4 tips for coping with chronic pain and depression

On their own, chronic pain and depression can each have devastating effects. And both are more common than you might think. 

Approximately 1 in 5 Canadians — or 8 million people — experience chronic pain. This condition also has an economic cost of as much as $40 billion per year. 

Similarly, almost 1 in 8 Canadians (11.3% of respondents) in a 2021 mental health survey were found to meet the criteria for depression. 

Given how common these two health conditions are, it’s no surprise that there would be some overlap between the two. However, the relationship between chronic pain and depression runs deeper than you might think and can have devastating consequences when left untreated. 

In this article, we explore the following topics: 

1. What is chronic pain? 
2. What can cause chronic pain? 
3. The connection between chronic pain and depression
4. What happens when you have chronic pain and depression?
5. Why are chronic pain and depression so closely linked? 
6. 4 ways to cope with chronic pain and depression

What is chronic pain?

According to an article published in the National Library of Medicine, “chronic pain is usually defined as any persistent or intermittent pain that lasts for more than 3 months.” This includes different categories of pain, such as neuropathic pain (involving the nervous system) and nociceptive pain (resulting from damage to non-neural tissue). 

WebMD further explains that chronic pain generally lasts much longer than what would be expected based on the original injury or issue. Additionally, chronic pain can lead to concerns such as

• High stress hormone levels
• Low energy
• Muscle pain
• Decreased mental and physical performance
• The development of mood disorders
• Sleep disruption
• Irritability, anxiety, and agitation

Chronic pain is a major public health problem throughout North America and Europe, with approximately 20% of the adult population experiencing this condition. 

What can cause chronic pain?

The Cleveland Clinic explains that chronic pain can be caused by a variety of factors. 

Sometimes, there is an obvious cause to chronic pain, such as arthritis, cancer, or another disease. In these cases, the chronic pain might be expected or could have been reasonably anticipated. 

But even chronic pain that has a clear original cause can be unexpected. For example, some people experience chronic pain from an injury (such as a sprain or broken bone) or illness even after the original issue has healed. 

On the other hand, chronic pain sometimes appears without a clear cause such as an injury or physical illness. This type of pain can be related to stress, anxiety, and depression. 

It’s also important to remember that pain can have multiple causes — some people may experience chronic pain tied to multiple origins or may experience multiple types of pain at once.  

The link between chronic pain and depression

With the help of modern science, researchers have confirmed that pain and depression are closely related: depression can cause and magnify pain, and vice versa. 

As the Mayo Clinic reports, these two conditions can even combine to form a “vicious cycle in which pain worsens symptoms of depression, and then the resulting depression worsens feelings of pain.”

But why is this so? 

It has been found that depression can cause physical symptoms such as back pain and headaches. On the other hand, chronic pain can lead to difficulty sleeping and increased stress levels, which can both lead to depression. 

Pain that causes disability can also impact people’s self-esteem, hinder their ability to earn a sufficient income, and prevent their participation in social activities, all of which can contribute to depression. In fact, it has been found that chronic pain sufferers with limited independence are more likely to become depressed. 

Because of this unpleasant cyclical relationship between the two conditions, it has been found that as much as 85% of chronic pain patients also suffer from severe depression, while approximately 65% of people suffering from depression complain of pain. 

Because depression in people with chronic pain frequently goes undiagnosed, it often goes untreated. Pain symptoms and complaints take center stage on most doctor visits. The result is depression — and sleep disturbances, loss of appetite, lack of energy, and decreased physical activity, which may make pain much worse.

What happens when you have chronic pain and depression?

According to WebMD, the issues that those with both chronic pain and depression might face include: 

• An alteration in mood
• Work and employment issues
• Anger issues
• Prolonged anxiety
• Weight management problems
• Confusion
• Low self-esteem
• Sleep issues and fatigue
• Financial and legal problems
• Irritability and agitation 
• Decreased sexual performance 
• Social isolation

Unfortunately, it has been reported that “patients suffering from chronic pain-induced depression exhibit a poorer prognosis than those with chronic pain only.” 

Why are chronic pain and depression so closely linked?

While researchers once thought that the cyclical relationship between chronic pain and depression was due to psychological factors, advancements in science have revealed that pain and depression actually share biological mechanisms. 

This is because these two conditions usually involve the same anatomical structures. As it happens, the same parts of the brain (the part that interprets physical sensations and the part that regulates emotions and stress responses) are involved in generating both depression and the experience of pain. 

Additionally, the same neurotransmitters (serotonin and norepinephrine) that contribute to pain signaling are involved in depression. 

So, along with chronic pain contributing to depression by impacting people’s sleep, mood, and daily functioning, there is actually an underlying shared mechanism between the two conditions. 

4 ways to cope with chronic pain and depression

While these conditions can be debilitating — both on their own and together — there are many treatment options available to those living with chronic pain and depression. 

While we discuss multiple individual treatments in this section, it is important to remember that the most effective treatment plans will usually combine multiple elements and approaches, taking a holistic approach to the management of your health and well-being. 

1. Antidepressant medications

Some people who struggle with both chronic pain and depression find that antidepressants help to improve both sets of symptoms. 

This is because these two conditions sometimes involve the same nerves and neurotransmitters, and some types of antidepressants are also known to reduce the perception of pain. 

2. Stress-reduction techniques

Turning to stress-reduction techniques such as meditation, mindfulness, hypnosis, journaling, and relaxation training can help improve the symptoms of pain, depression, and anxiety. 

An aggravated stress response can exacerbate the symptoms of both pain and depression, so it is important to engage in relaxation training that calms the nerves. For example, you might want to consider yoga, mindfulness practices, and progressive muscle relaxation. 

3. Exercise and physical therapy

Many people with chronic pain avoid exercise. This is often due to concerns about mobility, discomfort, or the possibility of injury. However, when you avoid exercise, you actually increase the risk of injury and increased pain. 

The reality is that ample evidence confirms that consistently engaging in physical activity can boost your mood and alleviate anxiety. 

Now, evidence is also starting to emerge that suggests that exercise — especially aerobic exercise — can alleviate pain and improve well-being in chronic pain-related conditions such as fibromyalgia. Some evidence also suggests that muscle-building exercise may also improve pain, mood, and general functioning. 

By working with your doctor and movement specialists — such as the team at Symmetry Motions, a Toronto-based physical therapy and movement longevity clinic — you can find a way of excercising that feels right for your body and works with your unique schedule and abilities. 

4. Talk therapy

One of the most effective ways to cope with chronic pain and depression is to engage in talk therapy with a trained psychotherapist, social worker, or counselor. 

Psychotherapy can be easily paired with other approaches to treatment, such as exercise and relaxation techniques, and there are different types of psychotherapies that can be helpful in treating pain and depression or anxiety. 

For example, cognitive behavioral therapy (CBT) is one of the most common and effective approaches to treating chronic pain, anxiety, and depression. CBT acknowledges that our feelings, thoughts, and bodily sensations are all connected. Based on this, therapists help patients learn to cope with their pain and difficult feelings instead of feeling victimized by it. 

For example, you might have negative thoughts regarding your pain that seem to automatically pop up and make you feel worse. However, these ways of thinking aren’t usually accurate representations of reality. An experienced therapist can help you change these patterns of thinking and gain a sense of control over your circumstances.

Summary

Chronic pain and depression are common conditions that frequently occur together. While they can be debilitating and difficult to manage, there are ways of coping with their symptoms that can improve the quality of your life. 

At Blue Rabbit Therapy, our team of registered psychotherapists and social workers are here to help you cope with your chronic pain and depression one step at a time. We work with you to create a custom treatment plan that suits your unique goals.