Can’t sleep? Feeling down? Always in pain? You may have PIDs!
PIDs – also known as Pain-Insomnia-Depression Syndrome is not something new.
It is just another way that shows how pain, insomnia, and depression can happen together sometimes, especially in people with long term pain.
Does Pain cause depression?
Yes, pain can cause depression – and yes, depression can cause pain!
Long term pain wears you down, increases stress and anxiety and can change your mood.
If this goes on long enough, you can develop mild to moderate depression.
Sometimes headache and back pain start as the first signs of depression.
And of course, the way we feel and process pain (emotional reaction) can also change our mood, and worsen depression.
We also know that people receiving treatment (drug and psychological support) for long term pain, also show improvement in the way they feel (mood or tension). Importantly, when treatment continues for one year or more, people have both less pain and better control of mood and tension (anxiety).
What can we do about it?
There are many drugs available for the treatment of chronic pain, including;
- NSAIDs including Aspirin, Diclofenac, Ibuprofen – over the counter medicines (OTC)
- NSAIDs – OTC creams, gels, ointments
- Naproxen, Indomethacin, Meloxicam, and Celecoxib – script (Rx) only medicines
- Paracetamol (OTC) for moderate pain
- Paracetamol/Codeine analgesics – OTC and Rx
Note: Some of these pain medicines cannot be taken with other medicines, and may cause dangerous side effects. If in doubt, ask your pharmacist – and a Home Medicine Review may also help. Download Home Medicines Review form
People with long term pain should not use over the counter codeine analgesics regularly because these are not very useful in the long run – Am I addicted to Codeine pain tablets?
There are also some complimentary medicines like vitamins, herbs and food supplements that may help with pain, including;
- Willow bark, devil’s claw, corydalis, bromelain
- Glucosamine and chondroitin, curcumin, and boswellia – for osteoarthritis or joint pain
- Omega 3 fats may help with pain and inflammation – a combination of more fish in diet and supplements is probably best here.
- creams and liniments – capsicum, comfrey, oil of wintergreen, arnica, menthol, emu oil, eucalyptus, calendula, lavender, tea tree oil, and many others.
- the hot water bottle and or the ice pack!
Once again – some of these complimentary medicines cannot be taken with other medicines, and may cause dangerous side effects. If in doubt, ask your pharmacist – and a Home Medicine Review may also help.
Does Depression cause sleep problems?
Yes, most definitely – and sometimes, sleep problems (insomnia) start before depression sets in.
People who have sleep problems are much more likely to become depressed.
It seems that having trouble falling asleep, waking up during sleep, having unrestful sleep, and having daytime sleepiness is common in people with depression – and what’s more, people having trouble getting to sleep and waking during sleep are more likely to become depressed.
Anxiety (stress or tension) and not being able to relax plays an important part in getting a good night’s sleep. It is important to have good sleep habits so that getting off to sleep is easier – try these useful tips from the NPS “Sleep right, sleep tight” factsheet;
- Wake up at the same time each day, even after a poor night’s sleep. ¬
- Be as active as possible during the day and spend time outdoors. ¬
- Reduce the amount of caffeine you have each day. Avoid caffeine-containing drinks after lunchtime (e.g. cola, tea, coffee, cocoa, energy drinks). ¬
- Avoid naps during the day. If you do nap, keep it to 20 minutes and before 3 pm. ¬
- Avoid smoking and drinking alcohol in the evening. ¬
- Avoid heavy meals, exercise or working on the computer late in the evening. ¬
- Relax for 30 minutes before going to bed.
- Try a warm bath. ¬
- Don’t eat, work, watch television, read or discuss problems in bed. ¬
- Ensure you’re comfortable and that your bed is in a quiet, dark environment. ¬
- If you’re too hot or cold in bed it will be harder to sleep — try and keep cool or warm. ¬
- Don’t stay in bed if you are awake for more than 20 minutes, go to another room and do something relaxing – when you get tired, come back to bed again!
A sleep diary may also help you find out what to do and not to do for a good night’s sleep!
To download a sleep diary, follow the links below
Does poor sleep (insomnia) cause Pain?
We know that pain can cause sleep problems but it seems that some types of pain can also get worse after a bad night’s sleep – especially migraine, musculoskeletal pain after sport (delayed onset muscle soreness) and fibromyalgia.
In simple terms, people who have regular sleep problems are also more likely to have regular problems with pain at sometime in the future.
What can we do about PIDS?
We need to treat all 3 problems together.
It doesn’t make sense to take a sleeping tablet and not treat the pain or depression as well.
In fact, some sleeping tablets can make pain worse (hyper-analgesia), and so these medicines should only be used for no more than 2 or 3 weeks at a time.
In the same way, we cannot just treat depression without doing something to control pain.
It also seems that when we get pain under control, mood (and depression) seems to get better more quickly than does the quality of sleep, and so good pain control may just be the key to coping with PIDs.
It is also important to understand that medicines are only part of the solution because sometimes our lifestyle (diet, alcohol, exercise, stress levels) may need to change if we are to get PIDs under control – and sometimes we need help (CBT) from specialist pain clinics to change the way we think or behave when our pain changes.
Remember, talk to your doctor or pharmacist if you want advice for your pain, mood and sleep problems because your treatment may be different to someone else’s.
And if you are worried about taking too many medicines or if your medicines are causing you side effects, a Home Medicines Review (or RMMR) may just help you handle your PIDs much better.
Author – Emmanuel Pippos, Consultant Pharmacist