Woman struggling with chronic pain and depression on couch

The Link Between Depression and Chronic Pain

by | Mar 14, 2024 | Blog

According to the American Psychiatric Association (APA), people living with chronic pain have a greater risk of developing mental health issues such as depression. The two are very closely related: depression can cause (or increase) pain and pain can cause depression. In fact, one study found that nearly 85% of people with chronic pain experience severe depression

If you experience both chronic pain and depression, know that you’re not alone and treatments are available. In this article, we examine the link between depression and chronic pain and look at treatments that can target both of these issues together.  

What is chronic pain?

Pain is defined as an ‘unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’. Chronic pain is characterized as any type of persistent or intermittent physical pain that lasts longer than 3 months. Pain can also be considered chronic in situations where an individual continues to be in pain for 1 month after anticipated tissue healing.

Chronic pain is a big public health issue that affects around 20% of the general public in the USA and Europe. The American Pain Foundation estimates that 32 million people in the U.S. experience pain lasting longer than a year

Chronic pain symptoms include:

  • Soreness
  • Discomfort
  • Muscle spasms
  • Changes in skin temperature
  • Stiffness
  • Muscle pain.

Additionally, a person with chronic pain might experience things like: 

  • High levels of stress hormones
  • Mood disorders
  • Low energy
  • Lower than usual mental and physical performance. 

Common causes of chronic pain include arthritis, traumatic injuries, headaches, degenerative disc disease, and long-term conditions such as fibromyalgia, diabetes, back pain, and irritable bowel syndrome. 

Different types of chronic pain

Chronic pain can be divided into two types: neuropathic and nociceptive pain. Neuropathic pain is caused by a lesion or disease involving the nervous system while nociceptive pain is a result of actual or threatened damage to non-neural tissue (i.e. not related to the nerves or nervous system). 

Neuropathic pain is treated by targeting the nervous system while nociceptive pain can be treated with analgesic (pain-relieving) and anti-inflammatory medication.

As chronic pain changes a person’s body, it may make them more sensitive and begin to experience pain in places that previously felt fine. They may also experience disrupted sleep, leading to tiredness during the day and reduced productivity. These factors, coupled with the actual experience of pain, can make life extremely challenging for a person, leading to feelings of irritability and depression. 

What is depression?

Depression, also known as major depressive disorder, is a common mental health disorder that can negatively affect how a person feels, acts, or thinks. It’s usually characterized by a low mood and loss of pleasure or interest in activities a person may have once found enjoyable. 

Depression is different from other mood changes and tends to affect a person’s entire life, including their work, home life, and social life. It can often make a person’s other medical conditions or treatments more complex, including chronic pain. For example, one study found that 65% of patients with depression reported also experiencing pain

Below, we’ll explore the link between depression and chronic pain. 

The connection between depression and chronic pain

Numerous studies have found an overlap between depression and chronic pain, with an estimated 85% of people with chronic pain also experiencing severe depression

People who experience chronic pain might find themselves struggling with major losses in their lives, including lack of sleep and exercise, reduced social activities, affected relationships, and even issues with work and earning an income. All of these factors can contribute to depression, especially for those who are already vulnerable to clinical depression. 

The depression and chronic pain cycle

It’s normal for pain to be associated with an emotional response such as anxiety, irritability, or frustration. These feelings often dissipate as the pain is relieved. With chronic pain, however, these feelings may linger and make someone feel constantly stressed. 

Chronic pain is challenging and can make a person lose enjoyment in normal activities, have reduced function, and experience relationship difficulties. A person might become burdened with the idea that they may never be pain-free or that pain might worsen with time, leading to feelings of anxiety, sadness, grief, and anger. 

Sometimes, this burden can become so strong that it leads to psychiatric disorders like depression. While major depression is the most common mental illness associated with chronic pain, generalized anxiety disorder and post-traumatic stress disorder are also common. 

Effects of having both chronic pain and depression

Emotional responses to chronic pain that are usually associated with depression include: 

  • Low mood
  • Feeling of helplessness
  • Dissatisfaction with life
  • Difficulty concentrating
  • Trouble sleeping or oversleeping
  • Lack of motivation

Over time, these feelings can begin to affect a person’s life and lead to other problems like:

  • Mood changes
  • Irritability
  • Anger
  • Confusion
  • Low self-esteem
  • Chronic anxiety
  • Family stress
  • Lethargy and fatigue
  • Lack of interest in social activities
  • Financial concerns
  • Weight loss or gain
  • Legal troubles
  • Work issues
  • Fear of injury
  • Reduced sex drive

Some research has compared the experiences of people with both chronic pain and depression to those who only have chronic pain. People who have both chronic pain and depression reported: 

  • More intense pain
  • More unhealthy coping mechanisms
  • Feeling less in control of their lives

The role of neurotransmitters

Some research examines the overlap between chronic pain and depression by looking at two chemicals, serotonin and norepinephrine, that play a role in both depression and chronic pain. These chemicals are known as neurotransmitters as their primary role is to send messages between neurons (nerve calls) and muscles. Both serotonin and norepinephrine can inhibit as well as trigger pain. 

One study found that when a person with chronic pain experiences a reduced level of these neurotransmitters in their body, they are more likely to develop depression. 

Factors in the link between depression and chronic pain

Several factors can play a part in the connection between chronic pain and depression, and sometimes a patient can exhibit more than one of these. Common associations between depression and chronic pain include:

  • Vulnerability: The psychological distress and physical symptoms of chronic pain can result in major depression if a person is already vulnerable to depression. Common markers of vulnerability to depression include a past personal or family history of depression, experienced early loss of a parent, or misuse of substances. 
  • Decreased pain tolerance: Depression may be a precursor and sometimes even contribute to developing chronic pain. People with major depression can experience decreased pain tolerance that heightens the effects of chronic pain. 
  • Subtype: One theory suggests that chronic pain is a subtype of depression, as they share neurotransmitters and a pattern of persistence. That said, little evidence supports this theory. 
  • Bigger issue: Finally, chronic pain and major depression may be two symptoms of an underlying issue, such as multiple sclerosis or fibromyalgia. 

Treatments for chronic pain and depression

When chronic pain and depression are connected, they can often be treated together. Below, we look at some potential treatments for people who experience both depression and chronic pain at the same time. 

Antidepressant medications

Because chronic pain and depression share the same neurotransmitters, some antidepressant medications can be used to target both. While traditionally taken to treat symptoms of depression, antidepressants have been approved by the Federal and Drug Administration (FDA) to treat other conditions, including: 

  • Generalized anxiety disorder (GAD)
  • Obsessive-compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Social phobias

In some cases, doctors may prescribe antidepressants to help patients with pain, insomnia, and migraine headaches. The two types of antidepressants that can help treat chronic pain coupled with depression are: 

  • Tricyclic antidepressants: These include amitriptyline HCL (Elavil) and nortriptyline (Pamelor). This class of antidepressants works by increasing the amounts of serotonin and norepinephrine in the brain and blocking the effects of acetylcholine. They have been shown to be highly effective ways to treat neurologically-based pain (chronic neuropathic pain) like migraines, herniated discs, and other spinal nerve root problems, however they often come with side effects. 
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs): These are different to selective serotonin reuptake inhibitors (SSRIs), often used to treat depression. This class of antidepressants, which includes Effexor and Cymbalta boost the number of neurotransmitters in the brain and often have fewer side effects than tricyclic antidepressants. 

If you are experiencing both pain that is persistent as well as depression, it’s recommended you speak to a mental healthcare provider who can help you find the right antidepressant medication to treat both of these issues together. 

Talk therapy

In some cases, talk therapy can be a helpful treatment for depressed patients with chronic pain, particularly cognitive behavioral therapy (CBT). This type of therapy can help a person recognize the negative thought patterns that surround chronic pain. Working with a therapist can help patients change these thought patterns by thinking positively and identifying those negative thoughts that keep them trapped in the pain and depression cycle. 

Other treatments

Besides medication and talk therapy, there are a number of things a person can do to manage their experience of depression and chronic pain. These are typically self-care and lifestyle shifts that can boost mood and help manage pain, including:

  • Exercise: Regular, gentle exercise, such as walking or swimming can help relieve stiffness associated with chronic pain. If a person is able, it’s recommended to walk for at least 30 minutes everyday. 
  • Sleep: Maintaining a regular sleep pattern can help ease sleeping difficulties and boost mood during the day. Practicing sleep hygiene is a great way to prepare your body for rest. 
  • Relaxation techniques: Things like meditation and breathing exercises can help boost mood and relax stiff muscles. 
  • Hobbies: Hobbies can be an excellent way to distract the mind and provide some satisfaction in a person’s life. Whether it’s playing guitar, photography, knitting, or baking, finding a hobby you enjoy and dedicating time to it can bring some enjoyment to life. 
  • Support: Finding a support system you trust and feel safe around can help relieve the burden of depression and chronic pain. Don’t be afraid to share your feelings with someone close to you, whether it’s a friend or family member. 
  • Healthy diet: It’s always recommended to eat nutritious foods and maintain a healthy diet where possible. 
  • Avoid substances: If possible, a person with depression and chronic pain should try to avoid or minimize substances such as alcohol or nicotine, which can worsen symptoms.

Alternative therapies

In some cases, a person might like to consider alternative therapies to reduce their long-term pain or ease persistent major depression. Some alternative treatments which may be helpful include: 

  • Acupuncture: This therapy is part of Traditional Chinese Medicine (TCM) and involves inserting thin needles into specific ‘acupuncture points’ on the body to stimulate specific areas and relieve pain. 
  • Biofeedback: Biofeedback is a type of mind-body therapy that helps people change the way their body functions, including heart rate or breathing patterns. A person can use biofeedback to control their breathing in a way that reduces anxiety or sit differently to relieve muscle stiffness. 
  • Transcranial magnetic therapy (TMS): This is an FDA-approved depression treatment that uses MRI-strength magnetic pulses to stimulate areas of the brain that are underactive in people with depression. It is helpful for people with treatment-resistant or severe depression, or when antidepressants aren’t an option. 

Summary: the link between depression & chronic pain

It is common for people to experience both chronic pain and depression at the same time. Depression may cause pain in some people, and pain may be a contributing factor in developing depression. 

Thankfully, treatments exist that can relieve symptoms like low mood, disturbed sleep, loss of appetite, fatigue, and lack of interest in daily activities. If you’re struggling with chronic pain as well as depression, know that help is available. 

The best way to start is by speaking to a mental healthcare provider who can identify your symptoms and create a treatment plan to help you start feeling better. At BestMind Behavioral Health, we offer both Telehealth services as well as in-person consultations at our clinics in Colorado and Oregon. Get in touch with us or find a provider near you to start getting the care you need.