mental health

Chronic Pain and Mental Health

Pain serves an important function in our lives. When you suffer an acute injury, pain warns you to stop the activity that is causing the injury and tells you to take care of the affected body part. Chronic pain, on the other hand, persists for weeks, months, or even years and can have a large impact on your mental health. 

Some people, often older adults, suffer from chronic pain without any definable past injury or signs of body damage. Common chronic pain can be caused by headaches, low back, and arthritis. Unfortunately, there is scant objective evidence or physical findings to explain such pain. Until recently, some doctors who could not find a physical cause for a person’s pain simply suggested that it was imaginary—“all in your head.” This is unfortunate because we know that all pain is real and not imagined, except in the most extreme cases of psychosis. 

Emerging scientific evidence is demonstrating that the brain and nerves in the spinal cord of patients with chronic pain undergo structural changes. Psychological and social issues often amplify the effects of chronic pain. For example, people with chronic pain frequently report a wide range of limitations in family and social roles, such as the inability to perform household or workplace chores, take care of children, or engage in leisure activities. In turn, spouses, children, and co-workers often have to take over these responsibilities. Such changes often lead to depression, agitation, resentment, and anger for the pain patient and to stress and strain in family and other social relationships. 

What is the link between depression and chronic pain? 

Depression is the most common emotion associated with chronic pain. It is thought to be 3 to 4 times more common in people with chronic pain than in the general population. In addition, 30 to 80 percent of people with chronic pain will experience some type of depression. 

The combination of chronic pain and depression is often associated with greater disability than either depression or chronic pain alone. People with chronic pain and depression suffer dramatic changes in their physical, mental, and social well-being—and in their quality of life. Such people often find it difficult to sleep, are easily agitated, cannot perform their normal activities of daily living, cannot concentrate and are often unable to perform their duties at work. This constellation of disabilities starts a vicious cycle—pain leads to more depression, which leads to more chronic pain. 

In some cases, depression occurs before the pain. Until recently, we believed that bed rest after an injury was important for recovery. This has likely resulted in many chronic pain syndromes. Avoiding performing activities that a person believes will cause pain only makes his or her condition worse in many cases. Depression associated with pain is powerful enough to have a substantial negative impact on the outcome of treatment, including surgery. It is important for your doctor to take into consideration not only biological but also psychological and social issues that pain brings. 

Signs and Symptoms Some of the common signs and symptoms of chronic pain include: 

  • Pain beyond six months after an injury. 
  • Allodynia—pain from stimuli which are not normally painful and/or pain that occurs other than in the stimulated area. 
  • Hyperpathia—increased pain from stimuli that are normally painful.
  • Hypersensation—being overly sensitive to pain. 

Signs of major clinical depression will occur daily for two weeks or more, and often include many of the following: 

  • A predominant feeling of sadness; feeling blue, hopeless or irritable, often with crying spells • Changes in appetite or weight (loss or gain) and/or sleep (too much or too little) 
  • Poor concentration or memory 
  • Feeling restless or fatigued 
  • Loss of interest or pleasure in usual activities, including sex 
  • Feeling of worthlessness and/or guilt

What are Treatment Options for Chronic Pain and Depression?

The first step in coping with chronic pain is to determine its cause, if possible. A thorough evaluation by professionals who are willing and able to look at the “big picture” versus solely treating symptoms is essential. With chronic pain, there may be many layers to the problem that need to be addressed.  

Stay active and do not avoid activities that cause pain simply because they cause pain. Gentle activities like walking, yoga, and tai-chi are excellent ways to start moving, and have massive benefits for your physical and mental health. The amount and type of activity should be directed by your doctor, so that activities that might actually cause more harm are avoided.  

Relaxation training, hypnosis, biofeedback, and guided imagery, can help you cope with chronic pain. Cognitive therapy can also help patients recognize destructive patterns of emotion and behavior and help them modify or replace such behaviors and thoughts with more reasonable or supportive ones. While professional help may be necessary in severe cases, there are many apps and programs available online that can help you learn these techniques.  

Distraction (redirecting your attention away from chronic pain), imagery (going to your “happy place”), and dissociation (detaching yourself from the chronic pain) can be useful. 

Nutritional support can be very helpful. There is more neurologic activity in your gut than in your brain, but it is an often overlooked area. Poor nutrition can lead to chronic inflammation that affects you physically, mentally, and emotionally. Getting tested for food sensitivities and adding more whole, unprocessed foods can help.  

• Involving your family in your recovery may be quite helpful, according to recent scientific evidence. 

We are here to help. We can often suggest some simple techniques to help, and we are happy to work with other helpful practitioners to help you feel better and heal better.  

Adapted from

Lawrence H. Wyatt, DC, DACBR, FICC, Professor, Division Of Clinical Sciences, Texas Chiropractic College, Writer 

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