By Carol Levy, Columnist

"You're depressed."

Friends say it. Family may say it. Sometimes doctors say it.

Well, duh. We live with pain for much of the day or all day long. It is hard not to be depressed!

Our lives have been changed in ways we never could have imagined. Pain is the boundary by which we live. Can I do this, go there, be with people, or work?

Pain is often the arbiter. I want to do something, but the pain tells me I can't.

How depressing. How sad.

Does that then mean we are psychiatrically ill? Does it mean that the pain is, as many of us have been told, "All in your head?"

I won't deny that for some patients the pain is psychosomatic or has a large psychological and emotional component. But for most of us the diagnosis is firm, the pain real and physical.

Interestingly and sadly however, MedicineNet.com and many other sources include this in their definition and description of what causes depression: “Chronic pain that does not respond to treatment.”

And yet when you click the link for "chronic pain" they do not refer to it being psychosomatic or having psychosomatic causes.

How many of us continue with treatments, procedures, and surgeries despite a lack of benefit? Does that automatically translate into psychogenic origin?

The questions arise. Did depression cause my pain? Would my illness not have appeared if I wasn’t depressed? Is that answerable? Would an answer matter?

What I do know is that depression carries with it not only a feeling of persistent sadness, but feelings of hopelessness and helplessness.

And how can we not feel hopeless, and helpless, when at one time or another most of us hear these kinds of statements from our doctors:

"There is no cure. You’ll have to learn to live with it.”

“I don't have an answer for why you have the pain you do.”

“There is nothing left to try.”

I remember being upset the first time I was prescribed an antidepressant. My doctor had to reassure me, "No, Carol. These drugs can work on the pain. I am not giving it to you because I doubt your pain is real."

Whether we have depression arising from pain or depression causing our pain to appear, it is worth trying to deal with it, through counseling and maybe medication too.

I often hear people with chronic pain ask if their shortness of breath, weakness, insomnia, etc. could be related to the fibromyalgia, back pain, neuropathy or whatever condition they suffer from.  It is easy to think that all our physical changes and complaints come from our diagnosed illnesses. It is harder to see past what we know we have.

I think the same is true for depression. Even if we get relief from pain, the depression may still be there.

It is incumbent on doctors -- and us -- to accept that a psychological issue and diagnosis may exist separate and distinct from our chronic pain.

It is important that our psychological state be seen as equally important, worthy, and possibly separate from our chronic pain. And we need to allow ourselves the acceptance of a dual diagnosis, even if it is a psychological one.

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.” 

Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.