Chronic Pain & Depression
Chronic pain causes emotional distress. Sufferers of chronic pain have increased rates of clinical depression. Learn about common ways that chronic pain disrupts mood regulation and provides emotional challenges. And, learn about the common features of depression as well as how to get support to help you cope.
If you suffer from chronic pain, it is no news that it leads to sadness, frustration, and anger. It can lead to hopelessness and dispair. These challenging emotions are present in the time of shock of an unwanted diagnosis or, with some patients, during the long phase of searching for a valid diagnosis and effective treatment. But, they don’t end there. For many people, challenging emotions are ongoing and can develop into a depressive episode.
I’m offering this article because many of my patients have benefitted from surveying the range of ways that chronic pain contributes to psychological challenges. This open appraisal can help you attend to parts of your life where you need to address your needs and bolster your supports. Without careful attention, unaddressed needs can turn into new problems.
Multiple Pathways To Depression
Coping with chronic pain is challenging due to the complex ways that it can impact a person’s life. It disrupts core elements of our lives which normally function to keep us less stressed and free from depression. Here are some of the ways that it can increase the risk of depression:
Chronic pain reduces sleep quality
Chronic pain interferes with good sleep. Chronic sleep deprivation causes people to be more irritable and emotionally labile, have less physical and mental energy, and have more difficulty concentrating and responding to complex stressors including interpersonal stress.
Chronic pain impairs social support
Quality time with friends and family members is often limited for sufferers of chronic pain. Many opportunities for supportive social interactions are limited by physical limitations. These limitations can erode social support which is essential for optimal coping and preventing depression.
Chronic pain disrupts partner and family relationships
Chronic pain can make you irritable and can compound whatever interpersonal stress you have in your close relationships. Partner and family relationships are always challenging in many ways. Having chronic pain tends to complicate them. This new aspect of interpersonal stress can increase overall misery and erode the support you need from those with whom you are most closely connected. Because this affects those closest to you, the stress in those relationships is frequent, or ongoing, and can contribute quite a lot to your overall stress load.
Chronic pain is not sexy
Chronic pain reduces sexual enjoyment which reduces your personal pleasure and erodes intimacy. To the extent that a positive sexual connection has been counterbalancing of your life stress, you lose that when sexual activity is limited or stopped. Couples often report that when the quality of shared sex decreases, so does satisfaction in the relationship and the ability to resolve conflicts goes down.
Chronic pain interferes with physical exercise
Physical exercise has been shown to be protective against, and curative of, depression. We need our bodies to not be too sedentary for our minds to be more fluid and work through challenging experiences. Less physical exercise reduces this psychological fluidity which could make us become stuck in a negative mood or be in a more brittle state prone to mentally not coping well with a stress trigger. Lack of exercise can also compound chronic sleep issues.
Chronic pain interferes with hobbies, volunteerism, and meaningful activities
Studies have shown that being involved in meaningful activities in life is protective against having clinical anxiety and depression. Chronic health conditions can limit your ability to participate in these types of activities. While these limitations are often directly frustrating, they also erode our sense of meaning and ability to pursue our purpose in life. We lose that protective effect of engagement in deeper, and more meaningful, parts of life.
Chronic pain threatens your sense of agency
Part of how we cope with various challenges in life is having a sense of power to act in ways that produce desirable outcomes. When chronic health conditions repeatedly make us feel not in control of things which are so consequential, it can reduce our overall sense of agency in our lives. This helplessness can pervade our lives and contribute to a general sense of loss of control and hopelessness.
Chronic pain increases challenging emotions
It is normal to feel sadness, frustration, anger, and other challenging emotions in response to suffering chronic pain. And, the common result of living with chronic pain is that the relative amount of challenging (compared to neutral and rewarding) emotions increases. As that percentage increases and continues, the risk for depression increases.
Chronic pain medications sometimes cause fogginess or cognitive blunting
Many people experience cognitive effects from pain medications which can reduce enjoyment of activities. You might feel dull or have short-term memory issues. Again, limited range of opportunities effects social support and overall enjoyment.
Chronic health conditions often cause financial stress
Unfortunately, evaluation and treatment is often expensive and out-of-pocket expenses related to care and accomodations can cause financial burden and debt. Unpaid medical bills is in the top two reasons people file for bankruptcy in the United States. Financial stress increases your personal stress and can complicate your close relationships. It is demoralizing to endure especially when you think about how unfair our medical system is. Ongoing financial stress contributes to an increased risk of depression.
Chronic pain reduces fun and enjoyment
It’s challenging to enjoy an activity when there is a significant level of concurrent pain. When pain spoils experiences or people reduce enjoyable activities, the result is less overall enjoyment in life. When there is less overall enjoyment to balance out the challenging parts of life, we are more likely to get depressed. A common feature of depression is anhedonia which is the reduction of the ability to derive enjoyment from an activity that was previously enjoyable.
Chronic pain causes complex grief
All of the issues discussed in this article are challenging and require adjustments. Chronic pain also can cause a crisis of coping with a changed life and sense of self due to ongoing misery and limitations of activities and possibilities. Grief is the psychological process of adjustment to major life changes or losses. You can read more about that here.
Chronic pain causes anxiety and emotional dysregulation
The sustained elevated stress response from chronic pain has a negative impact on parts of the brain involved with memory, emotional regulation, perception of pain, and feeling anxious. This is part of the reason that researchers believe that chronic pain causes dysregulation of how the brain copes with, and responds to, stress. The brain changes caused by chronic pain seem to increase negative emotions and feelings of anxiety.
Understand Clinical Depression
Sometimes we might describe our emotional state at one moment in time as feeling depressed. However, clinical depression is an enduring collection of depressive features that last more than two weeks. In addition to a chronic sad mood or change in functioning to how you were before the onset of symptoms, clinical depression can include:
loss of interest or pleasure in activities once enjoyed
changes in appetite with weight loss or gain separate from dieting
trouble sleeping or sleeping too much
fatigue or loss of energy
feeling worthless or full of guilt
restlessness or slowed physical movements
thoughts of wanting to die or suicide
See this article by the American Psychiatric Association for further discussion and how to differentiate depression from grief.
If you think you are becoming depressed, it’s important to seek competent evaluation and treatment. Depressive episodes sometimes resolve spontaneously. However, when depression has been precipitated by a chronic health condition that persists, it may take specific treatment to prevent it from worsening and to resolve the episode.
If you are feeling suicidal or need immediate support, call 988 or 911 or go to the nearest emergency department.
What You Can Do
Talk with your doctor
Your primary care doctor can write a script for an antidepressant. However, some patients being treated for chronic pain get more competent care from their neurologist for two reasons: First, some antidepressant medications are also used by doctors to treat some types of pain. Therefore, you might get double benefit from those mediciations. Second, any new medication must be considered in the context of what you are already taking. So, your pain doctor might be well-suited to evaluate that. Or, you might need to talk with a psychiatrist to get the best medication for your psychiatric needs while having it fit well with your existing medications.
Find a therapist
If you are having anxiety or mood issues that are troubling or debilitating, I suggest that you work with a Mindfulness-Based Cognitive Therapist to address those issues. If you’re looking for a competent professional, you can call the customer service number on the back of your insurance card, look up local mental health providers, or do a search for your area on a listing service like Psychology Today.
Explore wellness practices that help with chronic stress
There are many wellness practices that help with chronic stress. Mindfulness Practices, Concrete Thinking and The Body Scan are three types of practices that can have a very beneficial impact on chronic stress. Mindfulness has been shown in multiple studies to have a beneficial effect on chronic pain with research showing an improvement in subjective pain from 20 to 40 percent! You can learn, and be guided through, these powerful techniques in my 7-day online course for coping with pain. Check there out HERE.
Prioritize social support
Social support is essential for coping with stress, especially chronic health conditions. As we explored above, social support can become thin due to the challenges of coping with limitations. However, I encourage you to do what you can to connect in meaningful and healthy ways with others as much as is feasible. Even if you can’t easily engage in social activities in the range of ways you did before suffering from chronic pain, explore what you can do to connect with others.
Prioritize self care
You are the expert on you. Coping with chronic pain will include crafting an ever-evolving wellness plan to address your mental, emotional, physical, social, and spiritual needs. See my PIESS video for an explanation of a holistic way of checking in with yourself. If you have trouble finding ways to take care of yourself, that’s another reason to talk with a therapist. We help with that kind of thing.
Jon
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