Understanding the link between chronic pain and depression

Posted May 15, 2014 at 9:55 am

By Faith Trussell, RN, BSN

Hurting bodies and suffering minds often require the same treatment. People with chronic pain have three times the average risk of developing depression or anxiety, and depressed patients have three times the average risk of developing chronic pain. On average, 65% of depressed people also suffer from chronic pain (most commonly headaches, back, joint and abdominal pain). Pain and depression create a vicious cycle in which pain worsens symptoms of depression, and then the resulting depression worsens feelings of pain.

The proverbial “Which came first – the chicken or the egg?” question comes to mind: Which causes which? The answer is both! In many people, depression causes unexplained physical symptoms such as back pain or headaches. In other cases, pain causes depression, especially when it limits a person’s independence. But it is important to note that physical pain and depression have a deeper biological connection than simple cause and effect; the neurotransmitters that influence both pain and mood are serotonin and norepinephrine. If either of these transmitters are not regulated well by the body, the result of the chemical imbalance can be BOTH depression AND pain.

Unfortunately, depression in patients with chronic pain frequently goes undiagnosed, and consequently, untreated. Pain symptoms take center stage on most doctor visits. The result is increased depression, which just makes the pain worse. Pain, especially chronic pain, is an emotional condition as well as a physical sensation. It is a complex experience that affects thought, mood and behavior. Some studies suggest that if physicians tested all pain patients for depression, they might discover 60% of currently undetected depression.

The association of depression with pain is especially found in these three chronic conditions: 1) Migraine headaches. One study found that a person with a history of major depression was THREE TIMES more likely than average to have a first migraine attack, and a person with a history of migraines was FIVE TIMES more likely than average to have a first episode of depression. 2) Fibromyalgia. This mysterious disorder includes symptoms of widespread muscle pain. Brain scans are lending credibility to the suspicion that fibromyalgia could be caused by a brain malfunction that heightens sensitivity to both physical discomfort and mood changes. 3) Arthritis. In a large and diverse population of older adults with both arthritis and depression, studies concluded that treatment with antidepressant medication and 6-8 sessions of psychotherapy not only reduced depressive symptoms, but also decreased pain and improved functional status.

If you have pain and depression, get help before your symptoms worsen. You don’t have to be miserable. Ask your doctor about certain medications (SNRI antidepressants) that inhibit the reuptake of both serotonin and norepinephrine. Correcting this chemical imbalance may help you start enjoying life again. Medication and/or therapy with a licensed professional could make the difference in your daily physical AND emotional pain.