Depression and Pain in Your Head?
Dealing with Brain Injury symptoms and consequences quite frequently, I am exposed to the contention that Depression is the culprit when it comes to the subjectivity of pain. Subjective pain is that which is rated according to the one complaining, not the observer. Objective pain is that which can be observed independent of the one complaining.
Brain Injured Victims are often accused of malingering pain symptoms as a result of being depressed. And the depression is dismissed as a personality flaw or pre-existing a brain injury.
Well this is the what came first argument: the chicken or the egg. Certainly there is medical support for the statistics of depressed patients being more likely to report subjective pain symptoms. Also there are statistics supporting the evidence that pain leads to depression.
It is difficult to weed out the two but that difficulty is not justification to dismiss complaints of pain due to depression or depression being the true source of pain.
When it comes to pain, the two competing schools of thought are that it's either "all in your head" or "all in your body". A new study led by University of Oxford researchers indicates that, instead, pain is an amalgam of the two. Dr. Chantal Berna and colleagues used brain imaging to see how healthy volunteers responded to pain while feeling low.
The article is "Induction of Depressed Mood Disrupts Emotion Regulation Neurocircuitry and Enhances Pain Unpleasantness" by Chantal Berna, et al. Berna, is affiliated with The Centre for Functional Magnetic Resonance Imaging of the Brain, Department of Clinical Neurology and Nuffield Department of Anaesthetics, University of Oxford, Oxford, United Kingdom.
The article appeared in Biological Psychiatry, Volume 67, Issue 11 (June 1, 2010), published by Elsevier. The authors' disclosures of financial and conflicts of interests are available in the article.
Like the post.
Patients who have suffered traumatic brain and spinal cord injury, as well as other neurological or orthopedic injury, often have severe upper or lower extremity movement impairments. In short they have difficulty in doing the everyday living tasks that others take for granted.
It is well documented in the literature that an important component in achieving optimal rehabilitation outcome is intensive active movement practice. Traditional Occupational and Physical therapy mainly provide the patient with task orientated training (TOT) also known as Task Specific Practice (TSP) or functional movement training. TSP is intensive repetition of everyday functional tasks or Active daily living tasks.
On a practical treatment aspect, many brain and spinal cord injury patients do not have sufficient movement ability to enable them to do repetitive active tasks or the active tasks can not be customized to work on their specific motor, sensory or cognitive impairment. This may lead to frustration and depression in itself!!
It is therefore an ongoing challenge for physical therapists and other health care professionals to find effective interventions that improve arm and hand function for patients with more severe paresis. Recently, additional rehabilitation tools such as the HandTutor have been developed that focus on evaluating and training isolated and co-ordinated movement parameters. Correct functional movement is dependent on normal kinematic movement parameters such as range, speed, and accuracy of movement. On a practical treatment level the HandTutor allows many patients that do not have sufficient movement ability to enable them to do repetitive active tasks, or the active tasks can not be customized to work on their specific motor, sensory or cognitive impairment. The HandTutor is a rehabilitation glove and software which offers impairment oriented training and augmented feedback. The HandTutor encourages active repetitive customized isolated or inter joint coordinated finger and wrist hand exercises and rehabilitates fine movements of the hand and wrist. The software is dedicated to rehabilitation and is easy to understand by both the patient and the therapist. This enables the exercises to be customized to the patients movement impairment so that they remain encouraged and motivated to continue intensive exercise practice. The HandTutor is used in hospitals and community hand therapy clinics as well as through tele rehabilitation. Examples of patients that are treated include Stroke, TBI, spinal cord injury CP, Orthopedic hand and arm surgery.
Alan
Thank you for your post. I am very interested in rehabilitation methods and technology. Can you send me a picture of the Handtutor?
Rehabilitation has come a long way since biofeedback. All these exciting methods are a real boon to many different types of motor skill diminished patients. I agree that the repetitive nature of tasks associated with ADL and work are difficult for TBI survivors. This is a fact that does not get a lot of attention. Are you working with the military at all?
Fight the good fight.