Mental Health Awareness month: Depression and migraines

There is no such thing as pain without emotion. Pain comes with an emotional reaction. Often with chronic pain depression and anxiety. (2)

With migraines, we are three times more likely to develop depression.

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And we have a higher risk of suicide as well, even factoring in the depression.

This week is mental health awareness week and I think depression is an important topic with chronic migraines specifically. With chronic pain, we tend to have this belief that the pain would make anyone have troubles coping. That anyone would be down. Frustrated. Have dark moods. And depression, if we acknowledge to ourselves it is even that. We say everyone must feel like that sometimes… because of the pain. Indeed, pain itself is a suicide risk factor all on its own and it is a risk factor with migraines aside from depression… because suicide is what happens when we exceed our coping strategies and have no hope in resolving that problem. And that situation is something chronic migraineurs find themselves in often. But we also blame the depression on the pain, feeling it is normal to be like that with pain. In fact, depression associated with a medical condition like chronic pain… is a type of depression. But it is depression. And it can be dangerous if it is not treated along with pain management. If the pain is out of control the depression will respond to that. So both need to be effectively managed at the same time. It is my belief the depression treatment will not be very effective if it is therapy based if the pain isn’t being managed at all. When it is depression associated with chronic pain that is. You have to show there is some Hope in pain management. I am all for therapy though. Very valuable for this type of depression because a therapist that

In fact, depression associated with a medical condition like chronic pain… is a type of depression. But it is depression. And it can be dangerous if it is not treated along with pain management. If the pain is out of control the depression will respond to that. So both need to be effectively managed at the same time. It is my belief the depression treatment will not be very effective if it is therapy based if the pain isn’t being managed at all. When it is depression associated with chronic pain that is. You have to show there is some Hope in pain management. I am all for therapy though. Very valuable for this type of depression because a therapist that specializes in chronic pain can help with the depression and with coping with the pain, and how they work together and tangle together. And oh, how they tangle together.

Sometimes depression isn’t depression related to a condition, sometimes it is Major Depressive Disorder and ignoring it can be dangerous. It can lead to suicidal thoughts and actions even without the risk factors of the pain and migraines. This is the type of depression I was diagnosed with. Actually did exactly what I said, ignored it for years because I thought it was the pain. Just the pain causing it and I could deal with it. But it wears on a person. Gets the best of them. And going to the pain clinic, seeing the pain psychologist and ultimately being put on Abilify (I have severe adverse reactions to antidepressants) was the best thing that ever happened to me. Trying to cope with pain while fighting your brain is a difficult battle every day. Makes it twice as hard to cope. It is a heavy burden to bear. Having it lifted enough to deal with it effectively makes me able to use all the strategies I need to cope with the pain. Depression doesn’t just make you fight yourself mentally and emotionally. It saps your energy and motivation. You have strategies and habits you want to maintain… but then just can’t find the will to do them. Or even why. Why bother? What ever changes? What is even the point? All those thoughts happen. But every bit counts in a routine with pain, as we all know. Ice helps. Magnesium helps. Vitamins help. Meditation helps. Medication helps. You add all the things that help and you get something that helps you manage your pain.

Management of our comorbid mental health conditions is vital. There is no shame in it. There shouldn’t be anyway. There is the stigma. There is even doctor stigma. There is so much stigma it is insulting to me and to society as a whole. I have been pretty insulted by the stigma myself. But that is on them, which is why we need awareness. But don’t you feel shame just because of that stigma. 1 in 5 people will have mental health problems in their life. That is a lot of shame if people expect us to feel that. And we have no reason to. Our neurtransmitters are a little out of sorts is all.

“13 Reasons why” was not for me

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I got right into this series and watched it like crazy. I knew it was about suicide but I watched it anyway. I shouldn’t have. I can read a book about suicide and I am fine but visually seeing a suicide scene and aftermath… it hit me like a fist.

I remembered my first suicide attempt. It was from pain and depression from pain. Like the show, I cut into myself. Watched myself bleed because I wanted to see the life flow out of me. I wanted the violence of it. Chronic pain has no blood. You suffer and suffer but no one sees the wounds. I wanted the wound to show in my death. No one should have to suffer that much pain and function. I knew that fundamentally. I thought it was cruel and madness. And madness for me to particulate in it like it was okay to do that to a person. I felt useless and worthless at the same time. A burden. And I didn’t want to be one. I knew people would mourn but I knew they would know at least I wasn’t in pain anymore. You have to be in that headspace to truly know how deep and dark it is. But with the relentless physical pain of the moment tormenting you, all you want is it to end.

All that untreated pain. That overwhelming depression. I’m amazed I survived as long as I did.

When you survive an attempt it is traumatic. You see the impact. And that you see in the Netflix show as well. The mother finds the body and the father comes in and it is a devastating scene. You see their suffering throughout and know you too could have caused that. Surviving you know the impact you could have had. You see the effects on your family. See the fear and worry. I again felt that impact and worse felt how much worse it could have been. It was like a punch to the gut.

The show just was like a flashback. Of pain, of the trauma, of the impact. Of how hard it was after to reconcile not wanting to hurt those I love in such a brutal way and not wanting to survive with the pain. I couldn’t. Someone always suffers. I read somewhere that suicide is like a bomb. It takes out the person but the shrapnel wounds those around the person. The closest get wounded the most but those not as close also get wounded. The suffering is widespread. How does one reconcile a life of suffering or passing all that suffering on to a group of people?

Anyway, I loved the series in regards to bullying. It shows the impact one’s actions and words and inaction can have on another’s life. Something teens should think about. It doesn’t focus on the mental illness aspect but you can see the signs of depression plain as day. The isolation, she cut her hair, stopped hobbies, her poem, talked about numbness, the suicidal thoughts and long insomnia walk.

It is just not something I should have watched. I have been out of sorts all day. Listless and sad. It re-hashed something that was very traumatic for me. And layered it in a devastating storyline that didn’t hold the punches. I felt for her. I felt for me. It reminded me of a very dark time for me.

I am still depressed. Depression 2.0 I call it. Because I am treated with Abilify which takes away my Plummets of Doom. The Deep Dives into Despair. Evens things out. But I still have this softer depression. I no longer have suicidal intent. My brain has a switch. With depression, you keep fighting to a point. And then Switch, you don’t. You give up, curl up in a ball and wish it would all go away. And become vulnerable to suicidal thoughts.

Watching ’13 reasons why’ was good, disturbing and so very sad. It will hit everyone hard. As it should. But if you have survived suicide it may just hit you harder. All the memories may come to the surface again. I am not saying it is a bad thing. I don’t hide from my suicide attempts, I regularly talk about them. I want to end the stigma. I want people to be able to talk about it. Maybe showing such a vivid scene will help with that. But someone who has been suicidal, is depressed or has suicidal ideation there really ought to be a warning on there for that. We see a lot more in there that others do not. And then we reflect it back on ourselves. I’d say better to want with someone you can talk to.

We ticked off Fluffafur

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Time to focus on my mood again. I need some mood boosting days. Some self-care mood boosting. It has been a difficult time on the pain front. Very difficult time stress wise and depression wise. It has been worse this week for sure. But since January it took a dip and I have been sort of wallowing, I suppose. Sleeping too much. Fatigue. Lack of motivation. Then I got some bad news and it dropped significantly lower. Yay.

So time to do some self-management instead of wallowing. Depression sort of encourages wallowing, though. It saps motivation, you have fatigue and it makes it hard to make decisions.

But I think if I start making firm decisions and carry them out step by step it will help in the long run. That I will start Monday.

This weekend time for some self-care. I will focus on my writing and do some reading. Avoid negative interactions. Get in some meditation.

And above all focus on my humor. I need it. Fluffafur needs it. We all need it.

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I am depressed

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I actually knew I was depressed. It isn’t a surprise or anything. However I have been looking through my files for ‘evidence’ to give my insurance company for my migraines and came across my psychologists letters to my doctor.

Initially when she diagnosed me she diagnosed me with mood disorder associated with a medical condition; as in depression associated with my chronic pain. And primary insomnia. I remember this because, yeah, it made sense to me. In pain, also depressed. However, she got to know me and changed that to Major Depressive Disorder. I don’t remember that, but, that being said I was depressed at the time and my memory of such things is hazy at best. I had been returning to work after my first suicide attempt and was seeing her because I was worried work would pretty much cause a second attempt. And I was right, but it would take some time.

Different people are affected in different ways by major depression. Some people have trouble sleeping, they lose weight, and they generally feel agitated and irritable. Others may sleep and eat too much and continuously feel worthless and guilty. Still others can function reasonably well at work and put on a “happy face” in front of others, while deep down they feel quite depressed and disinterested in life. There is no one way that people look and behave when they have major depression. However, most people will either have depressed mood or a general loss of interest in activities they once enjoyed, or a combination of both. In addition they will have other physical and mental symptoms that may include fatigue, difficulty with concentration and memory, feelings of hopelessness and helplessness, headaches, body aches, and thoughts of suicide.All about depression.com

I guess I can see why she changed it. My depression did become its own beast. Initially years ago I do believe it became a problem simply because of the pain. The pain was getting the best of me and I was pushing through the pain to work… and it was really becoming a massive problem so I was depressed about it. But tack on a few years of That and it ingrains itself pretty good. Get some strong habitual depressive thoughts. Some steady suicidal ideation and a couple of attempts in there. A lot of self-worth issues and guilt. But I masked my depression very well, up to the suicide attempt obviously and other than no succeeding I regret that I can no longer mask it. I prefer to pretend it is all well and just deal with it myself. But clearly that is risky when you are suicidal.

After the second attempt my current psychologist sent me to a psychiatrist for medication. Clearly he agreed it is Major Depressive Disorder and at the time needed to be medicated as well. And it really, really did. I would get in a lot of pain and all I would think about is wanting to die. How much better off everyone would be. How much better off I would be not suffering. How I wouldn’t be a burden anymore. And I was useless anyway, no one would miss that. Take me away and there is no one thinking she was necessary for this or that. I was fundamentally useless with pain. Those thoughts and more on repeat. The med, Abilify, stops that. I do get suicidal, from pain alone. But I do not get the plummeting mood that drives me to want to die,  just die that very moment. It evens it out. So I am depressed but it is milder and easier to tolerate. The pain isn’t so I still get the issues with that.

Here is the criteria I found on All about depression.com

Diagnosis of Major Depressive Disorder, Single Episode

From Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition

A. The person experiences a single major depressive episode:

  1. For a major depressive episode a person must have experienced at least five of the nine symptoms below for the same two weeks or more, for most of the time almost every day, and this is a change from his/her prior level of functioning. One of the symptoms must be either (a) depressed mood, or (b) loss of interest.
    1. Depressed mood. For children and adolescents, this may be irritable mood.
    2. A significantly reduced level of interest or pleasure in most or all activities.
    3. A considerable loss or gain of weight (e.g., 5% or more change of weight in a month when not dieting). This may also be an increase or decrease in appetite. For children, they may not gain an expected amount of weight.
    4. Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia).
    5. Behavior that is agitated or slowed down. Others should be able to observe this.
    6. Feeling fatigued, or diminished energy.
    7. Thoughts of worthlessness or extreme guilt (not about being ill).
    8. Ability to think, concentrate, or make decisions is reduced.
    9. Frequent thoughts of death or suicide (with or without a specific plan), or attempt of suicide.
  2. The persons’ symptoms do not indicate a mixed episode.
  3. The person’s symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas.
  4. The person’s symptoms are not caused by substance use (e.g., alcohol, drugs, medication), or a medical disorder.
  5. The person’s symptoms are not due to normal grief or bereavement over the death of a loved one, they continue for more than two months, or they include great difficulty in functioning, frequent thoughts of worthlessness, thoughts of suicide, symptoms that are psychotic, or behavior that is slowed down (psychomotor retardation).

B. Another disorder does not better explain the major depressive episode.

C. The person has never had a manic, mixed, or a hypomanic Episode (unless an episode was due to a medical disorder or use of a substance).

It is a pretty serious co-morbid for migraines and chronic pain. We have to have it treated well and see a psychologist to manage it.

Christmas blues

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Christmas is my favorite holiday. For the obvious reasons. You get to give presents, awesome. You get presents, awesome. You get to spend time with family and have a meal, awesome. We deserve an awesome holiday in the bitter cold winter to make us happy. I have to say, I never put the Jesus in Christmas, so there is none it now. It is a complete non-religious venture for me and always has been. So don’t remind me in comments of the True meaning… the meaning for me is family and always has been.

That aside, totally not feeling it this year. Lost my younger brother passed not too long ago and will be missed at Christmas. My older brother and his girlfriend, tend to do things, well let’s just say not with our side of the family anymore. My brother does what his girlfriend values. And it isn’t us. So we likely will not see them either.

But it isn’t just that. I have been very stressed with my insurance application and lack of funds until it gets sorted. It is causes my mood to vary immensely and erratically. To a degree I don’t like. I mean when I was working one reason I felt the need to stop was I was getting to that danger zone suicidal thought wise. But feeling like this application isn’t going well, and that I might have to go back to that pain level and situation, plummets my mood all over again. Not good. I feel very sick… sicker than usual in ways that are hard to explain. Lots of pain, massive amounts of fatigue… yeah all that jazz. But just unwell.

Like the Matchbox Twenty song Unwell

All day staring at the ceiling
Making friends with shadows on my wall
All night hearing voices telling me
That I should get some sleep
Because tomorrow might be good for something
Hold on
Feeling like I’m headed for a breakdown
And I don’t know why
But I’m not crazy, I’m just a little unwell
I know right now you can’t tell
But stay awhile and maybe then you’ll see
A different side of me
I’m not crazy, I’m just a little impaired
I know right now you don’t care
But soon enough you’re gonna think of me
And how I used to be, me
Yeah, unwell. But of course I am indeed depressed. I suppose that does indeed factor in with all the pain I am in. Drags a person down. I know I should be excited… but I feel very tired. Of just everything. Profound mental and physical exhaustion to the depths of my being.
Not to say I am not doing things despite it. Like exercising, which is painful in itself, but yay doing it. My physio as well. Meditation. Check. Feel like I am checking off boxes of things I should be doing and then forcing myself to do them…. just because.
Yeah, doing things just because.

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Insurance companies do not ‘get it’ do they?

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So I call from my insurance company asking for information they insisted they didn’t need in the first place, because they are that awesome. I should have got it in the first place, knowing who I am dealing with. But they also said my doctors clinic notes do not show sufficient evidence for disability.

And I wonder how that can even be. This is to show I cannot work. So setting aside the depression that caused two suicide attempts… set That aside. Set aside the FM. Then I have the daily intractable migraines that have never responded to any treatment at all ever.

I wonder if they comprehend what intractable means. It means nothing has been able to decrease Frequency or Intensity of my migraines. And I am Daily. As in every single day I go to work with a migraine of the intensity between a 7-9. And I am expected to drive. And I am expected to think and not make errors. To communicate despite aphasia. To remember despite brainfog and pain interfering with short term and long term memory. Hell I am expected to see and hear despite auras that actually make that pretty hard to do. I can take a triptan 2-3 out of those 7 days in a week so impossible to treat every work day, assuming they even worked all the time. Except I can’t even do that because my doctor explicitly told me to take them rarely due to the extreme adverse effects I get. But I do take them anyway when I am working, because I want the hell to be dampened slightly for a few hours and I will deal with breathing problems and chest pains… hell I’d welcome a heart attack. And I am unfortunately serious about that one, due to the whole suicidal ideation factor. I have lost 40 pounds due to nausea and vomiting. I get chest pains all the time because of the triptans, which I ignore.

But mostly, goddamn it all, it is the effing pain. It is the pain I can’t take all the time and work. The pain leads to lack of sleep, and sleep deprivation which makes the pain worse. And leads to waking up with a migraine or status migraines. Which leads to plummeting moods and suicidal ideation. And then more suicidal thoughts. Then suicidal intent and actions. It is a cycle I have repeated over and over and over. I wanted to stop it before it started. I was really struggling and I just wanted to stop it before I did something I couldn’t take back… is that so crazy? I get it, it is in fact crazy. But proactive. And understanding my own state of mind.

These guys have no idea of suffering. No idea how close to the edge we can be because of it. I have no idea what ‘evidence’ they are looking for. 2 chronic pain conditions apparently isn’t sufficient. Depression causing suicide attempts… not sufficient. You know what message that sends to someone who had depression with suicidal ideation? Yeah that message.

So being as that pushed me right into my dark place I have to spend the night on some work my psychologist gave me. Deciding between rational thoughts and distorted thoughts. Like my instance company is a douche bag and their ‘specialist’ aka a nurse, isn’t a specialist in anything… a rational thought. That the only way to ever end this and the pain is to kill myself, no insurance company, no work, no pain. Distorted thought.Well True, but not the Only way… one effing hopes that is. FFS this is an ongoing nightmare of mine. Everyone of my Actual specialists say I cannot work. This is the most idiotic process ever designed. So anyway, I’ll end this point while I go think non-suicidal things and work on my suicidal ideation worksheet.

Moment of despair

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I am waiting on my appeal for long term disability from work and that in-itself is pretty anxiety inducing. But I was just thinking of what it would be like if it didn’t go through. What it was like working. The pain, inability function, inability to concentrate, think… the failure, the missed days.

And I was overwhelmed with a sense of despair. You know where it almost chokes you? Where it feels like you are suffocating with this horrible overwhelming sadness. I teared up and blinked them back.

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It is frightening when that much despair hits you when you think about working part-time. When you think about how it felt. When you think that you might have to be in that space again of pain, depression, cognitive dysfunction… and having to function when you can’t. The guilt. Then more guilt at the inevitable failure. Then more guilt at every missed day. And how pathetic you feel. How worthless and useless. That you can’t even do a simple job. What a loser you must be.

I have the pain, the cognitive issues, depression here at home. And I struggle to do anything. But I am not forced to function for 8 hours where others are dependent on what I do and how well I do it.

It was a horrible sensation that told me to automatically stop thinking about it so as to not slippery slope myself into a depressive episode. Thoughts like that lead to dangerously dark thoughts. And deep depressions. And I know sometimes distraction is the best I can do. So after this post I am going to switch to fiction writing. I must not thinking about the failure of this appeal for my own mental well-being.

Selfish

This is a reprint of a post I made for Migraine Checked about suicide. Since this is the anniversary of my second suicide attempt. Unmanaged pain is a very dangerous thing.

 

I want to talk about the very serious topic of suicidal ideation and suicide. The stigma with suicide though still runs rampant though and while I have seen so many people understand this death and so many others were caused by depression… others feel they can judge those who die in this way. They say they are selfish. That they should have just got help before it got that serious. That they should not have let their families suffer for their pain. I have seen this on twitter and I have seen it on Facebook. I have seen it recently and I have seen it before and I will see it again. “Suicide does not take the pain away, it gives it to someone else.” And people think these things because they do not understand depression. And because they do not understand suicide. And they do not even understand the two do not necessarily have to go together. Physical pain alone is a trigger for suicide.

This is one thing I want people to understand about suicide:

 

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In my case my suicide attempt in 2010 was not this spontaneous occurrence. With profound pain came suicidal ideation that I fought off every time. Bravo me. I survived more times than you can count. Was that then selfless of me or just survival instincts? We want to live. We love people. But there was a war within me and one I was losing.

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There is a thought process that we go through during these times. My existence was torture and it seemed Unreasonable that I should have to exist this way. Irrational that I would choose to exist in that pain and in fact choose to make it worse. Why would any sane person do that? And all avenues I had tried to reduce that pain had been used up. Society, my employer and my doctor at the time were all by their lack of caring and disinterest stating they wanted me to suffer. So this was my existence. Forever. And forever is a long time when you are in pain. A very long time. You see how endless and indefinite it is. If you just knew how long it was you had to go on. You begin to think how nice it would be to have a fatal stroke because… that would not be your fault. Then you imagine if you could kill yourself but make it look like an accident then no one would have to suffer with the knowledge that you had killed yourself. Clearly, I knew I was suicidal but these were Bad Days with Bad Thoughts. And my bad pain days were usually status migraine stretches, so I just had to wait them out… until I could get back to normal pain days. Normal hell. Then my work place would give me these ultimatums. If you do not work every day… we will do something unpleasant. And that would cause more pain, more stress, more suffering. Until that last ultimatum in that last status migraine…

Do not ever tell me someone is selfish when they are suicidal until you have been in that mental space. Until you have gone down that slippery slope of thinking and reached that line… and crossed it. You have no idea what goes on in that space. No clue. We do think of the consequences of our actions. It is just that first, we understand that grief will end and our suffering has no end unless we make it end. That is the first misconception our brain convinces us of. Well with physical pain we are very aware there literally is no end. But pain has a way of consuming your capacity to see reason as well, but that is another rant. (I will just say extreme pain warps reality as well) Second, that our families will be better off without us. We are a burden after all. We are holding them back. Imagine how much different and better their lives will be if we removed ourselves? Of course they would not Want that… but if we did it for them, it would in fact be better after they grieved for us. I myself was sure of this. I also knew my insurance company covered suicide so I knew financially some of my expenses would be covered… an added bonus really. Frankly, I assumed my existence was really rather worthless. Just this endless mass of pain that has no real meaning and worth. Except essentially to torment me… and That seemed like the ultimate madness really. You can rationalize suicide. You can slide down that slippery slope until you have essentially made it make Perfect Sense. I even explained it to a therapist after the fact and she could not even argue against me… as in she could not explain to me how my reasoning was not rational. She should have been able to because there should be flaws in the reasoning but we can really have quite an in-depth rational going on.

And so, no point arguing is there? There are finding reasons to live I find. Finding ways to live. Finding what you need to change and figuring out how to do it. Living until living works for you. Seeing a psychologist is something I chose to do to help with pain management because pain management is what I was severely lacking in. And it was damned hard. I was traumatized by the suicide attempt. I think sometimes people think an attempt is just a cry for attention but in fact it is just… didn’t get it right for whatever reason. In my case poor timing on my part. I know I could have had good timing and not be here right now because I had done the rest of it quite well. But I will say… it should be taken very seriously and the cause taken very seriously and the treatment taken very seriously. In my case it wasn’t really. The pain wasn’t treated. The work situation remained. And I became depressed from it. But after that… when I shook free from that I was motivated to change my doctor, see the psychologist, start managing my pain in new ways and took a long leave from work. I suspect I might not be here if I had not made those changes. Pain like that when not treated can really consume a person.

In the end when you survive a suicide attempt you are always at risk for another attempt. There is less of a chance of survival with a second attempt. We have to make that choice to understand the future does not mean endless suffering. The future can bring with it positive changes if we look for the right solutions and get the right sort of help that we need. It is not always easy to find and it is not always an easy solution… sometimes it is a damn hard fight, a constant endless battle to manage our suffering… but better than it would be with no help at all. With no hope at all.

We need to talk about this. We need to reduce the stigma of mental illness. And reduce the stigma of suicide. Check out: Stop calling suicide victims ‘selfish’

 

Suicide Hotlines

Migraines and suicide #MHAM #CDNmigraine

Suicide attempts are 3 times more likely in people with #Migraine with aura. #MHAM

Suicide attempts are 3 times more likely in people with #Migraine with aura. #MHAM

 

Pain itself is a suicide risk factor. Suicidal ideation and intent can happen when pain exceeds our coping strategies. Which happens when we have no pain management and we are exceeding our pain limits.

During the 2-year followup period, persons with migraine or severe headache were at least 4 times more likely to attempt suicide than controls. The odds ratio in migraineurs — adjusted for sex, psychiatric disorder, and previous history of suicide attempt at baseline — was 4.43 (95% Confidence Interval [CI] 1.93, 10.2). Persons with non-migraine headache of comparable intensity and disability also had a greatly increased likelihood of suicide attempt as compared with controls: odds ratio, adjusted for the same covariates, was 6.20 (95% CI 2.40, 16.0). [Due to the wide, overlapping CIs the difference between the 2 odds ratio estimates was not statistically significant.]
Continue reading “Migraines and suicide #MHAM #CDNmigraine”

Pain epidemic #PainMatters

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We hear the media frenzy of the so called opiate epidemic, which seems to me to be people buying to on the street and less people getting it actually prescribed to them. And certainly little to do with chronic pain patients. But we never hear about the pain epidemic. And the lack of pain management.

The fact doctors are less trained in pain than your local veterinarian. Maybe pain patients should go to the vet instead? Or how about pain clinics. How many get to even see one? How many years does it take to get a referral to one? I was diagnosed with migraine and FM when I was 20, had hypermobility syndrome already by then… and when to a pain clinic when I was 38. Tried to kill myself from pain when I was 32. That should tell you a little about the lack of pain management I had going on then. Hopefully the average is sooner than 18 years.

What sort of treatment do they even get there? Are they getting to see a pain psychologist, taking a course in pain, learning to meditate, learning the exercises they need to do, having their medications assessed, being put on medications to help them have a quality of life, having them discuss their work situation and what improvements or changes need to be made their, any physio or other procedures to help with their treatment?

If you take away opiates because your all riled up about it for no reason… what will you replace it with so that pain patient has the same quality of life. Understanding that if you decrease their quality of life substantially you run the risk they will have suicidal ideation and/or intent. Doctors should be aware pain alone is a suicide factor. If they are not, here I am to tell you. Pain. Alone. Is a. Suicide. Factor.

It certainly was for me. I am on tramadol slow release twice a day. Before I went to the pain clinic I lived a different life. It was an existence of crawling through the pain every day. It has a raw desperate edge to it all the time. I was always pushing through the pain, exceeding my pain limits. In survival mode. Get through it. Get home. I was a hermit. Nothing left in me to leave the house. To socialize or do anything. I had a great deal of suicidal ideation. Wished I would die of a stroke or heart attack. I’d get chest pains from triptans that were nasty but never went to the ER… as I rather thought if they killed me it would be a natural death and that was better than by my hand. Finally a suicide attempt.

I never want to be in that place again with no managed pain. It is a hell I still think of. No one should have to endure that. No one should be shamed for opiates being part of their pain management.  Doctors should not be intimidated for using that tool when it is appropriate. And doctors should know pain matters. Our pain matters. Our lives matter. Our treatment matters.