Page Updated on Jan 31, 2020 by Dr. Reyfman (Pain Management Specialist) of Pain Physicians NY

Having to deal with chronic pain over a long period of time can be very difficult. Dealing with chronic pain and depression at the same time can get even tougher. Depression tends to make everyday living more difficult, as it tends to magnify the pain. Also, it is important to know that medications and psychotherapy can help with the depression and can help to make chronic pain more tolerable, so if you’re dealing with it on your own, you should stop and visit a medical clinic. Get the help that is needed and already out there!  

What is chronic pain? 

Depression and Chronic PainChronic pain is a pain that lasts much longer than expected. When you have chronic pain, you are also more likely to have unusually high levels of stress hormones, low energy, mood disorders, muscle pain and a lower mental and physical performance than normal.

Chronic pain can also get worse if there are any changes in your body, that make you more sensitive to pain. Chronic pain can disrupt your sleep and it can cause you to wake up in the middle of the night. It can make you tired, which will leave you with lower energy to be productive throughout the day. It can also cause additional irritation and this can make it difficult for you when you engage with others. Life can become even more challenging if you have to work full-time or if you have to care for children. All these feelings are able to cause irritability, depression and can even lead to suicidal thoughts.

Depression is one of the most common diseases affecting mental health. It is also a condition that many people with chronic pain have are being faced with. Depression makes other medical conditions and the treatment thereof more complicated. There are a lot of people throughout the world who have been dealing with pain that has lasted for longer than a year and about half of these people also complain of depression symptoms. Around 65% of people who are depressed also experience some type of physical pain. These two conditions are associated with one another also, as people who deal with the pain that limits their independence are more likely to get depression.

As depression in those who deal with chronic pain typically goes undiagnosed, it is also often left untreated. The physical pain, as well as the complaints, are what the patient, as well as the medical professional most usually focuses on. However, the depression isn’t being treated, although it might be what has been making the pain worse.

Is there a cycle between chronic pain and depression?

Pain is able to provoke an emotional response in everyone, not only those who are dealing with mental health problems. People who have pain may also be irritable, have anxiety and agitation. These are all feelings that are normal, due to the pain you’ve been experiencing. However, as the pain goes away, these feelings tend to disappear too. When it comes to chronic pain, the pain remains and so does the stress. With time, stress can lead to even more severe emotional problems, such as depression. Some of these problems that are connected to both chronic pain and depression, include: anger, altered mood, chronic anxiety, confused thinking, family stress, fatigue, irritability, legal issues, decreased self-esteem, physical deconditioning, financial concerns, difficulties with sleeping, a reduce interest in sexual activity, weight gain, weight loss, social isolation and troubles at work.

Having depression and dealing with chronic pain both share some of the same neurotransmitters. Neurotransmitters are the brain chemicals that work as messengers and travel between nerves. Depression and chronic pain, apart from sharing some of these neurotransmitters, also share some of the same nerve pathways in the brain and the spinal cord.

Therefore, chronic pain not only impacts the health state, but it also impacts the mental state of the patient. As it impacts social relationships, sexual relationships, and productivity at work, it can lead to many losses. All these losses contribute to depression, especially in people who are at a higher risk of getting this mental condition. When you get depression, the pain is magnified and it gets much harder to live with it. It gets very difficult to stay active and therefore to reduce stress. Research has also shown that people who suffer from both chronic pain and depression, feel their pain more intensely, don’t have that much of a control over their lives and tend to turn to unhealthy coping strategies.

As chronic pain and depression are so closely connected, once diagnosed, they should be treated together. There are many medications that can improve both chronic pain and depression. An ideal treatment is also one that helps to deal with all areas of a patient’s life that have been affected by the condition.

Antidepressants are one of the medications that are often used to treat both chronic pain and depression. They work towards the same neurotransmitters, that both these conditions share.  There is abundant evidence of the effectiveness of amitriptyline HCl (Elavil) and nortriptyline (Pamelor) are known to be highly effective when it comes to treating neuropathic pain, such as migraine headaches, herniated disks, and problems that involve the spinal nerve root.  However, these antidepressants also came with a lot of side effects and their use nowadays is very limited. There are newer antidepressants, such as Effexor and Cymbalta, that work well but have fewer side effects.

Physical exercise is also something that greatly helps and comes with no side effects. Many people who suffer from chronic pain tend to avoid exercise, however, this is very counterproductive. If you get out of shape, you are even more likely to feel more pain and are also at a higher risk of being depressed. When you exercise, the brain releases the same type of brain chemicals that are being released when you take antidepressant medications. Therefore, even if you might be dealing with pain, finding the right type of exercise routine can do wonders for both these conditions.