The Relationship Between Chronic Pain and Depression

It’s easy to slip into a depression if your body struggles with pain. It’s easy to slip into the absence of experiencing joy, satisfaction, or contentment in life if you carry pain each moment of the day.

Depression and long-term pain go hand in hand, and treating both of them become necessary in order to return to a restored sense of well being and life enjoyment. Major Depressive Disorder (MDD) is a common mental illness in the United States. In fact, about 9 percent of American adults suffer from depression and about 70 percent of all antidepressants sold in the world are sold in the United States. According to a 2011 report by the Center for Disease Control and Prevention, the rate of antidepressant use in the United States rose by 400 percent between 1988 and 2008. Globally, five percent of the population across the planet suffers from depression, according to the World Health Organization. It’s important to understand the relationship between chronic pain and depression, and what can be done to avoid this endless cycle. 

These statistics include a percentage of people who live with pain. The National Institute of Mental Health defines chronic pain as pain that lasts for weeks, months, or even years. Sadly, it does not ease with pain medication. Although the pain might have a direct cause, such as an injury or a medical condition, regular medical treatment of that disorder alone doesn’t always heal the pain. Furthermore, some pain does not have a source.

With the burden of having to manage daily pain, symptoms of depression can develop. A relationship forms between chronic pain and depression. Depression includes symptoms of persistent sadness, occupational and educational impairment, along with the following additional symptoms:

• A depressed mood
• Irritability
• Guilt
• Loss of interest in activities
• Social withdrawal
• Suicidal thoughts
• Poor concentration
• Poor memory
• Indecision
• Slow thinking
• Loss of motivation
• Sleep disturbance – insomnia / hypersomnia
• Appetite disturbance – weight loss/gain
• Fatigue
• Headaches
• Constipation

There is clearly a somatic element to depression where aches and pains develop, exacerbating the chronic pain that already exists. Research indicates that those with more severe depression can experience more intense pain. There are other connections between the body’s experience of pain and mental illness that studies are showing. For instance, a higher presence of cytokines, which send messages to cells affecting the immune system, tend to be higher in those who are depressed, which can lead to the experience of pain in the body.

Fortunately, for those who experience a relationship between chronic pain and depression, depression is treatable. With the right medication combined with therapy, an individual’s mood can stabilize and, over time, he or she can return to a healthy level of functioning at home or work. What’s important to know is that depression is best treated with a combination of both medication and therapy. Medication alone is not a thorough treatment plan, especially for those who experience pain. In fact, therapy can improve the effectiveness of that medication. Both medication and therapy are necessary for a safe, effective recovery from depression and pain in the body.

One very effective form of therapy is called Cognitive Behavioral Therapy (CBT). CBT essentially aims to change mood and the one’s experience of life by identifying negative and distorted thinking patterns. This successful form of therapy emphasizes the link between thoughts, feelings, and behavior, and more importantly, it attempts to identify the way that certain thoughts contribute to the unique problems of a depressed person’s life. By changing the thought pattern, both feelings and behavior change, which can result in a depression-free life.

Along with this, psychotropic medication can support the effectiveness of therapy. Medications, such as SSRI’s and SSNRI’s change the chemicals in the brain for a different experience to life. SSRI’s increase the levels of serotonin, while a new class of anti-depressants called SSNRI’s increase levels of both serotonin and norepinephrine in the brain. Both of these medication forms have been effective in easing symptoms of depression.

Furthermore, anyone who has been diagnosed with MDD would benefit from participating in group therapy. This, along with individual therapy and medication can ease the emotional, psychological and physical suffering that chronic illness and depression bring.

By Dr. James  Lin
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