While the chronic pain of IC can be difficult to deal with physically, its impact doesn’t stop with physical pain. During flares, especially, we can find ourselves crying more easily, angry, depressed, anxious or any mix of emotions. I remember once getting choked up at the grocery store when I realized the store was out of my favorite breakfast cereal. Most days, that wouldn’t phase me too much. But during a flare, all bets are off.

The physiology

It turns out, there is a physiological reason behind heightened emotions and chronic pain. Research has shown that chronic pain rewires the central nervous system and how it interprets pain, even if it’s acute pain. Pain affects our response to pain so much, in fact, that a 2010 study found patients who had chronic pain actually exhibited signs of disappointment when acute pain ended instead of relief.(1)

And that happens because chronic pain changes the prefrontal cortex, which is the region of the brain associated with emotion. A study in 2008 found that this region of the brain is constantly activated in patients with chronic pain so the neurons get worn out and alter their connections.(2) As a result, people with chronic pain end up having trouble sleeping and are more prone to being depressed and anxious while also often having difficulty making simple decisions.(2)

The prefrontal cortex is also the part of the brain in we use for making decisions and for cognitive flexibility, which means the ability to learn new things or adapt to change. Another study in 2018 showed that brains subjected to chronic pain were slower to learn new mechanisms and adapt to change.(3)

Along with all of that, a study in 2014 showed that people with chronic pain have a change in the circuitry of the brain that makes them less motivated to work for a reward, even though they still want it.(4) The study, which used mice, found that the mice in pain were moving around just as much as the ones without pain, but they were less likely to work toward getting food. However, when food was given freely they ate just as much as their counterparts. So they wanted the food, they just lacked the motivation to work for it. The researchers concluded the change came from the brain instead of the physical pain.(4)

Taking it one step further, because IC pain is located in the abdominal organs, it is visceral pain. Visceral pain simply means pain that comes for the organs in the core of your body. The medical community widely recognizes a link between visceral pain and emotions. Basically it’s related to that bad feeling you get in your stomach when under stress. A study about IBS found that IBS patients’ discomfort related to their emotional state; the more upset they were, the more severe their symptoms.(5)

The impact

With the physiological impact of chronic pain on the brain, it’s no surprise that people with chronic pain are three times more likely to develop psychiatric symptoms than the average person.(6)

For example, a study in 2007 confirmed that chronic pain can impair concentration and memory.(7) The study found that when the majority of patients had days of lower pain, their scores measuring memory and concentration were better than on days when they had more pain.(7) Researchers think memory problems come as a result of pain affecting the brain’s hippocampus.(8)

Another major impact of chronic pain that also affects emotions is sleep. A 2015 study said people with chronic pain lose an average of 42 minutes of sleep a night compared to their counterparts without pain.(9) Add in being up for trips to the bathroom, and IC patients can find sleep a major challenge. (Check out these tips for getting a good night’s sleep with IC.) Then lack of sleep contributes to depression and anxiety. It’s a vicious cycle, to say the least.

Unsurprisingly, depression is also a mental side effect of chronic pain. Depression symptoms include things already mentioned like struggling to concentrate and remember things as well as insomnia. It can also bring a loss of interest, feelings of sadness, appetite changes, low self-worth and more. Lack of sleep and lack of ability to continue with normal activities contribute to depression as well, even for patients who have no history of depression.(10)

Contributing to depression can be chronic pain’s impact on relationships. Whether you are disconnected from co-workers in not being able to work and/or have family and friends who aren’t supportive, relationships can suffer as a result of chronic pain. That lack of support can exacerbate depression.(11) Add in a struggle with sexual relationships, household tasks and interacting with children, and depression can certainly be an issue.(11)

And then, of course, there is depression’s good buddy, anxiety, that often shows up for chronic pain patients. IC patients are no different. Depression and anxiety are considered co-morbid conditions with IC, in fact. Because pain is our bodies’ response to injury, our bodies automatically try to flee from what is causing them pain. In the case of chronic pain, however, that’s impossible.(12) Along with that, many chronic pain patients (including ICers), tend to have anxiety on good days about when the pain will return or get worse.(12)

The management

Knowing that your chronic IC pain make you more prone to mental health struggles doesn’t mean that you just have to accept it and do nothing. This predisposition helps you know and understand how to better care for yourself — all of you. Just as you figure out how to manage your physical health, you should do your best to manage your emotional health as well. There are a few things that are just good practices for your mental health.

First, seek out a good support system. It can be family, friends or even an online community. Just find some people who will support and encourage you along your journey.(13) Be your own support system as well in being kind to yourself. Give yourself grace as you are dealing with chronic pain and all that goes along with it.(13)

Also, check out the resources available to you. What sort of mental health coverage does your insurance provide? What free support groups are available online or in person for IC as well as for mental health struggles?(13)

Taking care of your body helps your mental health as well. Rest when you need to. Eat good food. Find exercises you can do that won’t make your IC feel worse. The better you can feel physically, the better you will feel mentally.(14) But, also be realistic that you may not be able to be completely pain free. You can, however, do your best to be as healthy as possible.

Another way to help maintain good mental health is to get outside of yourself and do things for others. Volunteer to help a community organization if you are able to. Give yourself a project of mailing cards of encouragement to your family and friends. Finding a way to get outside of your own situation for a bit is helpful.(14)

Finally — and most importantly — don’t be afraid to ask for help. Talk to your doctor; seek out a therapist. Do whatever you need to do to get help, because you are worth it!(14)

References

  1. Marwan N, et. al. Predicting Value of Pain and Analgesia: Nucleus Accumbens Response to Noxious Stimuli Changes in the Presence of Chronic Pain. Neuron. April 2010 Volume 66, No. 1.
  2. Northwestern University. Chronic Pain Harms the Brain. ScienceDaily. Feb. 6, 2008.
  3. Cowen SL, et. al. Chronic Pain Impairs Cognitive Flexibility and Engages Novel Learning Strategies in Rats. PAIN. July 2018 Volume 159, No. 7.
  4. Goldman B. Study Reveals Brain Mechanism Behind Chronic Pain’s Sapping of Motivation. Stanford Medicine News Center. Jul. 31, 2014.
  5. Houghton LA, et. al. Visceral Sensation and Emotion: A Study Using Hypnosis. Gut 2002, No. 51.
  6. Harvard Health Publishing. Depression and Pain. Harvard Medical School. Updated March 21, 2017.
  7. University of Alberta. Chronic Pain Can Impair Memory. ScienceDaily. May 18, 2007.
  8. McAllister MJ. Memory Problems and Chronic Pain. Institute for Chronic Pain. Aug. 12, 2013.
  9. Roehrs T, et. al. 2015 Sleep in America™ Poll Finds Pain a Significant Challenge When It Comes to Americans’ Sleep. National Sleep Foundation. March 2, 2015.
  10. Florida Medical Clinic. The Psychological Impact of Chronic Pain. March 5, 2018.
  11. H-Wave. Chronic Pain on the Brain: 4 Psychological Effects of Living With Pain. Nov. 7, 2017.
  12. Padgett A. Do It for Your Mind – If Not for Your Body: The Psychological Effects of Chronic Pain. Augusta Pain Center. June 10, 2019.
  13. Lauman M. 5 Best Practices for Maintaining Good Mental Health. Psych Central. Updated July 8, 2018.
  14. University Health Service. 10 Things You Can Do For Your Mental Health. University of Michigan.