Chronic Pain & Mental Health
Reviewed by Robert P. Bogenberger, Ph.D.
Living in pain creates a number of challenges, including the potential for mental health issues. Chronic pain and mental health disorders like depression, anxiety, and stress have a great deal of overlap. As many as 85% of chronic pain sufferers will experience significant depression. Treatment options and management of symptoms can improve the quality of life for those experiencing overlapping chronic pain and mental health issues.
What Is Chronic Pain?
Chronic pain is any pain that lasts for six months or longer. The pain can range from mild to severe. For some people, chronic pain is an everyday occurrence. Others may experience pain that comes and goes.
Chronic pain symptoms can include throbbing, stinging, dull aches, stiffness, soreness, and other feelings of pain. Individuals with chronic pain often experience other symptoms like trouble sleeping, weakness, and feeling fatigued in addition to the feelings of pain.
Chronic pain may last after the injury or illness that initiated the pain has healed. This is because pain signals in the central nervous system can remain active.
Pain vs. Chronic Pain
Pain is often a sign that something is going wrong in the body. This can be simple and acute, such as when you step on a hard object or your finger accidentally touches a hot surface. In other cases, medical issues can cause pain that lasts longer, but it resolves when the medical condition itself is resolved. A broken leg, for example, may cause pain for a while, but that pain generally goes away once the leg is healed.
Acute pain typically lasts less than six months and is caused by something specific. Acute pain also tends to go away once the cause of the pain is resolved. Chronic pain, in contrast, typically lasts for more than six months, and it may not go away even if the underlying condition is resolved. In other cases, chronic pain occurs from conditions where no cure or resolution is possible.
Is Chronic Pain a Disability?
Chronic pain can be considered a disability. Individuals may qualify for accommodations or assistance if their chronic pain is a symptom of an illness or condition and it interferes with their ability to work or perform required tasks. In addition, individuals who experience mental health challenges as a result of chronic pain may also qualify for assistance or accommodation.
Causes of Chronic Pain
The exact causes of chronic pain are unknown. Causes will differ depending on the type of pain and other factors. Some common risk factors for chronic pain include:
- Genetics: Not only will some individuals have a predisposition for conditions that cause chronic pain, but researchers have also found that genetics may play a role in how we experience and perceive pain1.
- Age: Some chronic pain results because of the aging process. Older individuals may experience chronic pain due to changes to joints, bones, and other parts of the body.
- Illness or injury: Experiencing an illness or an injury can increase a person’s risk of developing chronic pain.
- Obesity: Chronic pain and obesity often coexist2. Obesity can worsen conditions like arthritis or other joint issues, for example. Chronic pain can also lead to weight gain.
- Mental illness: Those with mental illness issues also have an increased risk for chronic pain.
Does Psychological Pain Physically Hurt?
A broken heart may not be caused by an illness or physical injury, but it can still cause pain. Emotional and mental distress, including grief, loneliness, depression, sadness, and rage, can all cause biological pain reactions3 that are similar to physical pain. Many of the neural pathways for pain perception also regulate mood and anxiety.
While physical and emotional pain are different, they both cause neurological changes that affect the body. Some of the common physical effects of psychological pain include:
- Muscle pain
Common Types of Chronic Pain
While chronic pain can happen for a variety of reasons, there are some conditions commonly associated with chronic pain, including:
- Complex regional pain syndrome
- Gastrointestinal diseases (IBD, IBS)
- Menstrual pain (including endometriosis)
- Back and neck pain
- Cancer-related pain
Mental Health and Chronic Pain
Chronic pain impacts many aspects of daily life. This includes not only physical health, but also mental health. This means that for many people, chronic pain overlaps with stress, anxiety, and depression.
Chronic Pain and Depression
The relationship between chronic pain and depression is a complex one. Living with chronic pain can be stressful, both physically and mentally. Heightened long-term stress can affect brain chemistry, which can increase the risk of mental health issues like depression.
In addition, many of the neural pathways that the brain uses to signal depression are similar to those used to signal chronic pain. Because of this, chronic pain is also a symptom of depression.
Some of the symptoms associated with depression include:
- Feelings of sadness or hopelessness
- Sleep disturbances
- Loss of interest in normal activities
- Anxiety and restlessness
- Lack of energy
- Physical issues, like headaches and back pain
- Thoughts of death or suicide
Anxiety and Pain
For individuals with an anxiety disorder, chronic pain like muscle aches, headaches, and soreness is a common symptom. While doctors and researchers are still trying to understand the connections between anxiety and pain, many people with anxiety disorders experience chronic pain and vice versa. Some individuals with chronic pain may worry about what they feel or are experiencing, which may increase their risk of developing an anxiety disorder.
Some of the symptoms associated with anxiety include:
- Feeling nervous or tense
- An increased heart rate
- Feeling a sense of impending doom or danger
- Breathing rapidly
- Having trouble controlling worry
- Feeling tired or weak
Stress and Chronic Pain
Chronic pain and stress also influence each other. Chronic pain can create chronic stress about not being able to do normal activities, financial stress if an individual is unable to work, and even stress and fear about movements that might heighten pain. Chronic stress, in turn, can also affect chronic pain. Stress can tense muscles and raise cortisol levels, which increase inflammation in the body.
Some of the symptoms of chronic stress include:
- A lack of energy
- Aches, tense muscles, and other pains
- Frequent colds or infections
- Chest pain or elevated heart rate
- Upset stomach and nausea
Chronic Pain and Addiction
Chronic pain can cause or exacerbate addiction and substance abuse. Some medications used to treat chronic pain, like opioids, are highly addictive. Sadly, many addictions begin with opioid treatment after an illness or injury. In some cases, individuals with chronic pain develop a tolerance for a particular medication and need higher doses to achieve the same results. This increases the risk of addiction.
In addition, medications like opioids increase dopamine, a neurotransmitter in the brain. Known as the “feel-good” neurotransmitter, dopamine is related to pleasure and influences mood. Certain painkillers can result in an addiction even if used to treat acute pain, but especially if used long-term for chronic pain.
Those suffering from chronic pain who cannot access prescription painkillers may self-medicate with other substances, such as alcohol or heroin.
The Opioid Epidemic
In the 1990s, there was an increase in the number of opioids prescribed to treat issues like moderate-to-severe pain following surgeries and injuries. Pharmaceutical companies told doctors that patients were unlikely to become addicted to the prescribed drugs.
However, this wasn’t the case. Not only did patients become increasingly addicted to opioid prescriptions, but there was also an increase in addictions to non-prescription opioids, including heroin.
Once patients became addicted, it was hard to stop using opioids. In addition, people using opioids on a long-term basis can experience a rising tolerance, which means they have to use a larger dose for the same effect. This increased misuse and abuse of these substances.
In 2019, more than 49,0004 individuals died from an opioid-related overdose in the United States. It’s estimated that over 10 million people misused an opioid prescription the same year.
Is It Safe to Use Medication to Treat Chronic Pain?
Some medications may help alleviate symptoms of chronic pain, but they should only be taken if prescribed by a doctor. When possible, doctors today often prescribe painkillers that are less addictive than opioids, such as medicinal cannabis. Increased monitoring procedures and processes are in place today to help ensure that high-intensity painkillers do not result in addiction. Speak with your doctor about whether medication of any sort is right for you.
Chronic Pain Treatment
Although chronic pain can have many negative effects for those experiencing it, it can often be managed with treatment and self-care activities. For those experiencing mental health issues associated with chronic pain, seeking out a qualified therapist is important.
Can Chronic Pain Be Cured?
While chronic pain is often something that cannot be cured or reversed, it can be managed. Chronic pain treatments and other management strategies can reduce the amount of pain and create a better quality of life for those experiencing chronic pain.
Ongoing research and effects to find better treatments for chronic pain will continue to lead to better treatments and outcomes.
Chronic Pain Management
Currently, there are a number of effective treatments for those experiencing both mental health issues and chronic pain. These include:
- Cognitive behavioral therapy (CBT)
- Mindfulness-based stress reduction (MBSR)
- Somatic therapy
- Biofeedback therapy
- Emotional freedom technique (tapping)
In addition to therapy, medications, and other professional treatments, there are self-care activities that can also help chronic pain management. These include:
If you are experiencing any mental health issues, like stress, depression, or anxiety, due to chronic pain, reach out to a therapist today to find help.
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