Chronic pain is stressful, and can contribute to a wide range of health problems including heart disease, obesity, and diabetes. In addition to the physical symptoms, chronic pain also affects social, occupational, and recreational activities in the lives of those affected. And this can lead to mental health concerns like depression and anxiety. Let’s take a closer look at chronic pain and mental health concerns that you need to know about.
What the link between chronic pain and mental health?
The discomfort can be unbearable and increasingly difficult to verbalize to others including close friends and family. Feelings of seclusion and detachment may cause negative thought patterns to emerge. This can make pain treatment more difficult. The primary focus of medical treatment is understandably on the biological component of chronic pain. However, the social and psychological influences of chronic pain and mental health conditions can also be critical for a patient. This is especially true if they’re to achieve long-term success in pain management.
The following video gives a brief overview of what chronic pain is.
Chronic pain and depression and suicide
Depression unfortunately affects about 77% of chronic pain patients, according to the American Academy of Pain Medicine (AAPM). So if you feel sad or hopeless because of pain, you are not alone, and there is help available.
What is the link between depression and chronic pain?
Living with a chronic condition causes immense amounts of stress. You may have trouble participating in activities you once enjoyed. Perhaps the simple tasks of everyday living have become a challenge. With life becoming more burdensome, it’s natural to have a difficult time feeling joy or even falling into depression.
Biologically, chronic pain changes the brain, with neurotransmitters heightening a body’s sensitivity to feeling pain. This increased sensitivity often leads to a person picking up on sensations of pain unrelated to the original source. Greater feelings of pain often interfere with sleep, leading to stress and fatigue, which may result in anxiety, and finally depression. The trajectory is different for everybody, with each person reacting in a different way.
The reverse may also be true: a person with depression may develop chronic pain. In fact, aches and pains are often a symptom of clinical depression. Feelings of sadness or grief may result in a person engaging in less physical activity or gaining weight from eating high-fat or sugary foods in an attempt to self-soothe in unhealthy ways. Weight gain plus a sedentary lifestyle is a dangerous recipe for pain and depression.
Additionally, opioids have been linked to depression, reports Pain Doctor. So if you have been taking narcotics to manage the pain, they may be to blame for lingering feelings of sadness you may be experiencing. The following video discusses this in more detail.
Brain biology connects chronic pain and depression
Researchers have uncovered a biological link between the two disorders. Chronic nerve pain causes inflammation in the brain regions related to mood and motivation, according to research from Medical News Today.
Researchers found that this chronic pain-related brain inflammation triggered special types of immune cells, which in turn reduced levels of dopamine, the neurotransmitter linked to pleasure and reward. Schizophrenia may also produce abnormalities in dopamine production.
The research could point the way to finally uncovering the reason why patients with chronic pain don’t typically respond well to opioids. Painkillers work partly by increasing the brain’s dopamine response, but researchers found that didn’t happen in mice with chronic pain.
Researchers are working on a drug to normalize dopamine production in patients with chronic pain, which would hypothetically allow opioids to work. However, even if a new medication opened that possibility, it doesn’t reduce the enormous health dangers—both mental and physical—of opioids.
What is the link with suicide?
While the link between pain and extreme sadness is discussed often, the link between chronic pain and suicide is less publicized, perhaps because suicide is such a difficult topic to discuss. But, the matter is critically important: the nation’s suicide rate has climbed steadily since 2000, according to the American Association of Suicidology, up to 12.9 per 100,000. Those aged 45 to 54 are most likely to fall victim.
About 90% of all suicide victims have a diagnosable, treatable psychiatric disorder at the time of their death, according to EveryDay Matters. And among causes of suicide related to illness, chronic pain ranks No. 2 behind bi-polar disorder, according to Medical News Today.
Both pain and depression are considered risk factors for suicide, and many pain patients live with both. In fact, the true toll may be underestimated. Some doctors believe the soaring rates of opioid overdose may be less accidental and more intended to escape relentless pain. Dr. Steven A. King writes in Psychiatric Times:
“In most cases of overdose deaths, we have no way of knowing with any degree of certainty whether they were accidental deaths or intentional suicides.”
Additionally, opioids are depressants, which may exacerbate pre-existing feelings of excessive sadness while also muddying thinking and making it difficult for people to make good decisions.
What are the risk factors and warning signs for suicide?
- Feeling unbearable pain
- Substance abuse
- Sleeping constantly or not at all
- Giving away possessions
- Loss of interest in daily activities
To get help, call the Suicide Prevention Hotline at 1-800-273-TALK. People may also go to a hospital emergency room, call 911, or go to the psychiatric hospital. View this list of resources from the American Foundation for Suicide Prevention.
If you or a loved one is suffering from depression or experiencing suicidal thoughts, please take it seriously and find the necessary help.
Chronic pain and anxiety
Over 40 million people in the U.S, approximately 18% of the population, suffer from anxiety. While anxiety is often a debilitating disease, when combined with the chronic pain suffered by nearly one in four in the U.S., the results can be devastating for the patient, their family, and their friends. Chronic pain and anxiety feed off each other, with one condition intensifying the other. People with anxiety are more likely to suffer from chronic pain, and those with chronic pain commonly suffer from some degree of anxiety.
How are chronic pain and anxiety related? The research
One of the ways in which anxiety and chronic pain are related is believed to be through a complex series of connections in the brain.
Dr. Min Zhuo and his team at the University of Toronto have found not only a series of links between chronic pain and anxiety in the anterior cingulate cortex, the region of the brain that plays a part of emotion formation, processing, and learning, but they have also found a molecule with the potential to reduce anxiety that stems from chronic pain.
The first discovery relates to Long Term Potentiation (LTP), which is simply the brain’s ability to become more efficient at processing things that repeatedly occur, such as pain and anxiety. LTP seems to occur in the anterior cingulate cortex for both pain and anxiety. Most commonly, the number of receptors increases in this area, which may explain why the perception of anxiety and pain intensifies the longer they exist.
Before Long Term Potentiation occurs, this can be blocked with the newly-discovered molecule NB001, which makes this efficient neurological processing less likely to occur. Essentially, the molecule blocks the brain’s ability to wear a direct path to pain and anxiety. This molecule also helps reduce pain in animal study subjects.
Finding the treatment you need
If you suffer from chronic pain and mental health concerns, there is help.
For example, psychologists are experts in helping chronic pain patients cope with their thoughts, feelings and behaviors. They may work in a private practice or in collaboration with health care providers. Treatment plans are designed individually for each patient. These may include relaxation techniques, building new coping skills, and developing new ways of perceiving pain. Some psychologists may use a method called biofeedback to teach clients how to control certain body functions associated with stress.
Further, cognitive-behavioral therapy (CBT) is a type of psychotherapy which attempts to identify and resolve problems with disadvantageous thinking. The basis for CBT is the idea that our thoughts influence our feelings and behaviors. Thus, our outlook can improve despite external factors such as pain. If we give negative meaning to a situation or allow ourselves to form meaningless automatic responses, we can block ourselves from learning new skills for coping with it. With the guidance of a professional, patients can learn to recognize these patterns and actively plan to improve them. This is the main concept behind many treatments used by behavioral health professionals.
Psychologists also help patients adjust their lifestyle to allow continued participation in their favorite activities. It usually only takes a few sessions with a psychologist to improve pain management. However, a longer course of care is usually more beneficial for chronic pain patients. Overall, psychotherapy can be just as effective as surgery in decreasing painful sensations. With the help of a psychologist, patients with pain conditions can help their mind and body reduce pain and improve the quality of their life.
What types of treatments are available for someone who is suicidal?
Depression is highly treatable. Therapy options include cognitive behavioral therapy. With this, a therapist works with patients to identify unhealthy patterns of thinking and change them.
Some people find one of the many medications available for depression is helpful for lifting the mood. And increasing amounts of research is coming out about the power of simple things, like walking and spending time in nature, for lifting depression.
For instance, regular, moderate exercise has been found to alleviate both depression and pain, according to Scientific American. It may sound overly simple, but exercise regulates the brain in a way similar to prescribed depression drugs.
Thousands upon thousands of people have also found relief from depression through the ancient practices of yoga and meditation. These practices help people find meaning in life—and suffering—and teach practitioners to live in the moment, which brings peace. Some doctors have even begun prescribing yoga for people living with anxiety or depression, reports CTV News.
Research on treating chronic pain and anxiety
The brain is a powerful player in the relation between chronic pain and anxiety. And that’s not just in the way that neurons interact and change the physical structure but also in the way chronic nerve pain causes brain inflammation. New research out of the University of California – Irvine (UCI) and the University of California –Los Angeles (UCLA) has linked inflammation in the brain caused by chronic nerve pain to a number of different mood disorders including anxiety, depression, and even substance abuse.
Inflammation in the brain restricts the release of dopamine. This is our brain’s system of pleasure and reward that can be released as an analgesic to help relieve chronic pain. It instead activates immune cells called microglia that inhibit the release of dopamine. This might also explain why opioids are generally ineffective against long-term chronic pain. In studies completed on laboratory mice, opioids failed to stimulate the release of dopamine in the brain, specifically in the presence of inflammation. Mice treated with a drug that blocked the activation of microglia quickly felt relief.
Catherine Cahill, associate professor of anesthesiology and perioperative care at UCI, believes that this discovery can help connect pain, brain inflammation, and mood disorders like anxiety. She noted that although the research is new, the next goal is to apply this mood-regulation to humans, saying:
“We have a drug compound that has the potential to normalize reward-like behavior, and subsequent clinical research could then employ imaging studies to identify how the same disruption in reward circuitry found in rodents occurs in chronic pain patients.”
Anxiety does not have to be a part of chronic pain. There are steps you can take to identify and work through anxiety symptoms.
Talk to your doctor
Though the primary focus of pain management is typically providing treatments such as medications, physical treatments, injections, and other interventions that address the physical basis of the chronic pain, in many cases the relief this provides is limited by psychological factors.
Because chronic pain is a stressful condition that interferes with regular functioning, patients may develop a negative outlook that can reduce the efficacy of various treatments. The addition of psychologically-focused treatments enables many patients to experience significantly greater relief of their pain.
If you are feeling increasing symptoms of anxiety or depression or another mental health condition, talk to your doctor. The perception of pain can be intensified by mood disorders, but if your doctor isn’t aware it is difficult to address those symptoms. You can find a pain specialist near you by clicking here.