in WNY. My wife and I just came in from doing a little yard work. She helped me get the mower out of the shed, filled with gas and started it for me and I mowed the front lawn. Then rested in back on the patio for a few and mowed the back. She got a fire going in our fire pit and started burning branches and things. I got the ponds going and am watching today for leaks. All in all, a very nice day so far.

    Have a blessed and super Saturday, friends!

    BrenBren30813 replied to annette030's response:
    Goodness Annette, you have really suffered some of the most painful losses that anyone experiences. I'm sorry to hear about your parents, but I am grateful that you still have some family around. I think a while ago I read a post that you had made about one of your brothers (in CA), I think?? I hope he is doing better and feeling supported on his new path. I know that you are a very supportive person, they are lucky to have you around....goodness, I had no idea that you went through a time where you thought about suicide. That is a statement I never would suspect you to make. Not sure why I think that, but I do. You say the CBT helped you a great deal; was that relative to your darkest hours? If the anti-depressants make your conditions worse (more pain, and more hopelessness) at which point did you discover that? Did it take 4-6 weeks to realize those particular meds weren't helping, but hindering? What did that feel like? Did you have crying spells? Bouts of outbursts? Irritability? Those were all symptoms I had on Cymbalta. I had no idea it was that med until I was inappropriately tapered off (too quickly, I think). I was yelling at my husband each night around bedtime, crying while I was expressing myself, or talking about anything that was emotional, and I was so irritable that I might as well have had PMS for 5 nights in a row. It was awful, I will never go back to that med, nor will I be weened off of an ant-depressant that quickly. Too bad, it sounds like it really helps with most people who suffer from chronic pain/depression, and especially nerve pain.

    There is a stigma attached to anti-depressants, that is for certain. I'm not sure why my family wants me to speak so openly about which med's I take, then I hear in a "hush-hush" tone (and request), not too long ago, that my brother-in-law has been prescribed and anti-depressant. I know my family (a rather large one) was unable to hush about it because I found out. I didn't really hear any judgements or criticism, just more of a shocked reaction because this guy rarely takes advil and has toughed it out after passing 3 stones...he is like Hercules. Maybe that is why they were so shocked and it was the latest topic of all the gossip.

    Argh! At Thanksgiving last year as we all gathered around the table, there was a point brought up about pain med's and how they can inhibit a person's healing, they can distort a person's true emotions, they can suppress an individual's "pain" in a psychological sense, etc. The conversation was insane because they all agreed that pain meds cover up a person's ability to distinguish from psychological pan to physical pain...WHO KNEW?? Where have these docs been all my life as a chronic pain patient??----I apologize for my sarcasm, sometimes that's just the way I cope. Anyway, they all were very aware of my taking med's at the time, and they didn't seem to surprised when I chimed in, "..most people cannot function or have a normal like unless they take these medications.." I don't think the heard me.

    I better stop the rant before it really takes off. I appreciate the response, and as usual, you have very good insight. I'm glad you posted, because your point of view as a patient, and also as a former nurse, is very important.

    Take good care, Bren Bren
    BrenBren30813 replied to davedsel57's response:
    Hi there Dave, I think I'm going to take your advice about which details I will share with whom. I guess I'm just getting used to meeting so many new people and learning as I go. Most people just ask how you're doing, or what is going on with you, in order to be polite; it's not that they really want to sit down with you take the time to find out the answers to these questions, you know??

    Thanks for posting, missed you the last couple of days. I hope you are well!! Great to hear you were able to get out and do some yardwork today -- Isn't that the most spiritually uplifting activity?!? I love digging in the dirt. I just wish I could dig. Get better, I'm trying, peace, B
    annette030 replied to BrenBren30813's response:
    I have plenty of family around, three brothers and three sisters. Thank you for the kind words about my brother in Colorado. He is doing well so far. Hopefully, he will stay on that path.

    I don't think many people get to my age without going through some tough times.

    My depression was related to stopping work due to my medical issues. I really identify as a nurse, more than anything else, I guess. To not be able to work as a nurse anymore was devastating. I worked through that though with cognitive behavioural therapy techniques and volunteer work. I have kept my registered nursing license up by continuing education classes. I thought this year I would be ready to give it up, but I renewed it anyway, guess not, lol. I've been an RN for forty years now, guess I will shoot for fifty.

    I tried antidepressants for FMS symptoms and just got more and more depressed. Then my doc was treating my depression with meds and therapy with a great therapist and it still got worse. We stopped the antidepressants and I continued the therapy, and things started looking up. I cannot blame the drugs for the depression though, I know better than that.

    I have never taken Cymbalta, it had not been invented yet, lol. I had sworn off of antidepressants long before that. I haven't used one for about ten years now.

    My husband took Cymbalta for pain management a few years ago, he had no problems with taking it or with tapering off of it over a couple of weeks when he no longer needed it.

    When I was taking various antidepressants, it was so long ago that they weren't even tapering people off of them. I just stopped taking them when they didn't work. I had no problems with that, never had any withdrawal kind of problems. I think everyone reacts differently to them. I don't even know that they help most people, I think they help some people, and don't help others. There is a stigma to them though.

    I really do not discuss my meds with most of my family or friends. I just tell them I take what my doctor suggests and leave it at that. Too many people read an article or two in the news and think they are experts. If they make suggestions, I just tell then thank you, and say I will tell my doctor about it and he will decide.

    Take care, Annette
    BrenBren30813 replied to annette030's response:
    Hi Annette, I hope your pain levels are low today...

    I just re-read your post (as I often do, because looking at them when I'm in a different space helps, and I get more out of them that way) seems to me that you were very lucky to have found the therapist that you did when you needed him/her the most. I need that as well. I have seen many therapists over the years because I was unfortunate as a young child and went through some traumatic experiences...needless to say, I've been in and out of therapy since I was 14, and I'm now 34. I still am unable to spot a good therapist and the one I am with now seems to be good, but we don't really connect. What do you look for when you are "intervieviewing" them in the beginning?

    I have had a wide range of therapists who have: fallen asleep, yawned excessively, looked at the clock obsessively, taken codeine and had the head bobbing syndrome (like she was going to fall asleep), a religious counselor who just couldn't remember my name and everything was so genralized and surfacy..etc.

    I haven't found one that I've connected with since the age of 15. Quite frankly I could write a book about my life and horrible experiences that I need to work on, so finding the correct starting point and telling my story is just exhausting. In my last session I told the therapist that I was looking for CBT and asked if he did that...he said, "do you have an extra 15 minutes today?" I looked at the clock and it was 1:55 (I had arrived at 1:30); he meant could I stay until goodness, HE ONLY DOES HALF HOUR SESSIONS. Is this right??? I could barely get into anything in that amount of time, much less tell him about my week and what I ate for lunch. I'm thinking about skipping out and finding someone else. I hate to do that to anyone, but there is something lacking.

    Any advice on this? I want to make the most of my sessions, but the CBT he tried with me was like guided imagery and it took up 20 min. He spoke sooo slowly and seemed to just stretch the out the time.

    I just remembered something wonderful he did for me. The CBT person who sent me to him (to be evaluated for PTSD) was the therapis whom my PM doc uses for patients about to receive implants. Well, I was going to him just for an evaluation and to do CBT. Ends up the he (1st therapist) faxes over a copy of my evaluation and notes and the 2nd therapist let me read everything (even though he said right then, "we're not allowed to let patients read these records.") Well I read them and the 1st therapist got some things VERY wrong and I feel like I should talk to my PM doc about it before he gets a copy. Plus therapist 1 tried to steer me away from my current PM to another PM who ever-so-conveniently worked downstairs in his "group". He tried to talk me into going to the new guy because he doesn't prescribe narcotics and does wonderful work with SCS implants and nerve ablation. This guy was very creepy. I will not pay him another dime.

    I'm going to end on that note...sorry so much info, I don't get the adult talk most people do because my boy is only 21 months now and he doesn't say much.
    Take good care, and thanks again for helping me out, B
    annette030 replied to BrenBren30813's response:
    I interview therapists the same way I do a doctor if I am starting out in a new place. I know what I need to change and look for a therapist/doctor who is on the same page as I am. I don't give anyone more than three visits, if I don't feel comfortable after three visits I try someone else. I don't know why that seems to be a magic number for me, but it does. I am often not comfortable the first visit, but should be after three.

    The one time I was really bad and needed someone right away, I asked my doctor (long time doctor, and well trusted) to recommend someone, he did and she was great.

    The other times, I was looking for a therapist for my son, and I asked around different circles and when one man's name came up three times from three different agencies, I called him and made an appt. for me. I saw him and felt he would be good for my boy and he was.

    I would not tolerate anyone who was nodding out or falling asleep, that would be my last appt. One hour (a 50 min. theraputic hour) appts are the norm, although I knew one shrink who would double book, and dictate his note in front of you during your time. I guess that is one way to correct him if he gets it wrong. He was just a crook, he would bill both patients' insurance companies for a full theraputic hour.

    I feel you have to look at therapy the same as any other medical specialty. Make a list of what you are looking for and take it with you to see the therapist, go over the list carefully and take notes. If you feel really vulnerable, maybe take a friend or family member with you to help you focus that first meeting. Set goals and ask the therapist if he feels they are attainable goals, how long they should take to accomplish, and set time frames for re-assessments to see how you are doing. I feel that therapy should be set in a time frame, not just open-ended talking forever.

    I am not really into the kind of talk therapy when you just talk about how your week has gone. I feel it should be much more structured than that for me. For instance, if I could not leave my house due to anxiety, I don't want to talk about what happened in my childhood. I want to work towards getting my grocery shopping done or going for a walk outside. Give me solid homework to do, and I will do it.

    If you have been in therapy off and on since you were a teenager, you already know what happened to you when you were young, you should be able to share that with a therapist in one meeting. Now you may need to relearn how to do certain things so you will be happy. Perhaps you need to readjust how you react to certain people or things that happen in your life. Only you can decide what you need to change in your life.

    CBT is much more than just guided imagery, although that may be a start in learning how to relax, and it should take 20-30 minutes the first time you do it. I would suggest you get the book, "Feeling Good" by Dr. David Burns, MD and read it first to get an idea what CBT is all about. It was the most helpful book I ever read.

    Take care, Annette
    BrenBren30813 replied to annette030's response:
    Thanks Annette, that brought great insight as to what I should expect as a patient. I never thought of therapy in that way. I guess it makes sense, but I'm not used the idea of going in with a set amount of goals and presenting it to the therapist. I always thought I should go in, tell my story, leave it up to them to lead me down the path of healing/wellness whatever you call it. I thought I was in their hands as for the amount of time I would be seen; I don't know if I should expect an answer just yet?

    Anyways, thanks for your input. I think I have a bunch of this to figure out on my own as well. Take care of yourself, B
    annette030 replied to BrenBren30813's response:
    That is just how I feel about it. I consider therapy just another type of medical specialty. I wouldn't ever just turn over my health to a doctor for an unlimited amount of time to do with as he pleased.

    I guess we all have to figure this out for ourselves.

    Take care, Annette

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