Chronic Pain and Depression

Chronic Pain and Depression

Chronic pain can be both emotional and physical and it’s often difficult to determine which came first—the pain or the depression
Article by:Kathleen Smith, PhD, LPC
Chronic pain is a term used to describe pain that lasts beyond the typical time it takes for an illness or injury to heal. Sometimes chronic pain is also described as pain that lasts longer than three months. Research suggests that anywhere from 30 to 50% of people with chronic pain also struggle with depression or anxiety.1

Chronic pain isn’t just a physical condition—it’s an emotional one as well that has tremendous influence over a person’s thoughts and moods. People with chronic pain may isolate from others or be unable to achieve mobility they once had. Chronic pain isn’t just associated with physical injuries either, as it can stem from conditions like heart disease, arthritis, migraines, or diabetes.

Sometimes it can be difficult to assess whether chronic pain has led to depression, or vice versa. People with chronic pain are three times more likely to develop symptoms of depression or anxiety, and people with depression are three times as likely to develop chronic pain.2 Depression frequently can cause unexplained pain, such as headaches or back pain, and people who are depressed might struggle to improve or maintain physical health. In turn, chronic pain can lead to trouble sleeping, increased stress, or feelings of guilt or worthlessness associated with depression. These influences can create a cycle that is hard to break.

Although depression can further debilitate people with chronic pain, these people may be less likely to recognize and talk about symptoms of depression with their doctor. In fact, half of all depressed persons who visit the doctor only complain about physical symptoms. 4 Because both pain and depression make each other difficult to treat, it’s important to address both when evaluating treatment options.

You might be suffering from depression in addition to chronic pain if you have some of the following symptoms:5

lack of interest in activities
depressed mood or irritability
changes in sleep patterns
changes in appetite
feelings of guilt or despair
lack of energy
trouble concentrating
suicidal thoughts.

Assembling a Treatment Team
Patients benefit the most when chronic pain and depression are treated together and utilize a team of people. This team of experts may include:

Physician. A physician can provide a through examination and evaluation, give a diagnosis, and, if necessary, prescribe both pain and psychiatric medications.
Pain  specialist. A pain specialist can educate the patient about the relationship between chronic pain and depression and help design a treatment plan.
A Therapist. Regular sessions with a therapist trained in cognitive behavioral therapy, or other form of psychotherapy, can help address anxious or negative thinking patterns and teach coping skills that reduce symptoms of both pain and depression. They can also work with patients’ families to help them better understand chronic pain and depression.
A Physical Therapist. A physical therapist who can help improve mobility, reduce pain, and increase low mood by introducing helpful exercises and muscle relaxation techniques.
Other professionals such as nutritionists, acupuncturists, and occupational therapists can provide special knowledge to help curb chronic pain and depression.

Treatment Options
There are many treatment options which can provide relief and healing to chronic pain and depression. Some of these include:

Talk therapy – Also known as psychotherapy, talk therapy can help an individual change patterns in thinking, learn coping skills for symptoms, and help prevent future depressive symptoms.
Stress-reduction skills – These skills can include exercise, muscle relaxation, meditation, positive thinking, etc. Therapists, pain specialists, physical therapists and others can provide recommendations to fit the needs and interests of the patient.
Medication – Standard analgesics and antidepressant medications may be prescribed to help combat symptoms. For extreme pain, opioids may be prescribed, but talk to your doctor about the risks and any history of substance use first.
Peer support – Many people find that support groups for chronic pain, mental illness, or both can provide both emotional support and psycho-education. If there isn’t an in person group in your area, consider looking online for support.
Inpatient or outpatient pain programs – More intensive programs can provide immediate and long-term support when depression and/or chronic pain is severe. These programs typically provide onsite medical support, individual and group therapy, and psycho-education for reducing stress and pain.
If you think that you might have depression in addition to chronic pain, never hesitate to be honest with your doctor about the emotional as well as physical symptoms you are experiencing. Just because pain is invisible doesn’t mean that it isn’t real or that it can’t be treated. Consider today who you can recruit to help you regain control over your body, mind, and spirit.