Doctors should monitor both physical and mental symptoms when treating pain as symptoms of the body and the mind are “frequent fellow travellers”, one expert has said.
Dr Kurt Kroenke, an expert in physical and psychological symptoms, has written a commentary on the subject, urging doctors not to neglect the psychological symptoms in people experiencing pain.
He discusses the link between pain, which is one of the most common reasons why people see a doctor, and depression and anxiety, which are the two most common mental health issues in the world.
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Dr Kroenke, from Regenstrief Institute and Indiana University School of Medicine, writes: “One of the reasons for the bi-directional linkage between pain and depression, as well as anxiety, is the existence of a feedback loop. Individuals with pain don’t sleep well and their resulting tiredness affects their mood, making them vulnerable to depression and anxiety. Having problems with depression or anxiety can increase susceptibility to pain.
“Also, areas in the brain that affect the pain that people experience are connected with areas that regulate mood, making physical and mental symptoms closely associated.”
Dr Kroenke discusses how treating depression and anxiety is linked to improvements in pain. Treating pain does not improve depression and anxiety to the same extent but this does not diminish the benefits of treating both the physical and psychological symptoms, he says.
He writes: “Symptoms of the body and the mind are frequent fellow travellers. But patients seeing their primary care physician for a headache, back or muscle or leg pain or stomach ache often neglect to mention the symptoms commonly associated with depression and anxiety that they are also experiencing such as fatigue, lack of motivation, nervousness and moodiness. And physicians don’t always ask about symptoms beyond the ones which brought the patient into the office.
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“Un- or under-treated, these emotional symptoms can cause long-term suffering and impaired quality of life. If clinicians measure and monitor both physical and mental symptoms they will be more able and likely to treat them. But there is no blood pressure cuff, lab test or X-ray for symptoms. We don’t have a way to measure symptoms other than from what the patient tells us, yet screening and diagnosis are crucial to improving patient outcomes.”
Dr Kroenke is a leader in the growing field of symptomology and has developed a number of widely used scales to help doctors measure their patients’ levels of pain, depression, anxiety and risk of suicide.
He concludes his piece with a quote from Roman poet Ovid: “I am no better in mind than in body; both alike are sick and I suffer double hurt.”
Read the article in JAMA Network Open.
