The Relationship Between Chronic Pain and Depression

By Sandra Gill, LCSW

Addressing the relationship between the mind and body is an integral part of our process at Advanced Pain Care. 

As a practicing therapist for 20 years, I’ve supported patients from all walks of life.

We know your mental health is a critical component of your well-being and that chronic pain and mental health influence each other — especially when it comes to depression. 

Understanding that relationship can dramatically impact your recovery from chronic pain.

How Does Chronic Pain and Depression Influence Each Other?

There’s a direct correlation between chronic pain and depression. If you have either chronic pain or depression, you are three times as likely to develop the other (according to Harvard Mental Health).

Studies have shown that 30 to 85% of chronic pain patients struggle with depression. Alternatively, about 60% of depressed people report chronic pain issues.

This correlation isn’t a coincidence. The combination of pain and depression creates a cycle in which pain worsens symptoms of depression and depression intensifies your experience of pain. 

Ask any chronic pain patient and they’ll likely agree: there’s an emotional component to living with chronic pain. It’s both a physical sensation as well as a psychological disturbance.

Depression tends to cause a negative state of mind. Constant pain signals in the body can cause a person to be continuously aware of their physical pain. 

So the combination of depression and chronic pain signals in your brain intensifies your experience of pain and depression. 

I’ve encountered patients who are able to cope with their pain. 

But for some, living with chronic pain creates a lot of different life stressors, both mentally and socially. Their pain affects their thoughts, moods, and behaviors.

If this sounds like you, you should know this isn’t a reflection of your ability to recover. It’s the way your body attempts to cope with its overwhelming pain signals. 

It’s why APC is so dedicated to the mental health component of your pain treatment.

What Are Some Indicators of Depression in Chronic Pain Patients?

Chronic pain is both an emotional condition and a physical sensation. Pain affects our thoughts, moods, and behaviors.

If you have chronic pain and depression, your overlapping symptoms may include: 

Any one of these symptoms can feel insurmountable, and unfortunately, many people experience a combination of them.

If you’re experiencing these symptoms, you should know there are ways to manage them and improve your quality of life.

I’ve helped patients get through these challenging issues; and, we at APC want you to know we are ready to help you too.

How Does Depression Impact a Patient’s Recovery Process?

Chronic pain and depression create a cycle: pain worsens your symptoms of depression and depression intensifies your experience of pain.

In fact, your pain signals and depression share the same neural pathways in the brain. This means they directly influence one another, which makes your treatment and recovery process more complex.

Basically, chronic pain and chronic emotional distress alter your nervous system and perpetuate the problems related to both.

When you’re experiencing a lot of pain, it is hard not to think about it. Your daily thoughts are preoccupied with your physical experience. Thus, your pain can intrude into many areas of your life and mind.

You’re likely struggling to cope with the stress of pain and daily life

You might experience:

But recovery is possible! The mental health experts at APC know how to address these complex, interconnected issues.

Related: 6 Coping Mechanisms to Manage Your Chronic Pain

How Does APC Screen for Depression?

At some point, every APC patient will be screened for depression. If you’re a brand new patient, you’ll likely have a mental health assessment on a follow-up visit.

First, you’ll be asked to fill out a form that covers several different domains of mental health, such as depression, anxiety, irritability, sleep disturbance, and substance-use issues.

One important insight for us to know is whether you have pre-existing mental health conditions, or whether your onset of depression came after your chronic pain.

Then, one of our trained Behavioral Health experts will meet with you for about 20 minutes to get to know you better. 

We’ll let you know about our services and give you some options to consider, especially if you’re showing symptoms of depression.

You’re given the option to schedule a follow-up visit for a more formal diagnostic assessment, which can help determine what kind of ongoing mental health support you need.

What if I’ve Never Suffered From Depression Before?

We know that the state of your mental health can change over time. In fact, you might not report any mental health issues initially. But that might change.

For example, if you’re newly injured, you might feel okay mentally. But then six months later when the pain continues and it’s affecting your lifestyle, depression may set in.

That’s why we have a computerized system that all our patients fill out quarterly and annually, so we can track and assess the status of your symptoms.

Your depression, anxiety, risk of opiate misuse, and level of distress are the four areas that our system may flag for additional Behavioral Health support. 

We touch base with you regularly to see how you’re coping — psychologically and emotionally — with your chronic pain. 

How Do I Know if I Need Mental Health Support?

First, we’ll do a psychosocial diagnostic evaluation in which we ask different questions related to your social history, the history of your pain, and assess for any mental health conditions.

Then we’ll assign a diagnosis and provide you with options for ongoing, one-on-one therapy with one of our therapists or a referral in the community.

As a therapist for 20 years, I can tell if you’re experiencing depression, even though you might not be aware of it. 

Entering therapy is always your choice. We don’t force you into it. But we do want to educate you so you know it’s an option that is always available to you.

What Does Your Depression Treatment Plan Look Like?

Our treatment plan is a two-prong approach to help you manage depression and improve your coping skills for chronic pain. 

Your treatment plan addresses the source of your depression and the specific stressors associated with it.

Our therapists may use a variety of methods, including:

1. cognitive-behavioral therapy (CBT)
2. eye movement desensitization and reprocessing (EMDR)
3. mindfulness training
4. various talk therapies 
5. trauma-focused therapies

You may learn relaxation skills and behavior modifications, like pacing, adapting, and delegating. 

In addition, you may be referred to a psychiatrist or your primary care doctor for medication interventions such as antidepressants.

You might be wondering why medication is necessary for your treatment plan. Here’s how it works:

As I’ve discussed, there is two-way communication between our body and our brain. 

When pain signals are received by the brain, the brain releases neurotransmitters such as serotonin and norepinephrine to help block the perception of pain. These are the same neurotransmitters that regulate mood and stress.

Stressors can be external (what is happening in your life) and internal (negative thoughts and pain signals). 

From this standpoint, you are in a constant state of stress. Your serotonin and norepinephrine reserves get depleted. That reduces your ability to maintain a stable mood. 

Medications can help combat this by boosting your body’s serotonin and norepinephrine levels. 

What Does a Successful Treatment Look Like?

We consider your treatment successful if you’re better able to manage your pain and mood issues. 

We want you to have an improved mood, fewer negative thoughts, decreased pain, and improved daily functioning. 

Ultimately, everyone at APC is invested in helping you.

Your pain story is unique, and that’s why we want to meet you.

It can be hard to ask for help, but we want you to know that making the first step is all it takes. 

APC Is ready to tackle every aspect of pain in your life. Are you ready to stop the pain?

Related: Make an Appointment at an APC Near You