If you are suffering from chronic pain and starting to recognize the symptoms of depression, you’re not alone. And on the other hand, if you suffer from depression and notice an increase in pain from an old injury (or new pain popping up), you’ve got plenty of company there, too. Turns out, the relationship between pain and depression is bidirectional, with one intensifying or increasing the likelihood of the other. Is there a link between pain and depression? Yes — that’s why it’s critical to understand and treat both conditions.
Pain And Depression Explained
Pain and depression are intertwined conditions. While it is not guaranteed that a person with one will develop the other, the presence of either increases that chance in a substantial way.
The comorbidity of these conditions is not rare. Some early studies indicated that up to 85% of chronic pain patients experience clinical depression. And those with depression induced by chronic pain have a poor chance of recovery from either condition.
But what do these conditions look like?
Chronic pain and depression symptoms
Chronic pain is defined as pain lasting for three months or longer. It can result from a degenerative condition or a traumatic injury. The cause of the pain does not matter as much as the fact of its longevity.
In addition to the pain itself, chronic pain often comes with other symptoms, including:
- Poor sleep
- Mood swings
- Anger and irritability
- Loss of stamina
- Decreased flexibility and range of motion in the body
- Sexual side effects
- Gastrointestinal disruption
Depression is a clinical term used to diagnose a mood disorder that is much different from a day or two of sadness or grief after a loss. Symptoms can include:
- Loss of interest in daily life
- Changes in appetite (e.g., excessive hunger or loss of appetite)
- Loss of stamina
- Changes to sleep patterns (e.g., insomnia, restless sleep, or excessive sleepiness)
- Changes in weight
- Mood changes including hopelessness, despair, anger, and irritability
- Perseverating and rumination (going over the same thoughts)
How does mental health affect pain? People with depression can hold an extraordinary amount of tension in their body, leading to pain. They may also find themselves limiting their activity, which can lead to easier injury when they get moving again.
It’s also easy to see where these symptoms might overlap when a pain condition is diagnosed first. For example, fibromyalgia pain and depression are clearly linked both physically and mentally. Those who suffer from this whole-body pain condition find themselves desperately trying to find a comfortable sleeping position. Because of poor sleep, they may find that their fatigue makes it difficult to move through their day, causing an increase in stiffness and pain, plus lack of stamina. This then leads to a loss of interest in everyday activities. This lack of interest may cause a withdrawal from social activities and an eventual development of depressive symptoms.
And, so the cycle continues. A diagnosis of both pain condition and depression is critical to break it.
Diagnosing pain and depression
Pain and depression are typically diagnosed in deep conversation with your doctor and a team of specialists, if needed.
A chronic pain diagnosis depends on the specific suspected condition. Lower back pain is one of the most common form of chronic pain, but its successful treatment depends on narrowing down the condition that causes it. This includes getting a detailed family history, conducting a physical exam, and ordering lab or imaging tests to reach a conclusion.
For depression, a trained therapist uses the guidelines in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. If you experience at least five of the following for two weeks, you may receive a diagnosis of depression.
- Depressed mood more often than not
- No pleasure in almost all, if not all, of your normal activities nearly every day
- Weight loss or gain or significant change in appetite nearly every day
- Slow thoughts and slower or less physical movement that others can observe
- Lack of energy and fatigue nearly every day
- Feelings of worthlessness or guilt nearly every day
- Reduced ability to concentrate or think nearly every day
- Suicidal thoughts, a plan for suicide, or a suicide attempt
Are you suffering from chronic pain and depression?
Chronic pain sufferers know the daily trials that living with a pain condition can bring. Everything from reaching down to tie your shoes to hugging your children or getting groceries from the car can feel like an insurmountable obstacle. Over time, even the most determined people might find themselves feeling worn down.
If you suffer from pain and are experiencing a change in mood, sometimes a depression checklist can help. This is not a substitution for a conversation with your doctor, but it’s a good place to start.
The Relationship Between Pain and Depression
It’s clear in the research that there is a link between pain and depression. This link is physiological, and there are some important risk factors that set people up to experience both pain and depression.
Changes in the brain and the body
What makes this relationship more challenging is that the exact way in which pain and depression are linked is not yet identified. But there is plenty of evidence that the brain actually changes in people with chronic pain and depression — even if it’s not clear how or why.
What is clear is that pain and depression use some of the same neural pathways. The size of certain areas of the brain is also tied to the extremes of pain and depression experienced by those patients.
Other critical physiological links between pain and depression include:
- Decreased number of prefrontal cortex (PFC) synapses, which deals with pain processing and depression
- Decreased or maladaptive neuroplasticity in the brains of people with pain and depression
In addition to changes in the brain, pain that results in inflammation is also linked to depression. Inflammation is closely tied to the central nervous system — as noted above it affects the neuroplasticity of the response and can even predict how severe a depressive episode might be.
Risk factors for comorbid pain and depression
While not every person with chronic pain develops depression (or vice versa), there are some risk factors. Studies have shown that those most at risk of developing both conditions:
- Are middle-aged
- Are employed part-time
- Have female reproductive organs
- Are less educated
Some lifestyle factors might also increase your chances of these conditions, separately or together. Smoking, drinking, and substance abuse are strongly correlated with a rise in both pain and depression.
Pain conditions with the highest risk of depression
While it is largely individual in terms of which people living with chronic pain might develop depression, there are a few conditions at highest risk.
- Lower back pain, or any pain condition that significantly reduces your ability to function as normal, puts you at higher risk for depression.
- Fibromyalgia pain and depression may occur as a result of the longer time for diagnosis. People suffering from fibromyalgia also often have the stigma of an “invisible” illness where they look fine, but are suffering.
- Chronic gastrointestinal pain is associated with a higher chance of depression. This may also be due to social factors such as embarrassment or fear of bladder or bowel incontinence that causes a person to withdraw.
- Conditions that limit a person’s ability to complete their daily tasks or participate in activities they enjoy (e.g., joint pain) also put that person at risk for depression.
- Chronic pain conditions that are difficult to treat may have a higher incidence of depression. These might include migraines or trigeminal neuralgia.
Treating Pain and Depression
Getting a proper diagnosis of both pain and depression is the first step on the journey to wellness. Designing a treatment plan for both is the next.
Your doctor may start with lifestyle changes in diet and exercise. These holistic changes can ease symptoms of both pain and depression and promote an overall feeling of wellness, though they won’t treat the conditions directly. Some complementary therapies can benefit both pain and depression, including:
These treatments should also be combined with dedicated treatments for both pain and depression.
Chronic pain treatment options
Treating your chronic pain can help you not only feel physically better; it can also improve your mental health.
Once you have a proper diagnosis of the cause of your pain, your doctor will develop a treatment plan that may include some or all of the following:
- Physical therapy
- Over-the-counter medications
- Interventional procedures
Antidepressant medications do double-duty as a first-line treatment for some forms of chronic pain. Those pain conditions that have been effectively treated with antidepressants include:
- Diabetic neuropathy
- Postherpetic neuralgia
- Tension headache
- Face pain
- Low back pain
- Pelvic pain
Depending on your condition, you may also opt for interventional treatments like:
- Nerve blocks (e.g., medial branch blocks)
- Peripheral nerve stimulation
- Spinal cord stimulator
Because each pain condition is individual, your treatment plan will be, too.
Treatment for depression
Treating depression effectively is one of the best tools to fight chronic pain. Fortunately, there are a variety of treatments that can help. Two common therapies include:
- Cognitive behavioral therapy: This changes the way in which a person thinks about their experience.
- Eye movement desensitization and reprocessing (EMDR): Offered specifically for people suffering from depression or post-traumatic stress disorder related to trauma, this essentially changes the way the brain organizes its response to a traumatic event.
Antidepressant medications are also used to treat both pain and depression. Because these work differently on different people these can take some time to adjust.
Your doctor may try some of the following to help manage your depressive symptoms.
- Selective serotonin reuptake inhibitors (SSRIs): These are the most common starting point, with few side effects. They are also prescribed commonly for standalone chronic pain. SSRIs include citalopram, escitalopram, fluoxetine, paroxetine, sertraline, and vilazodone.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs): This may be combined with other medications. Examples include duloxetine, venlafaxine, desvenlafaxine, and levomilnacipran.
- Atypical antidepressants: Bupropion, mirtazapine, nefazodone, trazodone, and vortioxetine are not easily classified and may be used when other medications are not effective.
- Tricyclic antidepressants: Tricyclic antidepressants come with more severe side effects and aren’t usually prescribed first. They include imipramine, nortriptyline, amitriptyline, doxepin, trimipramine, desipramine, and protriptyline.
- Monoamine oxidase inhibitors (MAOIs): MAOIs require a strict diet due to potential serious drug and herbal medicine interactions and side effects. MAOIs include tranylcypromine, phenelzine, and isocarboxazid.
Some mood stabilizers or antipsychotics may be added to antidepressants. These can enhance the effects of the other medications. Some of these are temporary, while others are a permanent part of the treatment plan.
Hormone balancing therapy may also help shift your depression. This treatment may be temporary but can help provide a more stable mental environment while other treatments are in progress.
Find The Help You Need
The team at Arizona Pain has decades of experience dealing with both pain and depression. We understand how complicated dealing with the physical and mental aspects of pain can be, and we are here to help you get your life back.
With everything from comprehensive treatment plans through our outpatient program, the Mercy Care Center of Excellence, to targeted therapies designed to relieve pain, we offer personalized treatment for the most complex conditions.
Find the help you need to treat your pain and depression. Get in touch to set up an appointment today.