When Pain Accompanies Depression

The two-way connection between depression and pain has been known since the days of Hippocrates. Gastrointestinal problems, headache, and other less specific aches and pains are common features of depression.  Conversely, depression frequently sets in when individuals are battling persistent pain. Studies have also documented that as an individual’s number of physical complaints increases, so does the likelihood that depression may occur.

Paying attention to pain

Pain can serve as an early indicator of many things – including depression.  When pain persists after depression is diagnosed and its emotional symptoms have been treated, it can also alert a healthcare provider that a patient is at risk for a recurrence of depression. In addition to pointing to the possible presence of depression, persistent pain can also signal another physical problem that needs further medical evaluation.

Because of the significant link between depression and physical pain, it’s important to identify and address pain while diagnosing and treating depression.  Ironically, pain can make it more difficult to diagnose depression.  In general, both patients and doctors may be more comfortable discussing physical symptoms than emotional concerns.  As a result, addressing physical ailments may take precedence over probing more deeply for the possibility that pain is signaling the presence of depression.

What is chronic pain?

Physical hurt is an unavoidable part of life. It is expected that irritability, agitation and stress will accompany pain. Normally, as pain subsides, so do these responses. But chronic pain is pain that lasts much longer than would be expected from a specific injury or physical problem. When pain becomes chronic, the body reacts in many ways. Decreased energy, muscle pain or weakness, and difficulty performing both physically and mentally can occur.  Chronic pain can bring about neurochemical changes in the body, which can increase sensitivity to pain and cause an individual to experience pain in parts of the body that do not normally hurt.

This type of pain can interfere with sleep, which can then lead to daytime fatigue and lowered productivity. Ongoing pain can also make it difficult to interact with other people, resulting in the impairment of social interactions, relationships, sexual activity and even the possible loss of jobs and income.  Life with chronic pain can be extremely challenging, leading to feelings of irritability and even hopelessness when it seems there is no relief in sight.  It’s no surprise that this type of pain is so frequently associated with depression.

Understanding the link between depression and pain

Depression and chronic pain share some of the same neurotransmitters – brain chemicals that act as messengers traveling between nerves – as well as some of the same nerve pathways, and depression and pain can interact in a vicious cycle.  Depression magnifies pain, changing the brain’s sensitivity to painful stimuli and reducing a person’s coping skills. And the constant stress of experiencing chronic pain can lead to a cascade of other medical problems linked with depression, making it still more difficult to break the cycle.

Breaking the cycle

Because chronic pain and depression are so intertwined, they are best treated together. The good news is that effective tools and lifestyle changes exist to both relieve the symptoms of depression and help manage chronic pain.

Specifically, medication is commonly employed to fight both depression and pain, since they share some of the same neurotransmitters. Antidepressants have also been shown to be effective in reducing an individual’s sensitivity to pain, as well as improving sleep and overall quality of life.  Psychotherapy and a number of different self-care strategies including relaxation techniques are also beneficial.

As discussed elsewhere on this website, each individual’s experience with depression is different, and each calls for a unique treatment plan. You and your healthcare provider must work together to develop the plan that’s right for you. If you are facing both depression and chronic pain, it is important that your treatment plan addresses every aspect of your life impacted by depression and/or pain. Visit Know your treatment options for information about the many tools you and your healthcare provider can consider, including medication and psychotherapy.  In addition, visit Take care of yourself for even more lifestyle tools and ideas you can incorporate into your plan, including exercise, stress management and healthy sleep and eating habits.