Mental Health and Chronic Pain

Pain is an unpleasant aspect of existence, but it is a necessary one. Pain alerts us to damage being done to our bodies and prevents us from continuing an activity that is harmful. For most people, pain is an acute experience lasting less than three to six months, but for some people the pain is ongoing or chronic.

For chronic pain sufferers, there are many physiological consequences of the continuous or intermittent pain. Most notably, there are some profound and detrimental changes that can occur in the brain which is why people with chronic pain are four times as likely to seek treatment for depression or anxiety.

How Chronic Pain Alters Your Brain

It is truly tragic how pain and the fear of impending pain can destroy a life. From a scientific perspective, there are some serious physiological changes that occur for chronic pain patients. Pain is a trigger for stress which causes the body to produce a chemical cortisol. In turn, cortisol amps up production of the neurotransmitter glutamate.

Glutamate is found throughout the brain and plays a necessary role in signal transmission between nerve cells. However, if too much glutamate is present, then neurons may become overexcited and if sustained for too long a period, may kill the receptor nerve cell. Among the many physiological changes that accompany higher glutamate levels are headaches, higher blood pressure, and obesity. Glutamate has also been linked to depression, obsessive-compulsive disorder, autism, and schizophrenia.

Link between Chronic Pain and Mental Illness

There is almost no doubt in the medical community that ongoing pain strongly contributes to the onset and progression of mental illnesses like anxiety disorders, panic attacks and depression. One study found that in fibromyalgia patients, there was a 62 percent likelihood of developing depression and 56 percent chance of developing anxiety. Among the general public, there is 7 percent prevalence of depression and 18 percent prevalence of anxiety.

Many people assume that these mental health disorders result from psychological mechanisms rather than changes to the brain, but there is mounting evidence that both play a role. Chronic pain does produce isolation which can accelerate mental health decline. It is only natural to become depressed that a lingering health condition is not resolving on its own, and the constant threat of another pain episode is almost certain to produce anxiety.

Other factors also play an important role in mental health issues. Chronic pain often causes sleep quality to decline; many sufferers have difficulty falling asleep and remaining asleep. Pain may also interfere with the restfulness of sleep in general. Any decline in sleep quality can produce feelings of depression and anxiety as well as worsen pain symptom severity.

Finally, there is the cyclical nature of chronic pain. Because many of the neurological pathways of pain, anxiety, and depression overlap, they reinforce one another. In other words, chronic pain can cause mental health issues, which, in turn, can worsen pain symptoms.

Ways to Manage Your Mental Health

It is a full-time job managing your chronic pain, so it may be daunting at first to also tackle any mental health problems. It is easy to assume that if you resolve your pain issues, then any anxiety and depression will disappear on their own. First, you need to accept the possibility that your pain may remain an ongoing issue.

Secondly, even if your pain is gone, your mental health may still not recover without treatment. Especially if you have struggled with anxiety and depression for a long period of time, you may need counseling or medications to properly treat them. You may also want to consider the following:

  • Talk to your doctor—the first step in getting better is talking about your mental health with a medical professional. Your doctor may suggest talking to a psychiatrist or a counselor. Be open and honest about your feelings and symptoms; after all, your physician only has your word to base their advice on.
  • Medications—one of the first options you should consider is taking antidepressants like Prozac which can greatly alleviate symptoms of anxiety and depression. In fact, some pain conditions like diabetic neuropathy may even respond to certain tricyclic antidepressants. Furthermore, your doctor may also recommend opioid medications to help manage your underlying pain condition if it isn’t responding to other pain therapies.
  • Improve your sleep—sleep is one of the most fundamental aspects of your health. Not only does it play a critical role in healing, but it also helps maintain normal cognitive function. If your pain symptoms are interfering with your sleep, then you should discuss this issue with your physician as soon as possible.
  • Remove stress—one of the greatest factors in mental health decline is the presence of stress which has detrimental effects on the mind and body. You may need to work with a psychologist to identify key stressors in your life, modify how you respond to stress triggers, or act to remove them from your life. You may need to use techniques like biofeedback to recognize rising stress levels and modulate your psychological and physiological responses.
  • Mind-body techniques—your pain doctor may recommend that you take up yoga or mindful meditation to help you with your pain and mental health issues. These techniques can help you accept and control your pain symptoms, thereby removing that feeling of helplessness and despair that is often at the root of many pain-related mental health conditions.
  • Build a social network—it is very unhealthy to isolate yourself, but many chronic pain sufferers do so out of fear that the pain could strike at any moment or reluctance to burden others with their problems. Instead, make a concerted effort to nurture relationships with friends and family members so that you can feel free to discuss your physical and emotional needs. If you don’t have anyone like this currently in your life, then consider joining a support group for chronic pain sufferers where you can find people in similar situations.

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.