Chronic Pain and Depressions: Definitions

Chronic pain is pain that persists beyond the point where one would expect an injury to heal or an illness to pass. Generally, that means it’s lasted more than three months.

Depression is a persistent feeling of sadness lasting more than two weeks. It can involve feelings of hopelessness and guilt, an inability to enjoy things that formerly gave pleasure, insomnia, lack of energy, fatigue, slowed response time, dramatic weight gain or loss, irritability, withdrawal from others, and in the case of severe depression even suicidal thoughts and urges. Psychologists classify it as either exogenous (situational), meaning it’s a reaction to an identifiable external cause like the loss of a loved one, or endogenous, where the cause does not appear to be truly or wholly external and may in fact stem in part or in whole from the person’s physiology.

How Chronic Pain and Depression Influence One Another

As you can imagine, chronic pain can provide cause for persistent depression or make it more difficult to cope with depression. By making it hard to engage in the activities a person previously enjoyed, severe chronic pain can promote the social isolation that contributes to depression. It also produces levels of chronic stress that never permit the mind and body to relax. Over time, this wears an individual down.

In fact, chronic pain and depression are so closely interrelated that it’s sometimes a judgment call to determine which came first. What we do know from the research is that anywhere from 30% to 50% of those who experience chronic pain also suffer from depression, which means they’re three times more likely to suffer from depression or anxiety than the average person.

Similarly, depressed people are three times more likely to develop chronic pain like chronic back pain, headaches, or migraines. Chronic depression can make it more difficult to practice the good health habits that ward off pain, and chronic pain can lead to the insomnia, guilt, stress, and feelings of worthlessness associated with depression. In short, chronic pain and chronic depression can feed off one another in a constant destructive cycle.

The cycle can be especially difficult to break because chronic pain sufferers who are also depressed may not even realize they have the latter condition. Studies show that 50% of depressed patients only discuss physical symptoms when visiting their doctors. That’s more than unfortunate since physicians need to understand that an individual is suffering from both conditions to provide effective treatment.

Symptoms of Depression

Chronic pain sufferers should discuss the possibility that they’re also depressed with their doctor if they’re experiencing any of the following:

• Depressed mood
• Irritability
• Loss of interest in activities
• Alterations in sleep patterns (sleeping poorly or too much)
• Feelings of guilt, hopelessness, or despair
• Changes in appetite
• Impaired concentration
• Loss of energy
• Suicidal ideas and/or urges

Help for Those with Chronic Pain and Depression: The Treatment Team

Fortunately, those who suffer from both chronic pain and depression can be helped. The ideal way of addressing their problems is to assemble a treatment team capable of tackling all aspects of the clinical picture.

Physicians can provide comprehensive examination, evaluation, and diagnosis and prescribe both pain and psychiatric medications as indicated.

Pain specialists provide education about the relationship between chronic pain and depression and participate in setting up treatment plans.

Physical therapists can guide patients through exercises and muscle relaxation techniques that improve mobility, reduce pain, and lift depressed mood.

Psychotherapists trained in cognitive behavior therapy or comparable systems help patients recognize and combat maladaptive ways of thinking. They teach coping skills that help individuals deal with both chronic pain and depression and can counsel families to help them better understand what patients are going through.

Depending on the particulars of a case, occupational therapists, acupuncturists, and nutritionists can also contribute to the treatment of chronic pain and depression.

Help for Those with Chronic Pain and Depression: Treatment Approaches

There are a number of treatment options available to depressed patients who are also suffering from chronic pain. The treatment team is likely to recommend a combination of some or even all of them.

Psychotherapy, also known as talk therapy, teaches coping skills to deal with symptoms, helps patients alter maladaptive ways of thinking, and makes future depressive symptoms less likely.

Medication is sometimes necessary to control symptoms. Antidepressants combat depression, and a low-dose antidepressant can even reduce pain by producing a chemical change in the way the brain processes pain. Analgesics, of course, are intended first and foremost to fight pain. When pain is extreme, it’s conceivable that a doctor will prescribe opioids, but the risk of dependency and other issues make them medications of last resort, especially if a particular patient has a history of drug or alcohol abuse.

Stress-reduction skills are a whole family of skills encompassing meditation, muscle relaxation techniques, positive thinking, exercise, and many others, all potentially beneficial. Psychotherapists, physical therapists, pain specialists, and others can design a program to address a particular patient’s needs.

Support groups can provide both emotional support and valuable information to those suffering from chronic pain and depression. When face-to-face peer support is unavailable or impractical in light of an individual’s location or situation, support groups can also be found online.

Inpatient and outpatient pain programs are intensive programs offering support to patients whose chronic pain and/or depression is severe. Onsite medical care, individual and group psychotherapy, and psycho-education to combat pain and stress are generally some of the components.

The most important takeaway from all of the above is that effective help for chronic pain and depression is available, but only if your doctor fully understands what you’re experiencing. So be sure to tell him or her about all your symptoms, both the physical and the emotional.