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While most people think of depression solely as a mental health issue, the truth is that this illness can have a significant impact on an individual’s physical wellbeing. In fact, according to the World Health Organization, about three in four people with depression complain of pain-related symptoms such as headache, stomachache, and back or neck pain. In some cases, chronic pain and depression create a cycle that exacerbates both conditions, significantly impacting the individual’s quality of life.
Pain as a Symptom of Depression
Depression is a serious mental health disorder that can take a significant toll on the individual’s relationships, performance at work or school, and general quality of life. While symptoms such as a loss of interest in recreational activities and feelings of sadness or hopelessness are classic trademarks of this condition, depression often comes with physical symptoms, including pain.
Muscle Tension
Chronic muscle tension is common among people living with depression and often leads to pain. Tension is a natural response to stress, and in normal cases, muscles relax once the stressful situation resolves. Unfortunately, for someone living with depression, this muscle tension can be chronic. When muscles are always tight or strained, sensitive areas in the muscles can form and cause persistent pain. Tight muscles can also trigger headaches and persistent pain in the individual’s joints.
Chemical Imbalances
Depression is linked to dopamine and norepinephrine imbalances. These two chemicals play a significant role in helping the body regulate pain perception. With normal function, these chemicals can modulate the body’s level of sensitivity to discomfort. However, when levels are low, the body may become more sensitive to stimuli, amplifying painful sensations.
Sleep Issues
Many people living with depression have trouble falling asleep and staying asleep, resulting in periods of daytime sleepiness. Poor sleep quality can significantly lower the individual’s pain threshold, making them associate more sensations with pain and feel pain more intensely.
Inflammation
While inflammation gets a bad rap, the truth is that the body’s inflammatory response plays a key role in helping to fight off infections. However, chronic inflammation can cause chest pain, abdominal pain, joint pain, and stiffness. According to research, depression can cause a chronic inflammatory response, making the individual more likely to experience related pain and discomfort.
Reduced Pain Tolerance
A recent study suggests that those living with depression have a lower pain tolerance. While research is still exploring the relationship between depression and pain, depression was a consistent predictor of how an individual perceived and handled pain.
The Impact of Chronic Pain
While depression can cause physical pain, the reverse can also be true, resulting in a complex cyclical relationship that requires professional intervention. For those living with chronic pain, everyday activities such as personal care, working a job, and socializing with friends and family can become very difficult and impact the overall quality of life. When that pain isn’t effectively managed, it can trigger feelings of sadness or anger, which can eventually develop into depression.
Depression, in turn, can amplify the individual’s perception of pain, further causing isolation and distress. Lowered pain thresholds, sleep disruptions and a heightened sensitivity to pain may make day-to-day activities and emotions even more difficult to cope with, furthering the depression/pain cycle.
Not everyone living with chronic depression develops depression, and depression doesn’t always result in chronic pain. Even so, there’s a significant amount of overlap between these two conditions, making it important to treat both of them simultaneously. Working with a mental health care professional who specializes in treating chronic pain alongside depression is key to improving quality of life.
Biological Mechanisms
Although we typically assume physical pain has a physical cause, this isn’t always the case. There is a range of underlying biological mechanisms that link depression and pain and result in that cyclical relationship, including dysregulation in certain neurotransmitters and the regions of the brain that are involved in depression and pain perception.
Neurotransmitters
Research suggests that pain and depression share a neurological pathway, so it’s not surprising when these two conditions go hand-in-hand. Dopamine and norepinephrine play important roles in regulating the individual’s mood and impacting how they perceive discomfort. An imbalance in these chemicals, which is common with depression, can cause the individual to feel physical pain.
Shared Regions of the Brain
Several regions of the brain, including the amygdala, hippocampus, thalamus, anterior cingulate, prefrontal cortex, and insular cortex, are associated with the processing of both pain and depression. In general, these areas of the brain affect how an individual behaves, how they store memories and how they perceive the world around them. When these regions aren’t functioning normally, pain sensitivity and changes in mood can result.
Psychological Factors
Chronic pain can have a significant impact on an individual’s quality of life and contribute to their likelihood of developing depression.
A Negative Outlook on Life
When pain isn’t effectively managed, the individual can begin to have an increasingly negative outlook on themselves, their future and the world in general. The more they dwell on the pain, the more likely they are to experience feelings of negativity, isolation, and hopelessness. Not only does chronic pain impact their ability to function as they need to at home and work, but it can create a sense of powerlessness and frustration. Unsurprisingly, this can lead to depression when left unchecked.
Ineffective Coping Strategies
Depending on how an individual copes with their symptoms, chronic pain can create a lonely experience. For those who participate in enjoyable activities they can do with little discomfort, seek social support, and find relaxation techniques that work for them, the risk of depression is lower. However, for those with unhealthy coping strategies such as relying on drugs or alcohol to manage pain or staying isolated from friends and family, the risk of depression is significant.
Pre-Existing Vulnerabilities
Finally, there are some cases in which an individual living with chronic is more likely to develop depression due to pre-existing vulnerabilities. If they or a family member has a history of major depression, they have certain personality characteristics such as perfectionism and unhealthy levels of risk avoidance, or they have a history of trauma, they may be more predisposed to depression.
Treatment Approaches
Chronic pain can be a significant challenge to resolve, especially when over-the-counter medications are inadequate and prescription options aren’t feasible long-term. Fortunately, there are several treatment options that can help to improve an individual’s quality of life.
Neurological rehabilitation has gained significant popularity in recent years as a drug-free way to help people recover from injuries, illnesses and conditions that affect the nervous system. For example, evidence-based techniques such as biofeedback can give the individual greater control over their body’s responses to stress. This can help to train them to relax certain muscles and greatly reduce the level of pain they experience. Neurostimulation therapy, which disrupts pain signals from the brain, is another innovative technique that provides relief for many people.
Neurological rehabilitation is also an effective strategy for managing symptoms of depression. It increases blood flow to certain areas of the brain connected to depression and can teach the brain to stay relaxed even during stressful situations, such as pain flare-ups.
In most cases, these treatment options are incorporated into a holistic approach that includes talk therapy, physical therapy, nutritional counseling, and medication.
The cycle of chronic pain and depression can be difficult to break out of. At FHE, we have a team of health care providers who specialize in treating co-occurring conditions and can help you find the strategies you need to break the cycle. To learn more about our programs for addressing chronic pain and depression, contact us today.
