Depression and Chronic Pain

Living with chronic or long-term pain is tough. When you have chronic pain and depression, it's even tougher.

Depression magnifies pain. It makes everyday living more difficult. Still, it's important to know that medications and psychotherapy can help relieve the depression and make chronic pain more tolerable.

What Is Chronic Pain?

Chronic pain lasts much longer than would be expected from the original problem or injury. When pain becomes chronic, you may have:

  • Unusually high levels of stress hormones
  • Low energy
  • Mood disorders
  • Muscle pain
  • Lower-than-normal mental and physical performance.

Chronic pain gets worse as changes in your body make you more sensitive to pain. You may start to hurt in places that used to feel fine.

It can disrupt sleep and cause you to wake up at night. This can make you tired during and not as productive during the day. The ongoing pain can cause additional irritation and make it difficult for you to deal with others. If you have to care for children or work full-time, all this may make your life seem too challenging. These feelings can lead to irritability, depression, and even suicide.

What Happens?

Depression is one of the most common mental health problems facing people with chronic pain. It often makes someone's other medicalconditions and treatment more complicated. Consider these statistics:

  • According to the American Pain Foundation, about 32 million people in the U.S. report to have had pain lasting longer than a year.
  • From one-quarter to more than half of the population that complains of pain to their doctors are depressed.
  • On average, 65% of depressed people complain of pain.
  • People whose pain limits their independence are more likely to get depressed.

Because depression in people with chronic pain frequently goes undiagnosed, it often goes untreated. Pain symptoms and complaints take center stage on most doctor visits. The result is depression -- and sleep disturbances, loss of appetite, lack of energy, and decreased physical activity, which may make pain much worse.

Is There a Cycle?

Pain provokes an emotional response in everyone. If you have pain, you may also have anxiety, irritability, and agitation. These are normal feelings when you're hurting. Usually, as pain subsides, so does the stressful response.

But with chronic pain, you may feel constantly tense and stressed. Over time, the stress can result in different emotional problems associated with depression. Some of the problems individuals with both chronic pain and depression have include:

  • Altered mood
  • Anger
  • Chronic anxiety
  • Confused thinking
  • Decreased self-esteem
  • Family stress
  • Fatigue
  • Fear of injury
  • Financial concerns
  • Irritability
  • Legal issues
  • Physical deconditioning
  • Reduced sexual interest and activity
  • Sleep disturbances
  • Social isolation
  • Weight gain or loss
  • Work problems

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Why Is There an Overlap?

Depression and chronic pain share some of the same neurotransmitters -- brain chemicals that act as messengers traveling between nerves. Depression and chronic pain also share some of the same nerve pathways in the brain and spinal cord.

The impact of chronic pain on a person's life also contributes to depression. It can force you to struggle with tremendous losses, such lack of exercise, sleep, social network, relationships, sexual relationships, even a job and income. These losses can contribute to depression in people who are vulnerable to clinical depression.

It then magnifies the pain and reduces your ability to live with it. It becomes seemingly impossible to stay active to reduce stress.

Research has compared people with chronic pain and depression to those with only chronic pain. Those with both report:

  • More intense pain
  • Less control of their lives
  • More unhealthy coping strategies

Because chronic pain and depression can be intertwined, they are often treated together. In fact, some medications can improve both.

Is There a "Whole-Life" Approach?

Chronic pain and depression can affect a person's entire life. Consequently, an ideal treatment approach addresses all the areas of your life that are affected by them.

Because of the connection between the two, it makes sense that treatments for these conditions overlap.

How Do Antidepressants Help Both?

Because chronic pain and depression can involve the same nerves and neurotransmitters, certain antidepressants are often used to treat both. Some antidepressants can reduce the perception of pain.

There is abundant evidence of the effectiveness of tricyclic antidepressants like amitriptyline HCL (Elavil) and nortriptyline (Pamelor). They can be highly effective for forms of neurologically-based pain (neuripathic pain) such as migraine headaches, herniated disks, and other spinal nerve root problems. However, because of side effects, they aren't used much. Newer antidepressants such as the serotonin and norepinephrine reuptake inhibitors (Cymbalta, Effexor), on the other hand, seem to work well with fewer side effects.

How Can Physical Activity Help?

Many people with chronic pain avoid exercise. But you can get out of shape and have more risk of injury and more pain. Talk with your doctor to design an exercise plan that's safe and effective for you.

Trips to the gym also help ease depression by releasing the same kind of brain chemicals that antidepressant medications are thought to affect.

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Why Is Taking Control Important?

Chronic pain affects your ability to live, work, and play. That can change how you see yourself.

Getting busy and taking control of your life is important. Working with a doctor who refuses to let you see yourself as a victim is key.

 

How Does Talk Therapy Help?

In cognitive therapy, a person learns to notice the negative "automatic thoughts" that surround chronic pain. These often are distortions of reality. Some time with a therapist can teach you how to change these thought patterns and make you feel better.

It's also a proven treatment for depression and can reduce symptoms of anxiety in those with chronic pain.

What's the Best Way to Manage Pain and Depression?

Team up with a pain specialist or even your family doctor to create a treatment plan. When chronic pain and depression are combined, the need to work with a doctor is even greater.

As you develop a plan, keep in mind that the ideal pain management plan will be will have many parts. 

There are resources that can help you, such as:

  • The American Chronic Pain Association
  • The American Pain Foundation
  • The Academy of Cognitive Therapy 

Stay committed to the plan until you feel in control of your pain and depression and can fully live your life and do the things you enjoy.

Find a cognitive therapist near you with experience treating chronic pain. The above groups can help you find one.

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on October 07, 2016

Sources

SOURCES: 

Harvard Health Publications: "Depression and Pain." National Institute of Mental Health: "Depression and Chronic Pain."

 

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