We all know the dip we experience in our mood when we suffer from a minor injury, say, a fall that leads to scuffed knees and palms. This might be a brief bad mood, but what about when an injury or condition leads to chronic pain? It makes sense that this type of pain would also affect our mood, but how are chronic pain and mental health related, and what can we do to treat both?
How does chronic pain affect mental health?
Chronic pain and mental health syndromes are considered bi-directional, that is, either can lead to the other. It can be difficult to pinpoint which condition causes which, but each certainly increases the intensity of both.
Consider this: a car accident leaves a previously healthy, active person with lingering lower back pain. This lower back pain does not go away, worsening and transitioning from acute to chronic pain when it lasts longer than three months. The pain becomes so intense that the person has difficulty sleeping, going to work, and generally participating in daily life including leisure activities. It follows that a person’s mental health would suffer under these conditions, especially if treatments for pain are ineffective or come with side effects.
Or the other side of the coin: a major depressive episode leaves another person unable to motivate themselves to do the things they normally love, like see friends, go for walks, or play with their dog. As they become more sedentary, the person’s body begins to ache and stiffen. Perhaps this leads to an injury due to exertion, and then chronic pain makes itself known.
Whether the pain comes before the mood disorder, or the mood disorder worsens the pain, we know that these two conditions are linked, serious, and require a multi-pronged treatment approach.
Chronic pain and mental health statistics
Unfortunately, exact chronic pain and mental health statistics can be difficult to come by. This is due to the sometimes-hidden nature of mental health conditions, as well as inconsistencies with patient reporting.
Regardless, here are some chronic pain and mental health statistics that are important to know.
Who suffers from depression, anxiety, PTSD, and chronic pain
Just over 7% of the U.S. population suffers from major depressive disorder, with women twice as likely to develop depression than men. Anxiety is the most common mood disorder in the U.S., with an estimated 40 million people over 18 suffering from this condition. Of those, fewer than 40% receive treatment. Around half of those suffering from depression also have an anxiety diagnosis.
Post-traumatic stress disorder, once considered a “soldier’s disease” is also widespread in the U.S. An estimated 7-8% of people in the U.S. suffer from PTSD after a traumatic event, with women more likely to suffer than men.
Bringing it all together is chronic pain. Estimates vary, but most agree that approximately 20% of people in the U.S. have chronic pain at any given time. People living in poverty, with a high school diploma or less, and those with public health insurance are more likely to experience chronic pain.
Troubling studies are also bringing together a racial component to who suffers from chronic pain and mental health challenges. Black people in the U.S. are more likely than white people to suffer from depression, PTSD, and chronic pain. These are all compounded by more issues with sleep and higher levels of comorbid conditions.
The latest research on chronic pain and mental health
A variety of studies further illuminate the connection between chronic pain and mental health. If you’re interested in learning more of the research behind this connection, we invite you to click any of the following links to read specific studies.
- Depression is the leading cause of disability worldwide
- An average of 65% of depressed people also have chronic pain
- Between 30 and 50% of chronic pain patients experience depression
- People with chronic pain were almost twice as likely to be diagnosed with depression, and two and a half times as likely to be prescribed an opioid
- Pain treatments take longer to work in patients with depression
- Pain can cause anxiety, which makes people more sensitive to pain
- Anxiety increases the risk of chronic pain
- Focusing only on pain treatment and ignoring symptoms of anxiety can make pain treatment less effective
- Pain is one of the most frequently reported symptoms of PTSD
- An estimated 10% or more of people receiving treatment for chronic pain also have PTSD
- Depression is often a symptom of PTSD, and both make chronic pain more difficult to treat
Other studies of note connect chronic pain and anxiety to increased inflammation in the body. Researchers have also discovered a molecular link between chronic pain and depression. This link may lead in the future to treatment for both chronic pain and depression.
How to manage chronic pain and mental health conditions
Much of the latest research on chronic pain and mental health include expanded treatment options that bring the mind and body together to address aspects of both.
The most successful treatments for chronic pain and mental health treat both conditions simultaneously. Since chronic pain takes longer to improve in those with mood disorders, and mood disorders increase the likelihood that acute pain becomes chronic, this approach makes sense.
Here are treatment options that treat the entire individual, not just the disorder.
Diagnosis of chronic pain (and treatment)
One of the first steps to successfully treating chronic pain and mental health conditions is to properly diagnose and begin to treat the chronic pain where possible. Mental health and pain management are so connected that simply treating the mood disorders is not enough and vice versa.
In some cases, a conclusive diagnosis is not possible. And, if you have a diagnosis, generating a comprehensive management plan for pain is just the beginning.
Cognitive behavioral therapy (CBT)
Cognitive behavioral therapy for chronic pain and depression can have mixed results when it comes to the research, but it is incredibly helpful non-invasive option for some patients. This type of therapy helps patients look at how they are changing or distorting their experience. Reframing the running mental chatter is a tool that many therapists use to change a person’s response to the situation.
One large study of mind-body therapies (MBTs) found that CBT offered moderate to large improvements in pain outcomes. Smaller studies indicated that CBT for chronic pain and mental health was better than no interventions, but most reviews indicated no significant reduction in the use of pain medication.
Still, anecdotal reports from patients who suffer from chronic pain with no clear cause indicate that a boost in mood and a reduction in catastrophizing helped them to enjoy a higher quality of life. And another study in 2019 found that over time, CBT was more affordable and just as effective as anti-depressants in treating depressive disorder.
That said, medications can have a profound effect on depression, anxiety, PTSD, and chronic pain. Why anti-depressants seem to work to treat chronic pain is not well understood. It may be that the stress and tension of depression leads to increased pain in the body that is relieved when depression is treated.
Medication that treats depression, anxiety, chronic stress, and PTSD involves the same neurotransmitters that are involved in pain signaling in the brain. Mental health conditions and chronic pain also lead to changes in the nervous system. Anti-depressants, along with other therapies, can help to restore the brain’s signaling balance.
Can something as simple as sitting down every day for 15 to 20 minutes to breathe and feel whatever your body and mind are experiencing actually help reduce pain and mood disorders? The simple answer is yes. Meditation for mood disorders has the added bonus of helping chronic pain patients better learn to deal with flare-ups and daily struggles.
When combined with cognitive behavioral therapy, mindfulness meditation is an even more powerful tool to prevent depression relapse.
Across the board, exercise is an effective treatment for chronic pain and depression. Exercise boosts levels of the body’s “feel-good” chemicals and helps nerve cells grow and make new connections.
Mood disorders can make it challenging to get started, but once you get started (and continue) the effects of exercise are even more powerful. Even a short daily walk that increases gradually in duration and pace can help you feel better.
OWLCP – Our Whole Lives for Chronic Pain – is an online, comprehensive array of treatments that increases access to treatments for low-income people. Primarily focused on self-management strategies for pain, OWLCP also helps patients monitor and manage their pain medication use.
Explore your breath
Treat yourself to something ancient yogis have known about for thousands of years: pranayama. Breathwork for chronic pain activates the body’s parasympathetic nervous system, allowing the brain to take a break from racing thoughts. By breathing deeply, slowly, and consciously, the vagus nerve in the belly sends the brain signals to relax.
A relaxed body produces fewer stress hormones. Clenched muscles become loose, and the mind begins to settle. Practiced in conjunction with other treatments, breathwork can be a useful tool, especially for those who suffer from stress and chronic pain.
Increase social support
One pilot study in 2015 found that patients with a support network had better outcomes for both chronic pain and mental health challenges. The study looked at supportive text messages and reminders to stay active and connected to friends. Patient perception of pain decreased, and the ability to enjoy daily life increased.
Use these results and reach out to friends and loved ones for support. Set reminders on your phone for a daily check-in or exercise date with a neighbor. These small actions can help lift the shadow of chronic pain and depression. Don’t have anyone to turn to in person? Look to our online chronic pain support group to find help 24/7 on Facebook.
Turns out, chronic pain and mental health challenges are best treated with a comprehensive strategy that encompasses a variety of approaches.
One study found that a combination of self-management strategies and regular support from a healthcare provider reduced pain scores and decreased the chance of worsening symptoms.
Explore treatment options
All of these treatments indicate that the best approach to chronic pain and mental health concerns is biopsychosocial. This means that for a treatment to be successful it must address not only biological causes of each condition, but also the psychological and sociological roots of each.
When you do undergo any physical pain management treatments, like chiropractic care, physical therapy, or interventional approaches, make sure to talk to your pain specialist about any strategies to support mental health as well.
You can find a pain specialist in your area by clicking the button below or looking for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.