How Does Chronic Pain Impact Your Mental Health

Chronic pain is a disruptive health condition that can affect almost every aspect of a patient’s life including work, socializing and rest. Although the physical symptoms of this condition that may include severe pain, fatigue and diminished functionality may be the most apparent problems, it is important not to ignore the mental effects as well.

Some of the most prevalent secondary mental health components of long-term, chronic pain include

  • Anxiety
  • Guilt
  • Insomnia
  • Depression

Unfortunately, many of these mental health conditions can worsen chronic pain symptoms, which is why it is important to use a comprehensive pain management strategy that also treats mental health issues.

How Common Are Mental Health Issues among Chronic Pain Patients?

There have been many studies on chronic pain patients and mental health issues, and most find a very strong link between the conditions.  The studies found from 10 to 87 percent of chronic pain patients had depressive symptoms, while almost half of all male chronic pain patients and two-thirds of female chronic pain patients also exhibited anxiety.

Another kind of mental health issue that is more common among chronic pain sufferers is personality disorders. Only present among 4 to 6 percent of the general public, personality disorders are much more common among chronic pain patients.  Narcissistic PD is found among 2 to 28 percent of chronic pain patients; histrionic PD is found in from 6 to 23 percent of chronic pain patients; and obsessive-compulsive disorders are present in 7 to 16 percent of chronic pain patients.

Another manifestation of mental health problems is suicide which is much higher among chronic pain patients.  While the average rate of suicide in the United States is 12.6 per 100,000 person-years, among chronic pain patients, this rate rises to between 45 and 81 per 100,000 person-years. Thoughts of suicide occur in 28 to 48 percent of people with chronic pain.

Why Are Mental Health Problems So Common among Chronic Pain Patients?

There are many reasons why mental health and chronic pain conditions are so closely linked. First of all, many of the neural pathways used in processing chronic pain are also used for anxiety, depression and grief. Over a long period of time, the brain may conflate the two experiences, making it almost impossible to distinguish between them.

Secondly, chronic pain also has some profound behavioral and social effects that feed into mental health conditions. Long-term chronic pain produces social isolation that augments problems like depression and anxiety.  This isolation is caused by loss of enjoyment in many activities and changes in behavior. These behavioral changes can harm relationships, both social and professional. This deterioration of professional and social networks can damage mental and emotional health.

Finally, there are some serious psychological effects from sustained use of potent pain killers.  Drugs like opioids and benzodiazepines interfere with normal cognitive processes as well as pain impulse transmission. They can distort thinking, heighten depression and encourage isolation.

How to Treat Chronic Pain and Mental Illness

Due to the prevalence of chronic pain and mental illness in the U.S., we are developing a much fuller understanding of these conditions. In turn, we are learning how to implement a holistic approach to treatment of these intertwined issues.

If you are struggling with mental health issues as well as chronic pain, consider the following treatment options.

  • Take action—if your doctor doesn’t initiate a conversation about your emotional health while treating your pain condition, bring it up yourself. Studies show that patients who take charge of their treatment are more likely to find relief. 
  • Speak to a pain specialist—chronic pain may be very common, but not all physicians possess the expertise necessary to treat all aspects of the condition.  A pain expert is more likely to help with psychological components and recommend more effective therapies.
  • Seek counseling—many forms of psychotherapy have proven successful in managing chronic pain.  Biofeedback and cognitive training can limit the severity of secondary issues like stress and depression that make pain worse.
  • Antidepressants—many chronic pain patients respond positively to antidepressant drugs, especially tricyclics like Elavil and Pamelor.  It is believed that the shared pathways between pain and depression allows these medications to treat both conditions simultaneously.
  • Exercise—if you engage in regular exercise, you should see an improvement in your chronic pain and mental health conditions.  Physical exertion promotes production of endorphins, natural pain relievers and mood enhancers. It doesn’t need to be extremely arduous exercise to produce these effects.
  • Mind-body activities—many chronic pain sufferers benefit from techniques like mindful meditation or yoga that involve maintaining control of the body and mind. These techniques enable practitioners to move past fear of impending pain and eventually mitigate it. Long term practitioners claim that they can eliminate almost all of their pain symptoms.
  • Modify your lifestyle—if there are triggers for stress in your life, you may wish to eliminate them if possible.  If you cannot remove the source of the stress—which can make pain symptoms more intense—then use counseling to modify how you respond to it.

How to Get Started

Many of these treatment options can be implemented independently, but most will require some assistance from a health care professional.  The first step, of course, is to see your primary care physician who can refer you to a pain specialist and mental health professional.  You may want your primary care doctor to coordinate your team, or you may choose another specialist to take up that role.

With the help and guidance from your care team, you should try some techniques for managing chronic pain and boosting emotional health.  Not all of these methods may work, and many will not produce immediate results.  However, your care team should carefully monitor your progress and help you decide on which strategies to maintain.

Ultimately, however, your progress will depend on your choices. If you choose to isolate yourself and shut down your personal relationships, you may spiral into hopelessness. On the other hand, if you make small changes, you may be quickly rewarded.

Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care

M.D. Disclaimer: The views expressed in this article are the personal views of Robert Moghim, M.D. and do not necessarily represent and are not intended to represent the views of the company or its employees.  The information contained in this article does not constitute medical advice, nor does reading or accessing this information create a patient-provider relationship.  Comments that you post will be shared with all visitors to this page. The comment feature is not governed by HIPAA and you should not post any of your private health information.