Mental exercise and pain management

“I was recently diagnosed with acute arthritis and the pain is often unbearable. My doctor prescribes for me painkillers but I am not keen on taking the medicine for the risk addiction. What physical or mental exercises could help with cope with pain?”

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One of the most frequently asked questions of a psychiatrist is why one needs to be a medical doctor before studying the mind and becoming a psychiatrist. It seems to the lay person to be a total waste of time to go though all those years to become a doctor only to specialise on the mind in later life.

The truth of the matter is that one cannot be a complete doctor if one does not understand how their patients perceive some of the most basic sensations such as pain. Your question has presented us with an opportunity to examine this critical and often neglected question.

With your indulgence, allow me to address a more general question of the connection between mental health and general medical conditions.

We start by stating that arthritis, though not a mental illness is affected a great deal by what is going on in your mind. First of all, one with arthritis is about four times more likely to develop depression and anxiety than one without it. Pain, reduced mobility and loss of sleep in people with arthritis is the reason many develop mental health needs, and this is why a doctors need to be aware of this fact so as to treat both conditions at the same time. It is also true that a person who has depression has a lower threshold for pain than one who is not, meaning that as in your case, the occurrence of depression in arthritis will create a need for more medication. Psychiatric consultation is often sought in the care of those with arthritis. The link between diabetes and depression is equally clear and in clinical practice, we know that up to 50 percent of people with diabetes have a clinically significant depressive illness. Put another way, if you are diagnosed with diabetes, the doctor must consider and rule out the possibility that depression could be a condition that is also present and that could make treatment of the diabetes more difficult unless recognised and adequately treated. A depressed person is less likely to adhere to the prescribed medication for the diabetes than one who is not depressed! Seems so obvious. The link between heart disease and depression is well known and we only repeat this fact for emphasis. The link goes in both directions, meaning those with coronary heart disease are more likely than the general public to have depression and also that those with depression are more likely to develop coronary heart disease than those without depression.

If you are depressed and get a heart attack the chance of a full recovery are less than if you are not depressed. Equally if you have a heart attack and are depressed the recovery process is slower. This is a perfect vicious cycle and both the cardiologist and psychiatrist have to work together to get their patients better. The body and mind work together.

The other question that you raise is the matter of potential addiction in the treatment of arthritis and by extension the use of pain killer’s in general medical practice. This a matter that you must raise with your doctor during consultations, and in this day and age you must be able to search any medication on the internet to enable you have an informed discussion with your doctor about potential complications of any medication he might give you, not only with regard to addiction. In the past, doctors were taken as all knowing but today, most encourage their patients to understand which strategies work best in clinical practice. One must express their fear of addiction and is entitled to a full explanation as to why the doctor has chosen this as opposed to the other medication.

All in all, your question has brought to light the fact that physical and mental health exists in close proximity and that the physician and psychiatrist must work together for the betterment of the patient and each must be aware of his strengths and limitations in clinical practice. Liaison Psychiatry is the branch of medicine that bridges this gap.

Specific to your question, it is best that you express your concerns to the doctor with regard to the best physical and mental activities that would help in the entire treatment experience. Remember the old adage; a doctor who has not personally examined you has no business offering you a medical opinion in your particular case. All he can do is offer very general advice.