I became a neurologist because I’m fascinated with the human brain, and after 11 years in practice, it still never fails to blow my mind — pun definitely intended.
There are more connections in the brain than there are stars in the universe, making the brain, not space, the real final frontier (sorry, Star Trek fans!). We neurologists have spent hundreds of years studying the brain and discovering its secrets, and there’s still so much we don’t know. Some experts even suggest that our entire reality is a construction of our brain, which might explain how my wife can remember traffic routes instantly, while I keep looking at the GPS. Maybe she lives in a map and I don’t.
One thing we can all agree on, though, is that both the brain and the body play an important role in everything we do and how healthy we feel.
The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Physical and mental health are related and interdependent — one can’t exist without the other. In reality, they affect each other in many ways. If you’re physically healthy, the chances you’ll be mentally healthy are higher, and the reverse is also unfortunately true. Anxiety disorders are five times more common in people suffering from MSK conditions, and depression is three times more common.1
But it’s not all bad news. Studies show that 40% of members who reported depression and/or anxiety at the beginning of a physical therapy treatment report reduced symptoms at the end of it. In order to understand why this is the case, it’s important to understand how pain and depression/anxiety work together in the brain.
Pain and mental illness: a self-sustaining loop
When you’re in pain, you feel it in your body — but all the action is happening in your brain.
Pain is your brain’s defense mechanism: we evolved it to deal with acute injuries, like breaking a bone. When we feel pain, our brain is telling us to stop what we’re doing so we don’t do more damage. This works really well when you’ve got a broken leg, but not as well when you’re dealing with a chronic condition.
When you suffer from chronic pain, your brain is like a broken record, stuck on the same pain signals, repeating them over and over again.
Because pain happens in the brain, it also means that our perception of pain is influenced by all of the other things that affect the way we think and feel — our mood, how much we’re sleeping, and even external stimuli. When you stub your toe in the middle of a quiet day, chances are you’ll feel a rush of pain. When you stub your toe on the way to the bathroom in the middle of the night having just been woken by an ambulance, you might feel it less, because all that other stimulation is crowding it out in your brain. This all means that if you’re depressed or anxious, you’ll feel pain more intensely, which in turn can worsen your depression or anxiety.
When you add loss of function to that pain, things get even more complicated.
When an MSK condition makes it difficult to walk, bend over or lift your arm, all of a sudden, things that you usually do without thinking, like getting into the shower or loading your groceries into the car become debilitatingly painful and sometimes impossible, and this can trigger anxiety and depression, too… and those bad feelings can stop us from wanting to to the things we love, which makes us feel more depressed. If you’ve ever been confined to the couch with an injury, you know exactly what I’m talking about.
Over longer periods of time, this lack of movement will weaken our muscles and tendons, and at the same time decrease our threshold for pain, causing even more pain. These loops can go on for years or even decades, leading to conditions both physical and mental that get progressively worse.
Breaking the cycle
Thankfully, there’s a way to get out of this loop — and improve both your physical and mental health at the same time, no matter how far down the rabbit hole you’ve gone.
The first step is movement. Our bodies didn’t evolve to spend all day on video calls and all night binge-watching: they evolved to be in constant motion. Adding exercise into your day can improve your mood (not to mention your stress levels, energy levels and sex life!). If your movement program is a PT-designed therapeutic exercise program, then your chances of feeling better in body and mind increase even more.
The second step is to work on your mind. This starts with accepting pain as a normal part of life, and not judging it or yourself, and using tools like cognitive behavioral therapy and mindfulness techniques to smooth over the grooves in that broken record and get your brain back on track.
At SWORD, our digital MSK programs address both body and mind.
Our PTs are trained to get to the root of our members’ issues and prescribe a tailored exercise plan, and give members behavioral coaching along the way to help them think differently about their pain. Members also get access to an 8-week cognitive behavioral therapy (CBT) and mindfulness program specifically designed to help them overcome the anxiety and depression associated with chronic MSK pain.
To learn more about how SWORD’s solutions benefit both body and mind, fill out this form and someone will be in touch.
1S.R. Currie, J.L. Wang, Chronic back pain and major depressive disorder in the general Canadian population, Pain 107 (1–2) (2004) 54–60.
About the author: Dr. Fernando Correia, M.D.
Dr. Fernando Correia is the Chief Medical Officer at SWORD Health, where he leads clinical validation and medical affairs. He is a physician with a specialty in Neurology, and also holds an Executive Masters degree in Healthcare Management.
He co-founded SWORD with the firm belief that technology can lead healthcare into a new era, one where high-quality, evidence-based medicine is available to everyone, not just a select few. He also believes that a more humanistic approach to healthcare is needed, and that technology and the human touch can go hand in hand and make each other better.
Fernando received his M.D. from the University of Coimbra and his Executive Masters from Católica Porto Business School. He trained in Portugal and in the UK (National Hospital for Neurology and Neurosurgery and Great Ormond Street Hospital for Children). He lives in Porto, Portugal with his family, where he enjoys playing tennis, reading all kinds of books and savoring a good glass of wine.