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Section 11
Co-Occurrence of Depression and Chronic Pain

Question 11 | Test | Table of Contents

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In the last section, we discussed three sources of guilt for clients with chronic pain.  These three sources of guilt include:  unmet obligations; burden guilt; and external influences.

In this section, we will examine three concepts related to depression and fibro fog.  These three concepts related to depression and fibro fog include:  depression:  fact vs. fiction; fibro fog; and dispelling the fibro fog myth.

3 Factors of Depression and Fibro Fog

♦ #1 Depression:  Fact vs. Fiction
The first factor related to depression and fibro fog we will discuss is fact vs. fiction.  One of the urban legends related to fibromyalgia is that sufferers tend to be depressives.  It is true that 50 to 60 percent of fibromyalgia clients have had depression at some time in their lives. 

However, only 18 to 36 percent of fibromyalgia clients at any one time have major depression.  These numbers are about the same percentage of depressives found among rheumatoid arthritis clients and very close to the same percentage of depressives found among the general population.  Thus, much of the rumor spread about fibromyalgia being an instigator of depression is statistically inaccurate, but obviously many fibromyalgia clients do not know this.  They have heard unsupported evidence that led them to believe they are at a very high risk for depression. 

Helen, age 43, had been told by her medical doctor that because she had fibromyalgia, she would very likely become depressed.  After this meeting, Helen began to experience signs of depression:  sleeping for several hours during the day; sporadic crying; and weight gain.  However, prior to her meeting with her doctor, Helen reported having a full and happy life, even with her syndrome.  It wasn’t until the doctor had put the idea of depression into her head that she began to experience symptoms. 

So was Helen’s depression a result of her condition or a response to a suggestive stimuli? 

I believe that had Helen not been told about her potential for depression, she might not have given up so easily to the disorder.  However, because the doctor unwittingly implanted the thought into her head, she convinced herself that there was no fighting nature and that she should just give in to the inevitable. 

Think of your Helen.  Has he or she been negatively influenced by outside advice?  How has this affected his or her mental health?

♦ #2 "Fibro Fog"
The second factor related to depression and fibro fog we will discuss is "fibro fog."  Fibromyalgia clients often experience a state of mind in which they cannot seem to function properly.  This state of mind often manifests itself in clients that are suffering symptoms of depression and even in non-fibromyalgia depressives.  The mind, while sending the right signals to the hands or legs, does not seem to communicate well with the body. 

Many clients report forgetting to do small tasks or being unable to perform simple mechanical functions.  This disorientation was once thought to result from the lack of sleep many fibromyalgia clients experience, but now, a few researchers have discovered that fibro fog cannot be clinically proven to exist.  However, to fibromyalgia clients, the state is very real. 

Elodie, age 42, described one of her bouts with fibro fog.  She stated, "My senses seem powered by a dead battery.  My tongue feels thick and stiff, unruly almost.  My eyes become veiled and I can’t coordinate.  One time, I couldn’t phone my husband at his office.  I have a speed-dial phone programmed to reach his office, but I’d freeze up after hitting that button.  My fingers just simply refused to poke the digits for his extension in the right order.  I knew the number, but my brain seemed disconnected from my fingers."  Many clients like Elodie seem to embrace their fibro fog as an untreatable fact of life. 

Think of your Elodie.  What does he or she experience during a fibro fog attack?

♦ #3 Dispelling the Fibro Fog Myth
In addition to depression and fibro fog, the third factor related to depression and fibro fog is dispelling the fibro fog myth.  You may be surprised to learn about an interesting experiment done by Dr. Harvey Moldofsky professor of sleep studies and psychiatry at the University of Toronto. 

Dr. Moldofsky subjected study volunteers to a standard cognitive test.  He gave the computerized test to individuals with fibromyalgia and to matched control subjects without fibromyalgia.  Both groups were told to manage four different tasks they had to think about all at the same time.  Predictably, the fibromyalgia sufferers hated the experiment, while the controls liked it.  But much to the surprise of the fibro fog clients, who assumed they were doing poorly in the assigned tasks, they actually did them as well as the controls.  They just took somewhat longer than the controls did. 

What does Dr. Moldofsky’s experiment tell you about fibro fog? 

For me, it demonstrated that the condition which many clients believe to be a debilitating disorientation in fact just slows the client down, not completely stops them.  While an inconvenience, this state of mind is not necessarily the end of the world, as some clients would believe. 

One of the hardest concepts for fibromyalgia clients to grasp is that fibro fog is merely one more way for the brain to cope with the pain and other life-darkening aspects of fibromyalgia.  When I explained this to Elodie, she stated, "It can’t be just that!  I mean, there is something wrong with my brain, I can feel it breaking down!"  To alleviate Elodie’s fears, I suggested she get a neurological scan done to make sure that there were actually no abnormalities.  When the test results came back, they were completely free of lesions or "brain breakdown." 

Think of your Elodie.  Does he or she believe that fibro fog is still a physical rather than mental inconvenience?

♦ Technique:  Focus Factor
To help clients like Elodie with their fibro fog, I suggest a series of meditation techniques.  I have found that these techniques are remarkably helpful in reestablishing mental clarity and for giving the brain a new way to cope with the pain. 

At first, Elodie was skeptical.  She stated, "You’re not going to have me sit cross legged and chant Oooooom are you?  I can’t levitate or anything."  I explained to Elodie that the meditation she will be practicing is merely a means to stabilize the mind. 

How would you convince your skeptics

For Elodie, I asked that she try a meditation practice called "Focus Factor."  I asked Elodie to imagine a place that’s aesthetically pleasing:  an architecturally inventive building, the beach, art, or whatever felt right for her at the time.  I asked that she make her space pleasing for her:  play her favorite music, put on her favorite lighting.  I asked her to go to her "vacation spot" where she can relax and feel free from her pain and confusion.  I asked her to remain in that state for five minutes in the morning, afternoon, and evening, allowing herself to breathe deeply and escaping into her vacation spot. 

Think of your Elodie.  Would he or she benefit from "Focus Factor"?   What other meditation techniques do you know that your clients could try?

In this section, we discussed three concepts related to depression and fibro fog.  These three concepts related to depression and fibro fog included:  depression:  fact vs. fiction; fibro fog; and dispelling the fibro fog myth.

In the next section, we will examine three manifestations of anxiety in chronic pain clients.  These three manifestations of anxiety in chronic pain clients include:  generalized anxiety; social anxiety; and fear of mortality.
Reviewed 2023

Peer-Reviewed Journal Article References:
Alschuler, K. N., Ehde, D. M., & Jensen, M. P. (2013). The co-occurrence of pain and depression in adults with multiple sclerosis. Rehabilitation Psychology, 58(2), 217–221. 

Carleton, R. N., Duranceau, S., McMillan, K. A., & Asmundson, G. J. G. (2018). Trauma, pain, and psychological distress: Attentional bias and autonomic arousal in PTSD and chronic pain. Journal of Psychophysiology, 32(2), 75–84.

Jaremka, L. M., Andridge, R. R., Fagundes, C. P., Alfano, C. M., Povoski, S. P., Lipari, A. M., Agnese, D. M., Arnold, M. W., Farrar, W. B., Yee, L. D., Carson, W. E. III, Bekaii-Saab, T., Martin, E. W., Jr., Schmidt, C. R., & Kiecolt-Glaser, J. K. (2014). Pain, depression, and fatigue: Loneliness as a longitudinal risk factor. Health Psychology, 33(9), 948–957.

Kaye, S., Wygant, D. B., Umlauf, R. L., & Marek, R. J. (2021). Factor structure and validity of the Inventory of Depression and Anxiety Symptoms-II (IDAS-II) in a chronic back pain treatment-seeking sample. Psychological Assessment.

Poleshuck, E. L., Gamble, S. A., Cort, N., Hoffman-King, D., Cerrito, B., Rosario-McCabe, L. A., & Giles, D. E. (2010). Interpersonal psychotherapy for co-occurring depression and chronic pain. Professional Psychology: Research and Practice, 41(4), 312–318.

Watrous, J. R., McCabe, C. T., Jones, G., Farrokhi, S., Mazzone, B., Clouser, M. C., & Galarneau, M. R. (2020). Low back pain, mental health symptoms, and quality of life among injured service members. Health Psychology, 39(7), 549–557.

What are three concepts related to depression and fibro fog?
To select and enter your answer go to Test.

Section 12
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