Do you ever wonder if being depressed or anxious could contribute to your chronic pain? Turns out these feelings may be connected.

Studies show that 30 to 50 percent of people struggling with chronic pain also have a mood disorder such as depression and anxiety.

“For example, we know that simply having a bad headache or back pain for a day can affect our mood. Imagine having that pain every day for six months. It’s actually quite reasonable to expect anxiety and depression with chronic pain,” says pain management specialist Hersimren Basi, MD.

Read on for answers to common questions about the links between pain and depression and to learn how they are treated.

When is pain considered chronic?

Pain is chronic if, in general, it lasts longer than three months. This means it extends beyond the usual healing time for an illness or injury. When it lingers beyond three months, pain can be considered a disease in its own right, Cleveland Clinic pain management specialists believe.

Chronic pain also carries a hefty price tag. In the United States, it costs about $600 billion a year in healthcare costs as well as lost time from work.

Does pain cause depression and anxiety, or vice versa?

This is like asking, “Which came first, the chicken or the egg?” It can work both ways, says pain psychiatrist Xavier Jimenez, MD. Pain can cause depression and anxiety. Depression and anxiety can cause pain. This can create a cycle where one condition continually worsens the other.

For example, someone in pain from an injury may cut back on their activity because they’re afraid of being reinjured. If lack of activity keeps them from improving their physical condition, they may actually become deconditioned — and thus susceptible to injury, he explains.

In another scenario, “Chronic pain may cause sleep problems, or feelings of helplessness and worthlessness related to missed work or financial woes. These can all lead to depression,” says Dr. Jimenez.

How are the overlapping illnesses treated?

A comprehensive approach to treatment starts with a thorough evaluation to determine what might be contributing to both the pain and the mood disorder.

If something physical like arthritis is contributing to pain, then treating the pain itself — using the appropriate medication, physical therapy or other therapies, such as nerve blocks or other injections — may improve the depression.

“The hopeful news is that by treating your pain, the depression that may coincide with it can improve as well,” says Dr. Basi. “Treating pain can help you return both physically and mentally to who you truly are as a person.”

But for some patients, the psychological aspects of chronic pain must also be addressed. Certain medications that target both pain and depression can be prescribed. Other options include:

  • Cognitive behavioral therapy to help patients develop coping skills so they can manage their pain.
  • Relaxation training to reduce the stress response, which often worsens pain and increases symptoms of depression and anxiety.
  • Hypnosis to help patients reach a relaxed state that may allow for positive suggestion.
  • Exercise and physical activity to boost mood and also improve pain and function.
  • Self-help groups to provide psychological support.
  • Education for both the patient and family.

No matter what works for you, taking part in activities is a vital part of your recovery. It will help you focus on what you can do, instead of what you can’t do.


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