Tag Archives: depression


Depression and inflammation

Depression and inflammationFor some years there has been thinking about depression and inflammation being related in as much as when we are in the throes of inflammation, our mood changes. Think about when you feel unwell and how your mood drops, which is part of the well known sickness response. In some people, probably a large number, these sickness responses are the norm. In other words, they endure a level of this sickness response consistently that is underpinned to an extent by on-going inflammation.

Reports today about a study at Kings College London describe how inflammatory markers in the blood could identify a ‘type’ that would benefit from a certain antidepressant drug — read here. This would make the prescription specific for the person, so rather than trialing a drug, we would know which would be most likely to be effective for that person by identifying the blood markers.

Many people I see with persistent pain are low in mood and some have been diagnosed as being depressed. In my mind, it is entirely understandable why someone suffering on-going pain, who cannot see a way out, would be in such a state. In simple terms, the person with chronic pain may well be chronically inflamed. We know that people who perceive themselves to be under chronic stress will be inflamed as the body continues to protect itself via the immune system and other systems that have such a role. Typically and understandably, someone in a chronic pain state is stressed by their very circumstance and hence can be inflamed.

It is very common to suffer an enduring pain state and generally feel unwell; a sickness response. We all know what a sickness response feels like — we don’t feel ourselves, aches and pains, loss of appetite, irritability, emotional, sleepy, tiredness, poor concentration etc. This is underpinned by inflammation and how this drives a range of experiences and behaviours, all designed to create the conditions for recovery. In the short term this is adaptive but if prolonged, the symptoms are enormously impacting and potentially maintaining a cycle of stress and anxiety.

Like any problem, understanding its nature is the start point so that problem solving can be effective; i.e. think about it in the right way and take the right action, congruent with recovery and the desired outcome. Realising the links between health state, depression and inflammation helps to distance oneself from the lived experience, being less embroiled with that particular ‘film’, instead focusing on what needs to be done to overcome the problem.

A loss of the senses of self is often a part of a persisting condition such as chronic pain or dystonia. The overarching aim of a followed programme is for the individual to resume living their life with a sense of self worth which they can identify: I feel myself again. This self feels normal to that person, and only that person knows how that experience is lived. As best they can, I ask them to describe that experience, and this forms the desired outcome. The sense of self is at least a unification of body sense, interoception, exteroception, the inner dialogue and our past experiences. Improving body sense with exercises, some general and some specific, is a simple way of stepping towards that outcome. And of course there are all the other benefits of exercise to consider.

It will undoubtedly be very useful to identify who will benefit from which antidepressant drug, yet we must still consider each (whole) person. A comprehensive programme of treatment for pain for example, includes developing working knowledge of pain so that the person can independently make effective choices as well as eradicate fears, specific training, general activities, gradual progression of activity, and mindfulness to name but a few. However, it is not just the exercises that are important. The person also needs to be motivated, resilient and focused, all strengths that they have likely used before in other arenas but now need to employ here and now with their health — this is the strengths based coaching aspect of the Pain Coach Programme. In cases of depression, the chosen drug maybe more specific and hence more efficacious, yet there are other actions that are also important such as understanding the links as explained and consistent physical activity. Great work in the aforementioned study; it will be interesting to watch how this progresses.

Pain Coach Programme | t. 07518 445493



VulvodyniaVulvodynia is a painful condition, often exquisitely so, located in the vulva, which is the skin surrounding the vagina. Usually unexplained, this troubling condition can arise seemingly from nowhere, interfere with intimate relations and hence attempts to conceive. Vulvodynia is also known as a functional pain syndrome–these are painful problems that lack a pathology of note that explains the extent of the pain and include irritable bowel syndrome, fibromyalgia, TMJ dysfunction, migraine and pelvic pain. Functional pain syndromes are often concurrent with hypermobility, anxiety and depression, a further common character trait being perfectionism and a tendency for the person to be hard on themselves thereby creating a cycle of chronic stress.

The pain of vulvodynia is often very localised and triggered by direct contact. Naturally this occurs during sex and touch, but sometimes sitting position can bring on the pain. As with any sensitisation, there is a primary location of pain but there can also be a secondary area surrounding that is due to central nervous system (and other systems) involvement. Suspected vulvodynia or other pains in the pelvis should be assessed and examined by a gynaecologist as a first step before beginning treatment, and by a consultant who knows and understands both the condition and the impact — Miss Deborah Boyle at 132 Harley Street.

With vulvodynia often being part of an overall picture of sensitivity, it means that there is a common biological adaptation that is upstream of the range of seemingly different conditions (the functional pain syndromes). As soon as the individual understands that pain is not an accurate indicator if tissue damage, but rather a reflection of the perceived threat and prioritisation by the body-person, there is a realisation that the pain can change. Pain can change because perceptions can change as we take on board new information and consequently think and act differently, creating new habits. The new habits set the conditions for on-going and sustained change that includes overcoming pain.

We have limited attention and hence can only be aware of certain amount of stimuli in any given moment. If pain is consuming much or all of your attention and consciousness, then this is all that is happening in that moment, with all other possible experiences being disregarded–it is a matter of prioritisation. When the perception of threat is reduced by a constructive thought or action, the pain moves out of our attention span and we become aware of other thoughts, feelings and experiences. How we respond to pain is unique and learned through our lifetime right up until that point; all those bumps and bruises as a child, how our parents reacted, more serious injuries or illnesses and the messages we received from doctors, teachers and other ‘big people’, then through adult life, moulding our beliefs about ourselves, the world, health and pain each time we feel it. The sum of all this activity, most of which we are unaware of, sets up how you respond to the next ache, pain or injury, blended of course with genetics. It seems that some people are genetically set up to be more inflammatory, meaning that responses to injury are potentially more vigorous and go on for longer. Understanding this means that the right messages and treatment can be given, thereby appropriately addressing the injury or pain. One of the big problems is that this does not happen, and the explanations are structural and based upon the body tissues. This ignores the fact that we have body systems that protect and these systems have sampling mechanisms in the tissues and organs but largely exist elsewhere–e.g./ nervous system, autonomic nervous system, endocrine system, sensorimotor system, immune system. We have to go upstream as well as improve the health and mobility of the local tissues.

Going upstream is vital in overcoming vulvodynia, and this is where the Pain Coach Programme works–this is my part of the treatment programme. You may also choose to work with a women’s health physiotherapist who will work more locally. So what is the Pain Coach Programme?

The Pain Coach Programme is a a blend of the latest neuroscience of pain with a strengths based coaching approach to success. Understanding your pain and that you have the biology and strengths to overcome your pain is a vital start point. You have been successful in the past using these strengths, and you can do so again by drawing on these characteristics and using them to develop your health in terms of how you think and act. Overcoming pain is all about resuming a meaningful life, engaging with activities and people as you want to, in a way that allows you to flourish. The Pain Coach Programme provides you with the knowledge and skills that you need to in effect become your own coach, moment to moment making clear decisions that take you towards your vision of how you want to live. This alongside treatment and specific training to develop normal movement and a healthy body-mind. The skills you learn also help you to fully engage in life, whether this be at home, at work or at play.

If you suffer vulvodynia or other painful problems, call us now to start your programme: 07518 445493


The dark side — the brain’s creations

The popular press is awash with neuroscience, now to the point that some authors are becoming ‘anti’. We need debate, so hats off to those contributors who rightly ask questions. We should never sit back and accept a ‘fact’ but instead, test, test, test. Despite this fresh discussion, we do accept that the brain has a great deal to do with our experiences of life.

A single centre for consciousness has not been identified in the brain and is not likely to be discovered. Instead, our unique sensory and emotional experiences are created by vast, interconnected networks of brain cells, maintained and influenced by immune cells that populate the brain and spinal cord. The pain matrix theory of Ron Melzack is a great example of such a functioning network. From these networks emerge feelings, thoughts, movements, senses and pain to name but a few. Where we actually experience these emergent properties can vary enormously, although one could argue that the role of the brain is to create the most biologically appropriate experience for that given moment and context.

Recently, Mick Thacker and Lorimer Moseley wrote a brief paper discussing the idea that pain is emergent. This is a relevant and sensible calling upon philosophy to help us explain pain to patients at a time when there has been a trend to suggest that the brain is at fault. Indeed we need a brain to feel pain — see Lorimer talk here — just as we need a brain to see and hear, but how helpful is this to the patient with back pain? Even if they grasp the concept of the pain neuromatrix, to suggest that the pain is coming from the brain can be a challenging leap. Preferable is the explanation that pain emerges from the body but there is a significant part played by a widespread web of neurons and immune cells in the brain and spinal cord; this requiring a careful description to give meaning to the individual.

To take this a stage further, one could argue that a depressed state underpinned by ruminating thoughts is emergent from a network of neurons within the brain, yet often felt deep within the body in a multitude of unique ways––visceral. The heaviness of thought is usually reflected within the physical self via posturing, movement and gut instinct. Our minds that exist within the brain networks––who knows where––stream with thoughts that are occasionally useful, frequently the same, and always driving bodily responses. The brain does not discriminate between thinking about being somewhere and actually being there; a similar response ensues. This can be wonderful if the memory or thought cultivates the tape of a happy time. How often does this happen in comparison to a train of worrying or troubling thoughts? Especially if one’s mood is low, the impact of a negative situation or comment is far greater. This is the dark side of the brain’s creation of our multisensory experience; seeing, hearing, feeling, thinking.

The depths to which one can slip or drop are seemingly endless. It does appear modern life is contributing to this endlessness as the figures on depression rise. Perhaps it is the expectation that we should be happy, with all the convenience of immediate service and advancing knowledge, yet there is greater striving for this state. Bookshelves are packed with self-help books, Facebook and Twitter saturated with quotations about how to think positively, and the growing industry that is life coaching all pay homage to the fact that we are not achieving as ‘alchemists of joy’.

Where neuroscience can make a contribution is to give us the understanding of the mechanisms that can be translated into practical tools for everyone. There have been numerous steps in the right direction with some great discoveries that inform; for example: the similarities of physical and social pain (e.g. rejection, isolation), neuroplasticity, the way in which immune cells prune synapses, communication between the gut and the brain, and mirror neurons (a deliberately provocative inclusion — see here) to name but a few.

The idea that experiences are emergent from a neuronal network influenced by many factors including epigenetics (the blend of genetics and experience), is a very credible way of thinking about how we can re-shape our thinking, feeling selves. The basic neuroplastic characteristic of our neuroimmune system, or the ability to learn, means that by creating the right conditions with the right understanding and individualised strategies based upon fact, we can cultivate change. This does not preclude the use of medication or other medical interventions but this alongside sensible and wise action based on sound science to move us into the light.

** Please note that this is not an exhaustive discussion of either depression or neuroscience but rather an observation. I am aware that this may trigger thinking and discussion that are both welcome in the hope of advancement.

Specialist treatment, training and coaching for persisting pain, chronic pain and injury in London – call for appointments 07932 689081