Chronic Pain and Depression
Updated: Jun 9
Managing Depression When You’re in Pain
Living with chronic pain is a significant burden for anyone. When depression is added to that list, the burden becomes even heavier. Depression which can magnify pain, is one of the most common problems faced by people with chronic pain. Effective treatments are available to relieve the depression and make chronic pain more tolerable.
Chronic Pain and Depression: A Terrible Twosome
Depression is one of the most common psychological issues facing people who suffer from chronic pain, and it often complicates the patient's conditions and treatment. Consider these statistics:
• From one-quarter to more than half of patients who complain of pain to their physicians are depressed.
• On average, 65% of depressed people also complain of pain.
• People whose pain limits their independence are especially likely to get depressed.
Depression in patients with chronic pain frequently goes undiagnosed and therefore untreated. Pain symptoms and complaints take precedence during doctors visits. The result is depression, along with sleep disturbances, loss of appetite, lack of energy, and decreased physical activity which may make pain much worse.
Chronic Pain and Depression: A Vicious Cycle
Pain provokes an emotional response in everyone including anxiety, irritability, and agitation. Normally, as pain subsides, so does the stressful response. However, in instances where the pain persists, the stress response remains activated which can result in a number of problems associated with depression. Those problems can include:
• chronic anxiety
• confused thinking
• sleep disturbances
• weight gain or loss
Some of the overlap between depression and chronic pain can be explained by biology. Depression and chronic pain share some of the same neurotransmitters -- the chemical messengers traveling between nerves. They also share some of the same nerve pathways.
The impact of chronic pain on a person's life overall also contributes to depression. Some experts state that the pain comes from the losses such as employment, functional ability, sexuality, which can result in depression. Depression then reduces a person’s ability to cope further.
Research has compared people with chronic pain and depression to those who only suffer chronic pain. Those with chronic pain and depression:
• report more intense pain
• feel less control of their lives
• use more unhealthy coping strategies
Because chronic pain and depression are often treated together. In fact, some treatments can improve both chronic pain and depression.
Treating Chronic Pain and Depression: A "Whole-Life" Approach
Chronic pain and depression can affect a person's entire life. Consequently, an ideal treatment approach overlaps both of these disorders.
Research sites that since chronic pain and depression involve the same nerves and neurotransmitters antidepressants can be used to improve both chronic pain and depression. Feinberg states that, "Antidepressants work on the brain to reduce the perception of pain."
Many people with chronic pain avoid exercise which causes them to become more out of shape and, therefore, at a higher risk of injury and worsened pain. Gentle, regular physical activity such as swimming is a crucial part of managing chronic pain.
Exercise is also proven to help depression by releasing the same kind of brain chemicals that antidepressant medications release.
Mental and Spiritual Health
Chronic pain affects a person’s ability to live, work, and play. This can alter their self perception where they identity themselves as a 'disabled chronic pain patient, and, therefore, become the victim. It is essential to resist the urge to be passive and instead to get busy, take control."
Working with a health care provider who refuses to see you as a helpless victim is part of the formula for success. The goal is to replace the victim identity with one of a "well person with pain”. Research clearly shows that for the average person, certain kinds of mental training truly improve chronic pain.
Cognitive Therapy for Chronic Pain
An effective approach offered in counselling for the treatment of chronic pain and depression is cognitive therapy. A person thinks every moment of every second of every day. Cognitive therapy helps them to focus on their negative "automatic thoughts" that surround the experience of chronic pain. By erasing a replacing these negative thoughts with positive affirmations, an individual can change these thought patterns and therefore, improve the overall experience of pain. Cognitive therapy is also a proven treatment that reduces symptoms of depression and anxiety in chronic pain patients.