Chronic Pain And Depression: Treatment Options To Improve Health
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 more sensitive to pain 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 that 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.
Chronic pain and depression
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
When depression affects the outcome of the treatment
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 that 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 symptoms.
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 exercising or doing 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.
Selective serotonin reuptake inhibitors and other antidepressant medications
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 to improve mental health
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 set 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 treatment 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.
Effectiveness of online therapy as a treatment for chronic pain and depression
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 improvements 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 iCBT appeared to be even more effective in some outcome measures.
Takeaway
How do you cope emotionally with chronic pain?
According to the American Psychological Association, you can cope with chronic pain by doing the following:
- Managing stress
- Focusing on the positive
- Engaging in activities you enjoy
- Seeking support
- Consulting professionals regarding chronic pain symptoms
Many chronic pain patients experience emotional struggles like major depression, affective disorders, and depressive symptoms, which can make pain harder to manage. Building strong mental health habits and coping strategies is often key.
An example of chronic pain is neuropathic pain, in which the body’s neural mechanisms and neural plasticity are negatively affected by a health condition, such as a spinal cord injury. Both pain and the underlying health condition should be addressed by an internal medicine specialist or another doctor.
Patients often work closely with healthcare providers, such as internal medicine specialists or pain management experts. Consulting early may help lower risk factors for worsening physical and emotional symptoms.
Research and expert opinion from groups like the National Institute of Mental Health suggest that untreated emotional challenges are closely related to higher pain sensitivity and may make coping more difficult over time.
Sometimes, serotonin and norepinephrine reuptake inhibitors are used as part of the treatment for nerve pain. In some cases, doctors may also consider options like monoamine oxidase inhibitors, but it’s vital to seek medical advice from a healthcare provider before starting or stopping any kind of medication. Learning effective emotional coping strategies helps patients regain a sense of control.
What does chronic pain do to someone's mental health?
In many cases, people living with chronic pain tend to be more prone to developing mental health disorders like depression, anxiety, and substance use disorders. In addition, chronic pain can contribute to sleep issues and raise stress levels. Chronic pain patients often report feeling higher levels of emotional distress that may worsen over time.
Chronic pain is closely related to changes in the brain’s neural mechanisms and neural plasticity, which may increase pain sensitivity and raise the risk of developing affective disorders like major depressive disorder or major depression.
A systematic review suggests that ongoing pain can disrupt daily life, causing problems with sleep, mood, and overall health. Some patients suffering from chronic illness may also experience acute pain or develop conditions like postherpetic neuralgia.
Mental disorders linked to chronic pain can include psychiatric disorders that require careful treatment with approaches like treating depression using antidepressant medications, or managing severe cases with support from specialists trained in opioid analgesics.
Experts from organizations like the National Institute of Mental Health continue to recommend various techniques such as therapy, medication, and lifestyle changes to support recovery. Future care may involve future studies using methods such as double-blind research or reviewing outcomes through meta-analysis and self-report data to identify the most effective treatments.
Do people with depression have chronic pain?
Sometimes, major depressive disorder can come with physical pain symptoms like migraine headaches, muscle tension, and other forms of chronic pain symptoms. This physical pain may exacerbate other depression symptoms, but treating depression with cognitive behavioral therapy, talk therapy, or antidepressant medications typically offers relief.
In some cases, people with depression may experience neuropathic pain connected to changes in the nervous system and spinal cord. Individuals with both chronic pain and depression may face an increased risk of developing additional mental health conditions or depressive disorders.
To help manage symptoms, healthcare providers may suggest combining antidepressant therapy with physical activity and strategies to build effective coping skills. For some, conditions like chronic headaches, chronic back pain, or rheumatoid arthritis can worsen emotional and physical distress, and patients may benefit from working with internal medicine specialists.
Research—including findings from a randomized clinical trial and a systematic review—shows that managing chronic illness with a combination of treatments can lead to a significant reduction in both pain and depressive symptoms.
What are the emotional causes of chronic pain?
The U.S. Pain Foundation explains that some of the emotional causes of chronic pain can include grief, guilt, helplessness, anxiety, anger, and fear. Many chronic pain patients experience unexplained painful physical symptoms that are often closely related to emotional turmoil.
Long-term pain is also connected to changes in the body's neural mechanisms and neural plasticity, which may increase pain sensitivity and make emotional struggles worse.
If you believe mental health concerns may be the culprit behind your chronic illness, consider working with a professional in clinical psychiatry or therapy in addition to a pain specialist. Managing both major depression and major depressive disorder together with pain may improve outcomes.
According to expert opinion and research from the National Institute of Mental Health, strong emotions like grief and anger can act as risk factors for chronic pain. Some cases of acute pain that don't seem to have a physical cause may stem from deep emotional wounds.
A systematic review shows that emotional factors and affective disorders can lead to physical symptoms when stress isn't managed well. If these emotional sources of pain aren't treated aggressively, they may worsen over time and impact patients' ability to function in daily life.
Understanding how central sensitization works in the brain and body can also explain why emotional trauma leads to long-term pain. Sometimes, if pain is only managed with usual care, emotional struggles may continue and make the pain feel worse.
What are the five A's of chronic pain?
The five A’s of pain management in relation to chronic pain are as follows:
- Analgesia
- Activities of daily living
- Adverse effects
- Affect
- Aberrant drug-related behaviors
Can you stop feeling chronic pain through selective serotonin reuptake inhibitors?
In general, chronic pain may not have a cure, but it can be treated. SSRIs, or selective serotonin reuptake inhibitors, can help manage both depression symptoms and physical pain and may improve overall mental health. People with chronic pain symptoms sometimes feel better emotionally and physically after starting this type of medicine. However, the best course of action is to work with a doctor, especially specialists in psychiatric disorders, to identify the cause of the chronic pain and address it directly. That’s because chronic pain patients may have different conditions, like chronic illness or chronic low back pain. Understanding the real problem is important before starting any pain medications or antidepressants. Doctors can provide the treatment plan needed, which may include strategies for managing both pain and any related depressive disorders.
Using SSRIs may lead to pain relief, improve mental health, and lower pain sensitivity. Research through a randomized clinical trial shows that treating both pain and depressive disorders together often works better than focusing on just one issue.
Some people may also need other treatments alongside SSRIs, such as talk therapy, physical activities, or other strategies for treating depression. A full treatment plan often includes building strong coping skills to manage emotional distress, stress, and daily challenges caused by pain. Even if SSRIs can help, not every case of chronic illness or ongoing pain responds the same way.
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