People with type 2 diabetes are at an increased risk for anxiety, but with the . positive effects on blood sugar levels and musculoskeletal pain. Painful diabetic neuropathy is more than pain alone: examining the role of anxiety and to improve both physical pain and symptoms of depression and anxiety. This case illustrates an example of improved anxiety and . with type 1 diabetes and normal hypoglycemia awareness or unawareness.
Improved Anxiety Diabetes, Pain,
Various psychotherapies can be used on their own to treat pain in patients with depression or anxiety, or as adjuncts to drug treatment. Pain is demoralizing as well as hurtful.
CBT is based on the premise that thoughts, feelings, and sensations are all related. Therapists use CBT to help patients learn coping skills so that they can manage, rather than be victimized by, their pain. For example, patients might attempt to participate in activities in order to improve function and distract themselves from focusing on the pain.
Various techniques can help people to relax and reduce the stress response, which tends to exacerbate pain as well as symptoms of anxiety and depression. Techniques include progressive muscle relaxation, yoga, and mindfulness training. During this therapy, a clinician helps a patient achieve a trance-like state and then provides positive suggestions — for instance, that pain will improve.
Some patients can also learn self-hypnosis. In one study, investigators asked patients with irritable bowel syndrome to complete self-assessment questionnaires before, immediately after, and up to six years following hypnosis training. There's an abundance of research that regular physical activity boosts mood and alleviates anxiety, but less evidence about its impact on pain. The Cochrane Collaboration reviewed 34 studies that compared exercise interventions with various control conditions in the treatment of fibromyalgia.
The reviewers concluded that aerobic exercise, performed at the intensity recommended for maintaining heart and respiratory fitness, improved overall well-being and physical function in patients with fibromyalgia, and might alleviate pain.
More limited evidence suggests that exercises designed to build muscle strength, such as lifting weights, might also improve pain, overall functioning, and mood.
Many psychiatric drugs and pain medications are metabolized by cytochrome P enzymes in the liver, creating the potential for harmful drug interactions. Here are a few common examples. Nonsteroidal anti-inflammatory drugs NSAIDs are helpful for both long-term and short-term pain, acting to alleviate pain and reduce inflammation. However, both NSAIDs and SSRIs individually increase risk of gastrointestinal bleeding when used on an ongoing basis, so combining these drugs may raise the risk of bleeding even further.
But acetaminophen is metabolized through the liver by the same enzymes that interact with many SSRIs and other psychiatric medications. Liver function should be monitored in any patient taking acetaminophen for prolonged periods while also taking a psychiatric drug. Patients with liver damage from hepatitis C or alcohol dependence should also use acetaminophen with caution or avoid it altogether.
Lidocaine is sometimes used to treat nerve pain. Both this drug and TCAs affect heart rhythm, however, so they should be used together with caution. Opioid analgesics are used to treat moderate to severe pain.
In addition to being mindful of the usual cautions, such as risk of dependency, clinicians and patients should be aware of several potential interactions. For example, tramadol Ultram , an opioid, can interact with SSRIs to increase risk of seizure in patients who take both drugs at once. Opioids may also interact with benzodiazepines to cause respiratory difficulties. A patient who is taking a benzodiazepine should start an opioid at a low dose and titrate slowly up.
Codeine and hydrocodone may be less effective when taken along with psychiatric medications that compete for the same liver enzyme such as paroxetine [Paxil], bupropion [Wellbutrin], and duloxetine [Cymbalta]. Some psychiatric medications also work as pain relievers, thereby alleviating two problems at once.
Just remember that pharmaceutical companies have a financial interest in promoting as many uses as possible for their products — so it is wise to check that evidence exists to support any "off label" not FDA approved uses for medications.
Other patients may prefer to take one medication for the psychiatric disorder and another for pain. In this case, it's important to avoid drug interactions that can increase side effects or reduce medication efficacy see sidebar. A variety of antidepressants are prescribed for both anxiety and depression.
Some of these also help alleviate nerve pain. The evidence is less convincing about their ability to treat other types of pain, such as backaches, which are usually of muscle rather than nerve origin.
The research most strongly supports the use of serotonin and norepinephrine reuptake inhibitors SNRIs or tricyclic antidepressants TCAs as double-duty drugs that can treat both psychiatric disorders and pain.
The findings are more mixed about the ability of selective serotonin reuptake inhibitors SSRIs to alleviate pain. The SNRI duloxetine Cymbalta , for example, can also be used to treat the pain from diabetic neuropathy or fibromyalgia. Venlafaxine Effexor is also used for nerve pain, fibromyalgia, and headaches.
Likewise, mirtazapine Remeron may help prevent chronic tension headaches. One randomized controlled trial found that bupropion Wellbutrin , which affects dopamine and norepinephrine, was helpful at alleviating chronic nerve pain, but not chronic low back pain unrelated to nerve damage. This may be an option for patients suffering nerve pain and depression.
Be aware, however, that in some patients, bupropion may increase anxiety and contribute to insomnia. The TCAs amitriptyline Elavil , nortriptyline Aventyl, Pamelor and desipramine Norpramin are prescribed to treat nerve pain such as diabetic neuropathy and chronic headaches. Although depression can further debilitate people with chronic pain, these people may be less likely to recognize and talk about symptoms of depression with their doctor.
In fact, half of all depressed persons who visit the doctor only complain about physical symptoms. You might be suffering from depression in addition to chronic pain if you have some of the following symptoms: Patients benefit the most when chronic pain and depression are treated together and utilize a team of people.
This team of experts may include:. Other professionals such as nutritionists, acupuncturists, and occupational therapists can provide special knowledge to help curb chronic pain and depression. There are many treatment options which can provide relief and healing to chronic pain and depression. Some of these include:.
If you think that you might have depression in addition to chronic pain, never hesitate to be honest with your doctor about the emotional as well as physical symptoms you are experiencing.
Consider today who you can recruit to help you regain control over your body, mind, and spirit. This is a unique website which will require a more modern browser to work!
The Diabetes-Anxiety Connection: How to Spot the Signs and Find Relief
All of the time, effort, money, and stress interrupts your emotional stability Moreover, people living with type 2 diabetes actually improved their. Anxiety and the stress it causes can raise blood pressure, blood sugar, and psychological, and emotional changes that enhance the body's ability to deal with. The overlap of anxiety, depression, and pain is particularly evident in and then provides positive suggestions — for instance, that pain will improve. also be used to treat the pain from diabetic neuropathy or fibromyalgia.