How Are Chronic Pain And Depression Related?

If you experience chronic pain and depression, you know that these situations can make daily living a unique challenge. Chronic pain creates physical discomfort that's short- or long-term. You may be required to do certain activities or take medication regularly to minimize pain levels. 

Depression is a different story, and while some use treatment options like psychotherapy and antidepressants to manage their symptoms, its presence alongside chronic pain may seem unbearable. Here is what you need to know about depression and pain, as well as how each situation is related, in order to understand effective methods for coping.

Chronic pain explained

Chronic pain is experiencing prolonged periods of physical distress that may include more than just feeling pain or discomfort. The pain may last for months, with some being sensitive to pain more than others. The level of pain is different from the pain experienced from an injury. At times, it can seem intolerable when accompanied by one or more of the following:

• Mood disorders such as anxiety and depression
• Muscle pain and discomfort
• Limited physical or mental performance
• Lack of energy
• High stress levels

As your body ages, you may feel more sensitive to aches and pains. You might feel discomfort or hurt in an area that has never experienced pain in the past. You can also experience difficulty sleeping at night, leaving you feeling tired during the day. Your level of productivity is prone to decrease as the pain becomes a nuisance. Daily tasks such as caring for children, completing house chores, and managing job duties at work may feel like they have an added layer of challenge. Feelings expressed during these situations may lead to depression.

What happens when depression is present alongside chronic pain?

Studies show the most common mental health condition associated with chronic pain is depression. It may complicate the situation if you have other medical conditions or are taking other medications. Many living with symptoms of depression may experience aches often, referring to them as depression pains. 

People may experience pain symptoms long before realizing they are depressed. Then, symptoms such as lack of appetite, loss of energy and sleep, and withdrawal from physical activity can increase pain intensity. These examples are common complaints people report when visiting their doctor.

Navigating loss related to chronic pain may increase the chances of clinical depression, also known as major depression (major depressive disorder). These symptoms may last for two weeks or more daily and consist of the following:

• Experiencing constant sadness with periods of crying, being irritated, or feeling despair
• Eating too little or too much (appetite changes)
• Sleeping too little or too much (sleep changes)
• Having difficulty concentrating or recalling past events (poor memory)
• Feeling restless or tired often
• Losing pleasure or interest in activities you used to enjoy
• Feeling guilt or worthlessness

Sometimes, depression is severe enough to affect the outcome of your treatment. In such cases, psychological, biological, and social issues will be assessed closely to understand how they affect your pain.

Pain influences how the body responds

Pain can create feelings of irritability and anxiety. While these feelings are normal, stress levels in the body are affected and prone to fluctuation. Stress and tension influence chronic pain, and over time, these elements may affect how your body emotionally responds. It's like a cycle that repeats because stress brings emotional concerns experienced with chronic pain and depression, such as:

• Anger
• Mood swings
• Lack of interest in sexual activities
• Confusion
• Weight loss or weight gain
• Fatigue
• Sleep problems
• Isolation from others

There is also a risk of other problems related to personal finances, weight, work, and social isolation. More potential risks may include family relationship problems, low self-esteem, and legal issues. Many are fearful they will experience an injury, leading to additional anxiety.

Studies show chronic pain and depression have similar effects on the brain. They have similar neuroplasticity changes, have overlapping neurobiological mechanisms, and involve similar neuropathways. It may be why people experience migraines and depression or a specific form of pain regularly with depression systems. 

For some, being unable to engage socially, emotionally, and physically in daily activities because of chronic pain is a huge loss, making their situations more challenging.

What are treatment options when symptoms overlap?

Depression magnifies discomfort associated with chronic pain. People with chronic pain and depression experience higher pain levels than those without depression. Those living with both are also more likely to engage in unhealthy lifestyle habits affecting their ability to cope effectively. 

Some feel they have little control over what they can do in their lives. It is difficult to consider exercise or physical activities to help reduce stress. While these options can help minimize pain and symptoms of depression, there are other alternatives to consider that may help both.

Antidepressant medication

There are medication options available to relieve symptoms of chronic pain and depression. Nerves in the brain affected by both conditions may benefit from certain medications. Some medications may also help reduce pain intensity while treating certain types of aches, such as migraines and backaches. Some antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants, may be effective for treating multiple symptoms simultaneously with limited side effects.

Physical activity

Discuss possible activities to engage in regularly with your doctor. People with chronic pain may choose not to exercise for fear of injury or additional pain. An exercise plan can be created to meet your physical needs based on your capabilities. Staying focused helps you stay in shape and reduces injury risk.

Cognitive behavioral therapy or talk therapy

Talking about your feelings and emotions can create coping skills through dialogue to manage your pain. Psychological counseling or psychotherapy is an effective way to help understand personal thoughts and how they affect anxiety levels. Therapy for depression has proven to help reduce anxiety related to chronic pain.

Stress reduction methods and relaxation training

Reduce stress response levels associated with anxiety and pain by learning how to keep stress levels down and relax. Learning to meditate, writing about your feelings in a journal, and practicing other coping skills and strategies encourage favorable results at your own pace. Certain forms of exercise and physical activity, such as walking, bike-riding, performing deep breathing exercises, and practicing yoga, are great ways to help the body calm down and relax.

Pain rehabilitation

Pain rehab includes comprehensive support from medical and psychiatric professionals. This option may be suitable for people with chronic pain and other medical conditions or injuries. In most cases, it depends on the level of pain you're experiencing and how it affects your ability to complete daily tasks. Immediate and long-term support is also available through local inpatient and outpatient pain programs providing support for severe depression or chronic pain.

Hypnosis

Some may not think about this option when considering treating chronic pain or depression, but it may help an individual to relax and receive positive suggestions for coping with their symptoms.

Support from family, friends, and peers

There are local groups providing support to people experiencing both conditions. If you can't find a group to meet with in person, search online via social media. Having people who are close to you show their support is encouraging and helpful on many levels because they can help you be accountable.

Consider taking time to compare your options and setting some goals. Being in control of your symptoms is important because they can affect how you see yourself and how you live your life. Treatment options for both conditions may overlap depending on your symptoms. 

Try to educate yourself about depression and chronic pain and help others close to you understand your experience. If you feel like you're not achieving the results you want, consider talking to your doctor or specialist about making changes to your treatment plan. Combining treatments options may be more effective for gaining lasting results.

Tips on managing depression and chronic pain

When depression hurts, how do you manage your feelings and physical discomfort? You might try creating a treatment plan with your doctor or specialist. Because symptoms of depression and chronic pain intertwine, it is important to find methods to relieve and support your symptoms. 

A pain management plan may be created to help reduce physical discomfort. A detailed plan will help you focus on how to cope with the symptoms of both while encouraging you to be active daily. Try to be committed to following your plan and communicate your feelings and concerns to ensure your plan reflects actions you can complete to achieve favorable results.

Learning how to manage your pain includes creating a plan to follow that incorporates methods to help you cope with pain and depression. Understanding how they affect you physically, socially, and mentally can be important. Don't be afraid to voice your concerns with your doctor or mental health professional. Other support options are available, including online therapy and support groups. 

Online therapy for chronic pain and depression

With online therapy, you’re not required to make the physical journey or a long commute to visit a therapist’s office in person. This can be helpful if you’re living with pain that makes movement difficult. Through online therapy platforms like BetterHelp, you can attend a therapy session from the comfort of your favorite chair, bed, or a standing desk – wherever is most comfortable for you. Additionally, the flexibility to schedule appointments at convenient times has several benefits. You can schedule a session when you are less likely to be in pain, which can sometimes worsen throughout the day. Alternatively, scheduling a session when you are experiencing pain might make sense on some days so you can better articulate the sensations in the moment to a caring, concerned, and qualified online therapist.

Online therapy has shown efficacy in treating people living with chronic pain, depression, or both conditions. In a randomized controlled trial comparing an internet-based cognitive behavioral intervention to face-to-face CBT, evidence showed significant improvements for those in the first cohort. Specifically, there were reductions in pain intensity, diminishments in catastrophizing behavior, and improvement in pain coping decisions and quality of life. Not only was the online CBT intervention at least as effective as the face-to-face method, but on some outcome measures, iCBT appeared to be even more effective.