IS THERE A LINK BETWEEN CHRONIC PAIN AND DEPRESSION?

INTRODUCTION

When you’re in pain, being diagnosed with depression is common. People who are in chronic pain are four times more likely to experience depression in their lifetime than those who don’t have chronic pain.
Experiencing chronic pain and depression is often much harder than experiencing just one of these problems. This is because the two conditions often reinforce each other. But there’s good news – not everyone with chronic pain suffers from depression. And if you do suffer from depression while you have chronic pain, it can be treated. Let’s look at a few things like, what depression is, why pain and depression often occur together, and what you can do about them.

WHAT DOES DEPRESSION LOOK LIKE?

One in six Australians will experience depression at some point in their lives. A person may be depressed if they have frequently felt sad, down or miserable for more than two weeks, or have lost interest in many of their usual activities. They may also experience several of the following problems:

  • Difficulty concentrating, remembering things, and making decisions

  • Fatigue and decreased energy
  • Feelings of guilt, worthlessness, and/or helplessness
  • Insomnia (can’t get to sleep), early-morning waking (too little sleep), or excessive sleeping (too much sleep).
  • Irritability, restlessness
  • Loss of interest in activities or hobbies once pleasurable, including sex
  • Overeating or appetite loss
  • Persistent sad, anxious, or “empty” feelings
  • Thoughts of suicide. Even if you are not thinking of suicide or harming yourself, thinking about death is another possible NOTE: If you are having suicidal thoughts, seek immediate help, preferably from a mental health practitioner, like a psychiatrist. See the end of this page for emergency contact numbers.

Importantly, we all experiences some of these symptoms from time to time but it may not necessarily mean you are depressed. Equally, not everyone with depression will have all of these symptoms. Many people with depression have symptoms severe enough to cause problems in your ability to perform day-to-day activities, such as work, study, social activities or relationships. Some people may feel miserable or unhappy without knowing why.

WHY DO DEPRESSION AND CHRONIC PAIN OCCUR TOGETHER?

A number of reasons have been proposed as to why these two problems occur together.

  1. The same (common chemicals): depression and chronic pain use some of the same neurotransmitters (chemicals that communicate information through our brain and body). These chemicals also activate some of the same regions in the brain.
  2. Pain can cause depression. The impact of chronic pain may also lead to depression. Some people experience significant changes in their day-to-day activities, in many areas of life such as work, family, friends and leisure. These changes can lead to increased feelings of hopelessness, helplessness and depression.
  3. Depression can cause chronic pain. When we’re depressed, we tend to notice the things that aren’t going well in our lives (e.g. pain), and tend to be less motivated to take action to manage pain and depression (including exercise and good diet). This reinforces the pain/depression cycle.

TREATMENT OF CHRONIC PAIN AND DEPRESSION

Given that chronic pain and depression reinforce each other, treatment for each condition often overlaps. It is important to seek help from a team that can provide a holistic treatment plan that addresses the different areas of your life that are affected by pain and depression.

Common treatments for depression might include:

MEDICATION

Because persistent pain and depression can involve the same nerves and neurotransmitters, antidepressants are often used to treat both. Antidepressants can reduce the perception of pain and decrease the symptoms of depression. Some antidepressants are very good pain medications as well as antidepressants. Older antidepressants like amitriptyline and newer ones like duloxetine are good pain medicatons.

PSYCHOTHERAPY

Psychological therapy helps improve chronic pain and depression, with Cognitive Behavioural Therapy (CBT) one common approach. Other increasingly popular approaches are mindfulness-based therapies and acceptance and commitment therapies.

WHAT ELSE CAN YOU DO?

KEEP ACTIVE

It’s important to keep doing the things that are meaningful for you – even though you may worry they’ll trigger pain, or aren’t feeling motivated to do them. (If you’ve stopped doing a favourite activity for some time, you need to get your body moving again SLOWLY.)

KNOW YOUR TRIGGERS

Figure out the triggers that worsen your pain/depression symptoms. Knowing these may:

  • Help you cope when you’re triggered
  • Reduce the likelihood of pain flare-ups and depression spirals
  • Help you feel more in control of your experiences.

FEEL SAFE

Engage in activities that make you feel calm, relaxed and happy. These emotions tell your system that you’re safe, and you no longer need to be on high alert. Over time, your system will become less sensitive.

BE KIND TO YOURSELF

Try to remember that high standards can often be unrealistic. Remind yourself that you’re doing the best you can in your current situation.

CREATE A ROUTINE

Develop and maintain an eating, sleeping, and exercising routine. Create a schedule that keeps you involved with things you value. A routine can carry you through tough periods, helping you manage during stressful times.

CONCLUSION

Chronic pain and depression often arrive together, and can act to reinforce each other. While expert help is available, there are also things that you can do to help yourself manage them effectively. By practising the above techniques when these symptoms occur, you can begin to gain control of chronic pain and depression. 

Emergency contact information (24 hours)

Remember, in an emergency, you can always visit your local hospital’s emergency department. That’s what they are there for: for you!