10 Ways to Avoid Depression Over the Holidays

By Barby Ingle, PNN Columnist

Do you celebrate the holidays or do you secretly dread them? For some of us, the period between Thanksgiving and St. Patrick’s Day can be the most depressing time of the year.

The first reason is that we are exposed to less sunlight during the winter. We need light to maintain our physical, mental and emotional health. There are also societal pressures that can weigh heavily on pain patients, such as not being able to participate in holiday activities. The holidays can make us depressed, financially strained, anxiety ridden, and harder to be around.

Here are some early warning signs of depression:

  • Difficulty concentrating, remembering details and making decisions

  • Fatigue and decreased energy

  • Feelings of guilt, worthlessness, hopelessness and/or helplessness

  • Insomnia, early-morning wakefulness, or excessive sleeping

  • Irritability, restlessness

  • Loss of interest in activities or hobbies once pleasurable, including sex

  • Overeating or appetite loss

  • Persistent aches or pains, headaches, cramps, or digestive problems

  • Persistent sad, anxious or "empty" feelings

  • Thoughts of suicide or a suicide attempt

Take this seriously, as depression carries a high risk of suicide. Anybody who expresses suicidal thoughts or intentions should be taken very seriously. Do not hesitate to call your local suicide hotline immediately.

Depression can cause you to isolate yourself from others, decreasing your mobility and increasing drug dependence. A cycle begins where depression causes and intensifies the pain and stress on your body.

It can be hard to face the emotional aspects of pain, but it is important to look at the signs and be aware of them. Remember, pain causes depression, not the other way around! 


Depression can keep you from taking care of yourself. You cannot afford to let yourself fall into dark dreary moods. Be sure, no matter how you are feeling, that you are following the goals set for your care, such as taking the correct dose of medication at the correct time of each day.

It may take a little effort to keep healthy habits when you are depressed. Here are 10 tips fellow pain patients, friends with seasonal affective disorder (SAD), and I have used over the years.  

  1. Use artificial light sources. The body’s internal biological clock can get really out of sync during the winter season. Bright light therapy becomes an important tool.

  2. Try something new, such as a craft or hobby.

  3. Progressive muscle relaxation, hypnosis and meditation can reduce stress and pain levels

  4. Stop doing things you don’t enjoy and do things you like, such as listening to music or aroma therapy.

  5. Physical therapy and exercise can break the cycle of pain and help relieve depression

  6. Make a list of life’s blessings, reminding yourself what you have accomplished in life. Even if you can’t do it now, you could once and no one can take that from you.

  7. Cognitive and behavioral therapies teach pain patients how to avoid negative and discouraging thoughts.

  8. Change everyday routines to ward off physical and emotional suffering

  9. Clean out or organize an area of the house. It could be as simple as clearing a bedside table or filing your medical records. Getting organized in one area of your life can help you manage other areas more successfully.

  10. Seek professional help if you start feeling overwhelmed. Dealing with chronic pain can slow recovery from depression. Specialists should treat both problems together.  

Getting your depression under control will help you focus on managing your health. As you learn to let go of anxiety and stress, it will help lower pain levels and make the holidays more enjoyable.  

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Barby Ingle lives with reflex sympathetic dystrophy (RSD), migralepsy and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain Foundation. She is also a motivational speaker and best-selling author on pain topics. More information about Barby can be found at her website.  

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

Lightening the Load Over the Holidays

By Carol Levy, PNN Columnist

There was a train full of sewage traveling through Alabama. One town found the smell so horrid, likening the stench to “rancid meat” or worse, that they refused permission for the train to enter the town or even stop to transfer loads.

Another town welcomed the train. “Let it come. The smell can't be as bad as they say. They're exaggerating,” they said.

But then the train arrived. The second town found the stench to be as utterly revolting and repulsive as the first town had said. The second town had to experience it firsthand before they would believe a train could emit such noxious smells.

Sound familiar? I’ve always felt that those of us with chronic pain are singled out in a similar way, when we are disbelieved and told the pain "is all in your head.”

But if it can happen when people have a freight train full of sewage in their backyard, and even they are not believed, it gives me hope. Maybe we are not so different after all.

What does this have to do with the holidays, you ask?

When I heard about the train and the reaction to it, it started me thinking. The holidays are fast approaching and so are all the dinners and social gatherings that come with them.

I see the worries starting as I read posts on Facebook and elsewhere. Will I be able to do whatever they ask me to do? Will I have the energy to stay and make small talk and play with the kids? Will my family and friends accept me as I am, respecting my limitations and boundaries?


We can only answer those questions in the theoretical. We don’t know what the reality will be, how we will be, and how others will be when the holidays arrive.

Maybe now is the time to prepare ourselves. To realize some people will be respectful, helpful, compassionate and empathetic; while others will turn their backs on our needs and us. We often already know who will do what. We know who thinks, “It's not so bad. You're exaggerating.”

And like the first town with the sewage train, the residents' lives brightened and the stench dissipated when they got rid of the train. That is the thing about visiting. You know you can leave.

As the holidays approach, it is important that we allow ourselves the freedom to accept the caring folk, as well as the uncaring; the kind as well as the nasty; and the helpful as well as the hurtful.

And, most important of all, we must accept ourselves and all that we are.

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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.

7 Tips for Peace and Calm in the Busy Holiday Season

By Ellen Lenox Smith, Columnist

When the holidays are upon us, we tend to go into overload. Our minds are filled with all the things that have to get done. Maybe it’s presents to buy or make, meals to plan, company to prepare for, or packing for travel away from home.

We get so busy wrapping, cooking, cleaning and planning that, before you know it, your mind is spinning. If we aren’t careful, we get so wound up and tired that we can easily slip away from enjoying and experiencing the meaning these times with family and friends should have for us.

For those of us living with chronic pain and illness, it can also unintentionally cause a setback with our health. Life is difficult enough already without adding holiday stress to it.

Take the time to protect your health and learn to make it a priority among all the other things you need to take care of.

Here are seven tips to put peace and calm back into your life, while still enjoying the holiday season:

1)  Do your best to stick to your normal routine. Be honest with yourself and your body. If you are too tired or have too much pain, do what is best for you. There is nothing wrong with “not feeling up to it.” Give yourself permission to cut yourself that break.

2)  If you have chronic pain or illness, share with people that really want to know the truth. Many friends and family really don’t understand what you are coping with, possibly due to distance. Maybe you have had little contact, they don’t know how to approach what is happening with your life, or maybe they have chosen to ignore and not support you. 

It is a painful thing to experience when family and friends slip away. But in time, you will find others living with pain and illness that are more understanding and compassionate. Try to find that network, and learn how to live with and someday forgive those that don’t know how to be around the “new you.”  It will someday be their regret for their lack of compassion. Remember, there are many people out there that could use your friendship. Consider reaching out to others in need.

3)  Attempt to simplify your life to prevent the exhaustion many of us experience. One way our family has accomplished this is to no longer buy presents for each family member. A few years ago, we began selecting the name of one person and buying a present for them and no one else, except the children in the family. This had to be the most relaxing decision added to the holiday! The pressure is gone, and we now get to gather and just enjoy being together. 

This year, we have decided to take this idea one step further. We're donating the money that we would have spent on that one person to some person or cause that we want to help support.  We will share, when we all gather together, what we chose to do with our donation. We are all looking forward to hearing each others' choices. 

4)  Being with family and friends can be both wonderful and stressful. Try to make sure the conversations stay on a positive track.  When the topic appears to be getting into testy waters, try to sway the conversation away from negative topics. 

We have all had to calm down and regroup from the stress of the election, so try to steer away from anymore negative talk, blame and judgement. The Today Show even suggested that if you are the host, to set the rules and explain that this is a calm gathering. Consider designating a separate room if someone needs to talk politics. 

We have all experienced finding out that people we love and respect did not vote as we did. It can be a trial to hold onto these relationships, when there are dramatic differences of opinion we didn’t necessarily expect to find out about. We need to accept those differences and still appreciate the good in each other.

5)  If you don’t have a lot of space for overnight company, then be honest and provide them with suggestions nearby where they can stay. You want to enjoy your company and not end up resenting their presence. They could still join you for meals and activities, but provide you some much needed rest and quiet when they step away.

Share the responsibilities. There is no reason why each person can’t help bring part of the meal. Don’t take on so much that by the time your company arrives, you are really too exhausted to enjoy them. Maybe you could consider making some dishes in advance and thaw them out before they arrive. That can be your secret!

6)  Try to create calm in your home. Consider playing soft music to fill the air. That can be very relaxing, along with scented candles. Consider asking guests to put their electronic devices away or even collect them, so you can focus on each other and not those screens. There is plenty of time to catch up on messages and postings later. Let this be the time to truly be together.

7)  Make a list of things that come into your mind, in advance of the gathering, of things that need to be done that can help make things go more smoothly. Many of us living with pain get “brain fog” and can easily forget. I find this simple task takes the stress off me, knowing that I will read that list and remember all the things I need to keep me safe, medicated and protected.

Being with family and friends can leave us with wonderful memories. But exhaustion, caused by pushing and pushing yourself, ends up deleting the fun. Those of us living with chronic pain and illness can’t afford to set our health back by pretending all is just fine.

Rest, make simple plans, share the responsibility, and learn how to relax and enjoy. You won’t regret it.

 Happy holidays!

Ellen Lenox Smith suffers from Ehlers Danlos syndrome and sarcoidosis. Ellen and her husband Stuart live in Rhode Island. They are co-directors for medical marijuana advocacy for the U.S. Pain Foundation and serve as board members for the Rhode Island Patient Advocacy Coalition.

For more information about medical marijuana, visit their website.

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

Pain Companion: How to Survive the Holidays

By Sarah Anne Shockley, Columnist

The holiday season is upon us. For many it’s a time meant for joyful festivities, but for those of us in chronic pain, planning and participating in gatherings with coworkers, friends and family can pose significant challenges and stresses.
The demands on our energy, time and patience are likely going to become much higher than normal, and we’ll need to make wise choices about what we can and can’t do.

How do we find ways to participate enjoyably and not send our pain levels skyrocketing?

You Don't Have To Do It All

Learn to say no. Nicely, kindly, but firmly.

You don't have to be the person you were before you were struggling with pain, and you shouldn't try to be.

Yes, people have expectations of you and they forget that you're in pain. It's no fun, but you're going to have to gently remind others that you can't be everywhere and do everything they expect of you this holiday season.

Tell them that it's also hard on you, not be able to be as involved as you have been in the past, but that it is very necessary for your healing.

Let them know that the best way they can support your healing is to allow you to make the choices you need to make -- the choices that may keep you home a little more and out a little (or a lot) less often.

Give yourself permission to ask others to do more than usual so you can attend gatherings without wearing yourself out, and give yourself permission to stay home if you need to.

Let coworkers, friends, and family know that it's nothing personal about them. It's personal about you. You're taking care of yourself.

Give Yourself a Free Pass

Give yourself a free pass to say yes or no at the last minute, and decide you’re going to be okay with that. That means that you're going to reply with a firm "maybe" when you're invited anywhere. It means that you can leave the decision about whether you're up for something or not right up to the moment you're heading out the door. And it means preparing others to accept that.

Tell friends and family that you may need to cancel your attendance at the last minute, or that you may need to leave early, and ask for their understanding ahead of time. Let them know that you really want to be able to be with them, and your absence has nothing to do with how much you care about them. It has everything to do with taking care of yourself.

Then do what you need to do in that regard, and do it without guilt. Your priority is to find a way to take care of your need for rest and low stress, even in the midst of this demanding season.

Don't Cut Yourself Off

With that said, don't completely cut yourself off from friends and family either. Being with loved ones for special occasions can be one of the most joyful aspects of being alive, so you don't want to miss out entirely if you can help it.

So, here's my formula: Choose a small number, say 3 to 5 celebrations for the wholeholiday season that you feel are the most important to you personally. I don't mean the ones you used to think were important based on obligations to work, family and friends. I mean the ones you truly enjoy, the ones that feed your spirit, the ones you would really miss if you couldn't go.

If at all possible, find a way to get to those and only those. Go for only a brief period, if need be. Attend without contributing to food or preparations. Again, give yourself a guilt-free pass.

Let yourself have the times that are important to YOU, and say no to the rest.

This may sound selfish, but if you're in pain, you need to be a little more selfish. It isn't doing anyone any good for you to wear yourself out trying to do everything you used to do and go everywhere you used to go, if you will be raising your pain levels and not enjoying yourself.

So, instead of being exhausted and grumpy at too many functions, pick a few choice ones you can attend with enjoyment. Above all, be kind to yourself and take care of yourself first.

Find an Ally

Recruit a holiday ally -- a friend or family member who understands your situation -- who will do the explaining for you, drive you over to functions, pick up the slack in terms of bringing food or making arrangements, and agree to leave early with you if it's necessary.

You might find someone for the whole season or you might want to ask a different person for each function. Remind yourself: You need more help. You need to do less.

Don’t hide away this holiday season if you can help it, but also give yourself the gift of attending fewer functions, say yes only to the ones you really enjoy, find an ally or two who will support you, and giving yourself a free pass to say no so that you can fully enjoy the celebrations you do attend.

Sarah Anne Shockley suffers from Thoracic Outlet Syndrome, a painful condition that affects the nerves and arteries in the upper chest. Sarah is the author of The Pain Companion: Everyday Wisdom for Living With and Moving Beyond Chronic Pain.

Sarah also writes for her blog, The Pain Companion.

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.

How to Survive the Holidays Without Burning Out

By Elizabeth Katherine, Guest Columnist

My husband and I are very social and we love just about any reason to get the people we love together in a room, and the holiday season is great for that. But it can also be really hectic.

The thing I hear more than anything else this time of year is “I have so much to do.” As a chronic pain sufferer, I know daily life can be overwhelming, and when you throw in all the extras of the holiday season it can get real sticky real quick.

As a mom of three kids and an exceptionally busy husband, I often take on the household responsibilities as well as the additional tasks of holiday prep.

When my pain got to be an all-day everyday thing, I was heartbroken at the thought that these kinds of events wouldn’t be able to happen anymore, or that I wouldn’t be able to produce the kind of holiday that my kids were used to and I was used to.

Pelvic Congestion Syndrome causes me to have constant pain in my pelvis as well as my low back that gets worse the longer I am upright. As I have gotten to know my body and my limitations, I have been able to tailor the way I navigate the holiday season without burning myself out too much. I’d like to share some of my ideas with you all.  

The biggest piece of advice I can give you is to start with lists. Lists are the best thing that ever happened to those of us with brain fog and fatigue. Make a list of all the things you’d like to have done in order to prepare for the holidays. Create gift lists that layout who you’re buying for, and what’d you like to get them.

You can also avoid having to run out for that extra carton of eggs by making a list of the things you’d like to make for holiday meals and the ingredients you will need to make them.

Once you’ve laid out the what, it’s time to plan out the when. This is huge for us Spoonies because we have limited resources when it comes to getting things done. Sit down with your calendar and look at when you have free time. Schedule time to do your baking, household decorating, any parties you’d like to attend, and of course, time for gifts.

Make sure to schedule your rest time too. If you schedule in a 1-2 hour shopping trip, be sure that you also schedule yourself for some time on the couch or a movie afterwards.

Gifts are one of the biggest time sucks this time of year for anyone, but for those of us in the pain community it’s even worse because it involves so much shopping. If you haven’t yet, become familiar with online shopping, consider a membership to websites that offer discounts and free shipping such as Amazon Prime or Overstock.com. Utilizing this will cut down on the amount of time you need to spend out, plus, it’s a nice way to feel productive when you’re stuck on the couch.

If you enjoy the activity of shopping like I do, make sure you schedule a few different trips for that as well. Instead of running from one store to the next, map your plan out ahead of time. Make a list of the things you know you can get at each store you want to go to so you don’t waste your energy bouncing all around for one or two items. Consider pre-shopping online to see what colors and sizes the stores you are going to have in stock so you’re not disappointed when you get there.

Once you’ve got your gifts, you can use some of your resting time to wrap them. If you need help with this project, make it a social activity and invite a friend over to help with tape or scissors. This is also a good way to get any holiday crafting or homemade gifts done. Just don’t invite the person you’re making the gifts for!

Another way to get your to-do list done for the holidays is to delegate like a champ. Ask your spouse to move the decorations out from storage, and put the kids to work decorating the tree. You can curl up on your couch and watch it all while sipping hot cocoa and still feel involved. Or, if you prefer to do it all yourself, break it up into small bursts so that you don’t get too drained doing it all in one sitting.

My last piece of advice is to remember the reason for the season. It’s easy to get caught up in the craziness of it all, and even more so to look at all the things you can no longer do and feel frustrated.

At the core of it all, the holidays are about spending time with loved ones, and the intentions behind your choices are what matter the most. The people who love you aren’t going to care if you didn’t bring fruit cake to the party, even though it was your turn. The people you spend your time with during the holidays are the people who love you, chronic illness and all.

Elizabeth Katherine lives in Minnesota with her family. She writes about Pelvic Pain Syndrome and other topics on her blog, These Next 6 Months.

Elizabeth also enjoys the Facebook support group Spoonies for Life.

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

Power of Pain: How to Make Holidays Less Stressful

By Barby Ingle, Columnist                                               

Maintaining holiday traditions can be hectic and stressful -- even for healthy people. This should be an enjoyable time of year for everyone, but for people with chronic pain and physical limitations, they bring an extra element of challenges and stress. 

How do you cope with the holidays? Do you approach them in a hectic manner or do you break down the tasks into manageable ones? How do you get through the holiday season and enjoy it?

Here are a few tips I’ve learned about planning ahead, gift giving, and setting the expectation.

Start by prioritizing activities and only worry about things that are important to you and your family. Organize your schedule to include a time for each item to be completed by time frame and importance. Begin early with more complicated tasks and expect a “bad” day or two so they don’t cause stressful situations at the last minute.

It is important to avoid the last minute rush of gift buying and other holiday activities. Either cut out the nonessential steps, get help setting them up, or start early giving yourself plenty of time.

It is also good to work on your preventative health: nutrition, posture, and positive mental attitude.

When it comes to attending parties, I would suggest you attend others instead of hosting them yourself. That way you can make an appearance and leave before all of your energy is spent. You can let the host know that you can only stay for a limited time due to other commitments, and if you decide to stay longer, all the better. Once you explain your limitations to the event host, you’ll find your stress level will be reduced. Setting the expectation early is very important in group settings.

When it comes to gift giving, my best tip is to buy gifts online -- no walking or waiting! The items will arrive at your house or theirs, and you’ll save your energy for other tasks. Take advantage of free shipping when possible and online coupon codes to save money.

When it comes to making your gifts presentable, use gift bags. They’re easier than traditional wrapping, and save time and energy. Although decorations are beautiful, downsizing can still be festive and keep everyone in the holiday mood.

Communication is key to a successful season. It helps to talk to guests or party hosts ahead of time and explain your limitations as a chronic pain patient. When you are hosting an event, delegate duties as much as possible. The same goes when it comes to decorating. It is okay to ask for help and accept your limitations without guilt or blame. It is not your fault that you live with chronic pain. Help others understand your limits by sharing with them ahead of time what they are and telling them what they can do to help make it easier for you and other guests.

For the guests that “will never understand,” realize that you are not there for them. You are there for yourself first and others at the holiday event who love and support you. You can have a great time no matter who else is there or if they understand your pain or not.

It doesn’t matter what anyone else thinks about your health and protecting your body and mind. It is okay to take care of yourself first, especially during the holidays.

Let go of the stress, guilt and excess. Trim down the excess and turn the hustle and bustle of the holidays into a fun enjoyable time to be thankful for, with great memories to hold onto for years to come.

Barby Ingle suffers from Reflex Sympathetic Dystrophy (RSD) and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the Power of Pain Foundation. She is also a motivational speaker and best-selling author on pain topics.

More information about Barby can be found at her website.

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

12 Tips to Ensure Access to Healthcare This Winter

By Celeste Cooper, Guest Columnist

When we think of winter, we think of chilly days, getting cozy under a soft fluffy blanket, or curling up with a warm drink and a good book. We think of holiday festivities, and time with family and friends.

And as we prepare for winter, maybe we should also consider a safety plan that will assure access to the healthcare we need.

Those of us who live with chronic pain or illness have learned to expect the unexpected. We know that our symptoms can escalate without warning. Some of us experience a worsening of symptoms during the cold and dry winter months.  We may need additional medications to manage our symptoms or make more frequent visits to the doctor than usual. We need to do something to make sure our needs are met.


The following are some suggestions to make the winter months less intimidating:

1. Know what’s in your medicine cabinet. Take an inventory of medications, including prescriptions and over-the-counter drugs.

2. Dispose of outdated prescriptions, vitamins or supplements by following the Food and Drug Administration's guide on “How to Dispose of Unused Medicines."

3. If a replacement prescription is needed, ask your doctor or pharmacy for a refill now.

4. Know your insurance company’s policies on early refills before a winter storm hits.

5. If transportation or road conditions interfere with your ability to obtain a prescription, a substitute medication may be needed. Be sure to clarify with your pharmacist any differences in the medications or things to watch for.  

6. Most medical practices have a cancellation policy, sometimes imposing a fee if you don’t give 24-hour notice. Ask your doctor’s staff about their policy when a winter storm prevents you from keeping an appointment.

7. Identify your support network in case someone needs to pick up a prescription for you or provide transportation to the doctor.

8. Get to know your pharmacist so they can help you anticipate your needs. Ask for their business card and keep it where it is readily available, especially if you are not the one picking up your prescription.

9. Check to see if a pharmacy in your area delivers. If it’s not in your insurance network, check to see if your insurance carrier will make an exception under special circumstances.

10. Have information on an alternate pharmacy handy in case yours does not have the medication you need. Pharmacy inventories can also be affected by winter weather.

11. Consider using a mail order prescription plan. Paperwork from your physician may be required.

12. If you already use mail delivery for your medications, contact the supplier. Ask them how they protect your medications from extreme temperatures during shipment. Frigid temperatures can alter the potency and stability of certain medications. Even if you live in a temperate area, your medications may travel through areas that are not.

Let your doctor and pharmacist know you have an action plan and ask them for any suggestions that will assure your access to medication this winter.

As you get ready for winter and make plans for the holidays, also consider how you will manage your healthcare needs. If you are prepared, you can enjoy a healthier and safer winter.

Celeste Cooper, RN, is an advocate, freelance writer and author. She is also a person living with chronic pain. Celeste is lead author of Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain, and the Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain book series.

Celeste enjoys spending time with her family and the rewards she receives from interacting with nature through her writing and photography. You can learn more about Celeste’s writing, advocacy work, helpful tips, and social network connections at her website.

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.