For the 100 million U.S. adults suffering from chronic pain, emotional pain frequently follows. Some experts estimate that 50% of people with chronic pain also experience depression. The conditions are tightly entwined. While chronic pain dampens a person’s mood, depression can also lead to pain. But, why does depression hurt in a physical way in the body?

Why does depression hurt? 

Physical pain and depression go hand-in-hand. When a person is injured or has a condition that results in chronic pain, the brain actually changes.

Neurotransmitters begin to make the body more sensitive to pain signals, and the person may feel aches and pains that are unrelated to the previous injury or pain-causing condition. This increased sensitivity can lead to other issues, such as trouble sleeping. The cycle of chronic pain that leads to stress, which then leads to fatigue, which finally leads to mood or anxiety disorders begins, and a chronic pain sufferer may begin to feel clinically depressed.

But the reverse is also true: depression can also lead to chronic pain.

When people experience an event or a trauma, it is normal to feel sadness or grief. If these feelings persist for longer than two or three months, begin to intensify, are accompanied by thoughts of self-harm, the period of sadness or grief may have changed to clinical depression. Many depressed people begin to limit physical activity (they don’t move around), and their diets may suffer (eating poorly or eating primarily junk food). These two things in combination can result in aches and pains that can then become chronic, linked in a cycle of depression and pain that is difficult to treat.

What does depression feel like?

Many people think of depression as solely an emotional state, but people feeling low also frequently experience physical symptoms, including:

  • Headaches
  • Joint or back pain
  • Stomach discomfort

This physical discomfort can exacerbate depression, resulting in an unhealthy cycle that’s difficult to break. People who are depressed are three times more likely to develop chronic pain, according to Harvard Health Publications.

The connection between pain and depression may be biological. Neurotransmitters commonly implicated in depression, such as serotonin and norepinephrine, are also involved in the brain’s signaling of pain. Similarly, both chronic pain and depression can lead to changes in the nervous system, essentially paving physiological roads perpetuating the conditions.

Pain frequently leads to depression

Chronic pain is a long-standing pain that is not new. It may be as a result of an injury or trauma to the body that did not heal properly, or it may arise from a chronic condition such as fibromyalgia or arthritis. In keeping with the idea of a connection between the body and the mind, chronic pain can have an effect on other conditions a person may experience, such as any mood or anxiety disorders.

Specifically, chronic pain and depression often go hand in hand, with one condition worsening the other and making each more difficult to treat. Living in pain that never subsides, that limits daily activities, and decreases quality of life naturally leads a person to feel down. So, while depression hurts, pain can also lead to depression.

Symptoms of depression may include:

  • Ongoing fatigue
  • Difficultly sleeping
  • Trouble concentrating
  • Feeling sad or anxious for an extended period of time
  • Losing interest in activities or hobbies that were once enjoyable

The daily stress of living with chronic pain can also increase the likelihood that a person will develop depression. Migraine headache sufferers are particularly vulnerable to mood disorders. A study from the University of Toronto found that people experiencing migraines were twice as likely to experience depression.

Treatments sometimes result in depression

Sometimes the treatment for chronic pain can even lead to depression. In a study done by Saint Louis University Medical Center, researchers found that those patients who utilized high doses of opioids to manage chronic pain were more likely to experience depression.

Jeffrey Scherrer, Ph.D., associate professor for family and community medicine at Saint Louis University believes that the duration of the pain has as much to do with the development of depression as does the increased dose of opioids. He notes:

“…a strong potential explanation of our finding that increasing opioid dose increases risk of depression could be that the patients who increase dose were the longer using patients. This is logical as longer use is associated with tolerance and a need to increase opioids to achieve pain relief.”

Hospital stays can lead to depression

Other studies have found that one in three survivors of intensive care units is more likely to develop depression that is somatic, or physical, rather than psychological. This is a significant number of people developing depression, about three times the national average. Add in the complicating factor of post-traumatic stress disorder, and that number rises to four times the national average.

Dr. James Jackson, psychologist and assistant professor of medicine at Vanderbilt University Medical Center, identifies this as the important issue that it is and calls for prevention:

“Considering that each year, at least 5 million individuals are admitted to ICU in North America alone — more than are diagnosed with cancer — and about 80% survive, it’s a significant public health issue. We need to pay more attention to preventing and treating the physical rather than psychological symptoms of depression in ICU survivors. The physical symptoms of depression are often resistant to standard treatment with antidepressant drugs and we need to determine how best to enhance recovery with a new focus on physical and occupational rehabilitation.”

Somatic symptoms can include things like extreme fatigue, loss of appetite, weakness, and chronic pain. Researchers found that physical symptoms were less likely to be treated than psychological ones, perhaps due to the triage nature of mental health treatments in the U.S. Doctors are more likely to focus on serious psychological issues (e.g., self-harm) than they are “less serious” physical symptoms (e.g. pain or fatigue).

Why Does Depression Hurt? |

Diagnosing depression and pain

A 2011 report by the Institute of Medicine (IOM) indicated that approximately one-third of all people in the U.S. suffer from chronic pain annually at a cost of $600 billion dollars in treatments and lost productivity. The IOM also found that chronic pain was not managed effectively due to a shortage of pain specialists and an outdated class of prescription medicines. This mismanagement can quickly result in side effects in the mind.

Patients who experience chronic pain and depression find that one condition or the other is often missed in diagnosis. These two conditions present themselves similarly. Some symptoms of both include:

  • Irritability
  • Anger
  • Fatigue
  • Stress in the family
  • Abuse of alcohol, drugs, or prescription medicine
  • Anxiety
  • Poor sleep habits
  • Poor decision-making
  • Low self-esteem or self-worth

The doctor treating the chronic pain may not be able to distinguish depression from chronic pain. Similarly, a therapist working with a depressed patient may assume that the chronic pain is a result of the aches of depression: tense muscles and slumped posture that can lead to pain. Many depressed patients complain of pain, but the therapist may assume it is episodic (new to the depression) and not chronic (lasting longer than three months). This missed diagnosis makes it very difficult to effectively treat either condition.

Warning signs

Thankfully, new research on recognizing and treating both pain and depression as comorbid conditions (those that occur simultaneously) is ongoing. It is important to recognize warning signs of depression and intervene as soon as they are present. Those signs include:

  • Extreme fatigue: Just wanting to sleep or having poor energy
  • Low appetite: Nothing tastes or sounds tempting to eat
  • Change in sleep patterns: Insomnia or hypersomnia
  • Hopeless feelings: Nothing seems worthwhile
  • Pain: Recurrent, persistent pain

Some of these symptoms may happen after a traumatic event, but if they persist or worsen, talk to your doctor about treatment options.

Getting help 

So, why does depression hurt? Because depression and chronic pain are deeply connected. The body is not an isolated unit, and interacts with the mind. If you’re suffering from depression, it’s often common to also experience headaches, back pain, and stomach issues. Thankfully, if you get a diagnosis for both, you’re better able to treat both of them, at the same time.

Help for depression may include cognitive behavioral therapy and other lifestyle modifications. Also know that if you’re experiencing depression, there’s always help available. You can find free therapy options online or contact a crisis hotline at any time, 24/7.

Pain management is a complicated science, but working with a great pain management doctor is your first step. They’ll diagnose the cause of your pain and suggest treatment options that could work. These could range from lifestyle changes to more interventional approaches for severe pain.

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