Sciatica and Mental Health

Posted by kaptainkat @kaptainkat, Dec 30, 2022

I have been nosing around for connections between my emotions and my sciatica. Mostly I find articles about how or whether one's emotions AFFECT their sciatica. When various stresses can bring on episodes of pain.

I am NOT seeing much on depression brought about by sciatica. Feeling useless, hopeless, just wishing it would END.

I HAVE seen articles that suggest sciatica sometimes brings on feelings of guilt and shame. 'Why me?' 'What did I do to deserve/earn THIS????' And the DIS-ability leaves a lot of daily living chores up to someone else while 'we' sit inert barely enduring our pain.

I've seen where some antidepressants are prescribed for lumbar issues as they have a pain killing side effect. I have been on 90mg of Cymbalta for I believe two years now. I fired the psychiatrist that started me on THAT when he/his office/CVS left me cold turkey for a month. My next psychiatrist started me on Mirtazapine a year ago, and we have gradually up that to now 30mg.

My NEW psychiatric nurse practitioner is suggesting we up my Cymbalta to 120, 60 in the AM and 60 in the PM. He will take on that script from my GP. Who also keeps me in Gabapentine.

'Let's try it.' After all, it IS a PRACTICE, isn't it?

Obviously I would love to hear some feedback and other's stories and how they are dealing with their issues.

Interested in more discussions like this? Go to the Spine Health Support Group.

@debkl

Sciatic pain would be no different from other persistent pain. Depression and anxiety woukd be completely normal. Pain psychologist Rachel Zoffness is teaching medical students and doctors who encounter patients with persistent pain how science shows the connections.

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From what I gather, sciatica is NOT like 'other persistent pain'. As I understand, neuro-based discomfort is different from say a bruise or a sprain. And 'typical' analgesics don't do very much.

When I first started looking into this, I was surprised that SOME antidepressants were scripted for neuro pain. Cymbalta was either second or third on the list. So I (must) trust that my profesionals know what they are doing.

And My part is to be COMPLETELY CANDID about where I am emotionally and physically.

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@kaptainkat

From what I gather, sciatica is NOT like 'other persistent pain'. As I understand, neuro-based discomfort is different from say a bruise or a sprain. And 'typical' analgesics don't do very much.

When I first started looking into this, I was surprised that SOME antidepressants were scripted for neuro pain. Cymbalta was either second or third on the list. So I (must) trust that my profesionals know what they are doing.

And My part is to be COMPLETELY CANDID about where I am emotionally and physically.

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@kaptainkat That is what I have been told by pain doctors as well. Sciatica is usually caused by nerve pain due to an endless number of factors. I also have bone spurs and DDD and I relieve pain from that differently from sciatica.

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@kaptainkat

From what I gather, sciatica is NOT like 'other persistent pain'. As I understand, neuro-based discomfort is different from say a bruise or a sprain. And 'typical' analgesics don't do very much.

When I first started looking into this, I was surprised that SOME antidepressants were scripted for neuro pain. Cymbalta was either second or third on the list. So I (must) trust that my profesionals know what they are doing.

And My part is to be COMPLETELY CANDID about where I am emotionally and physically.

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The quality of pain can be different but other pain types can be persistent and severe. Bruises and sprains are considered to be acute, but a sprain, if still painful after 12 weeks and with medical treatment, would be considered persistent pain, which is what the industry is calling chronic pain. It doesn't matter if it is nociceptive, neuropathic, nociplastic, or whatever. It's simply pain that persists despite treatment and/or beyond typical healing time. Cymbalta is "thought" to disrupt nociceptive signals as well as chemicals in the CNS per the research I read when Rx'd this med. Persistent migraine, in a class all its own, is another example of non-neuropathic pain that is disabling. It is not yet known what trigger points are and why they cause pain but the can cause severe chronic pain and disability. The point is that depression and anxiety is common in people with persistent pain no matter what the cause. There's plenty of research going back decades on pain's effect on mental health and the use of antidepressants for pain.

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@bustrbrwn22

@kaptainkat That is what I have been told by pain doctors as well. Sciatica is usually caused by nerve pain due to an endless number of factors. I also have bone spurs and DDD and I relieve pain from that differently from sciatica.

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My comment wasn't clear. I'm not saying sciatica is like other persistent pain. It's that mental health can be affected by any kind of persistent pain and vice versa.

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@bustrbrwn22

@kaptainkat That is what I have been told by pain doctors as well. Sciatica is usually caused by nerve pain due to an endless number of factors. I also have bone spurs and DDD and I relieve pain from that differently from sciatica.

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Glad to have a random 'second opinion' that concurs with what I have 'found' on the Internet.

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@debkl

The quality of pain can be different but other pain types can be persistent and severe. Bruises and sprains are considered to be acute, but a sprain, if still painful after 12 weeks and with medical treatment, would be considered persistent pain, which is what the industry is calling chronic pain. It doesn't matter if it is nociceptive, neuropathic, nociplastic, or whatever. It's simply pain that persists despite treatment and/or beyond typical healing time. Cymbalta is "thought" to disrupt nociceptive signals as well as chemicals in the CNS per the research I read when Rx'd this med. Persistent migraine, in a class all its own, is another example of non-neuropathic pain that is disabling. It is not yet known what trigger points are and why they cause pain but the can cause severe chronic pain and disability. The point is that depression and anxiety is common in people with persistent pain no matter what the cause. There's plenty of research going back decades on pain's effect on mental health and the use of antidepressants for pain.

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Would 'nociceptive' be like the pain of a burn?
'adjective Physiology
relating to or denoting pain arising from the stimulation of nerve cells (often as distinct from that arising from damage or disease in the nerves themselves).'

And would 'nociplastic' be like 'phantom pain'?

Is there a distinction between 'persistent' and 'chronic'? Does 'persistent' include 'keeps coming back'? I have always considered 'chronic', like mine, to be 'never not there'.

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I now there are things I can do, and AM doing - PT exercises at home - to reduce the pain. I don't know that 'control' is the word so much as make it less.
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But I KNOW I it will ALWAYS BE THERE. As will the problems with my 'repaired' esophageal issues.
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Talk about 'Just for today...'* and 'This too shall pass...'*
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Thankmew for READING and interacting with my post! I look forward to you replies.
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(=^..^=)
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*From Alcoholics Anonymous

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@bustrbrwn22

@kaptainkat That is what I have been told by pain doctors as well. Sciatica is usually caused by nerve pain due to an endless number of factors. I also have bone spurs and DDD and I relieve pain from that differently from sciatica.

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Bone spurs and the various changes that nake up DDD can be a cause of lumbar nerve root conditions.

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I'm in such pain with my sciatica. My doc won't Rx prednisone--I understand it can be used only a few times per year. He offered to refer me for an epidural injection, but I'm just very, very wary (and scared) of anything having to do with poking near my CNS. I don't know if they do it with guided imaging or not. I just feel depressed b/c the pain has me hobbling--it extends from the right buttock all the way down to my ankle. And it was even present in my shin this morning. There are very rare side f/x with the injex, such as stroke, blindness, etc. I would just prefer not to take that risk. So I suppose I am stuck with only pain med (for which I'm very thankful, but which I wish I had more of b/c the pain comes more often than the daily quantity permits--i.e., 4 daily, for 6-hour intervals, but they last about 4 hours, and then the pain returns, but, hey, 4 hours are 4 hours are 4 hours...). I don't understand why he won't Rx prednisone--his nurse said he Rx's it all the time!! I know, "Cry me a river..." But why am *I* the exception? I don't get it. Well, back to my DDD and depression and anxiety. ("It's always something...")

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Yes sciatica is tuff stuff but you don’t say what’s behind it? Someone mentioned exercise, which I’m a firm believer in. I stretch and do my HEP every day before I get going even if I hurt because eventually my exercising and walking 2 miles daily works. I still need drugs for the chronic pain but most all of us do. Yes prednisone works but its side effects suck. Injecting too much causes bone premature destruction which is why it’s limited to a certain number a year. And oral prednisone works too but it leads to water retention and eventual kidney damage and in some situations it’s called for but not routinely. I hope you learn what is the cause and what may help relieve your pain safely.

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