Chronic Pain and Depression

Depression plays a significant role in chronic pain, particularly where sleep deprivation is present.  For some people, the stress and depression resulting from chronic pain can become consuming, and have the potential to significantly worsen and prolong the pain. Increased pain can, in turn, lead to increased stress and depression, creating a cycle of depression and pain that can be difficult to break.

In any type of chronic back or neck pain, it is essential to be aware of the potential development of depression, as depression can prolong and/or worsen the pain.  Often, clinicians will refer to a patient’s “suffering” which is the pain plus its emotional component (e.g. depression). As such, one can have a great deal of chronic pain with little suffering or minimal pain with great depression.

Steps to Address Depression

Following are several steps to help prevent or manage both the chronic pain and associated depression that may develop:

Early diagnosis of depression associated with pain.
Many physicians are not necessarily trained to assess for depression during the course of treating pain.  An informed physician can suggest a treatment plan early on that treats the patient’s depression as well as their physical pain, giving the patient the best chance at a positive outcome. It is advisable to talk to a doctor if any of the following common symptoms of depression are experienced:

  • A sad or anxious mood
  • Difficulty with falling asleep and/or staying asleep
  • Feeling of hopeless or lack of interest in previously enjoyable activities
  • An increase or decrease in appetite
  • Low energy or a lack of motivation over a period

Similarly, people should talk with their doctors if they believe they exhibit symptoms characteristic of stress-related back pain, which are similar to those of fibromyalgia:

  • Back pain and/or neck pain
  • Diffuse muscle aches
  • Muscle tender points
  • Sleep disturbance and fatigue

In many stress-related back pain cases, patients complain of the pain "moving around" or becoming noticeably worse either just before, during, or just after a stressful event or experience. 
Chronic pain can also be exacerbated by things such as physical de-conditioning due to lack of exercise and a person’s thoughts about the pain. An appropriate exercise program and meditation and other cognitive techniques, are all effective coping techniques that can help prevent the pain from worsening.

Identifying stress triggers or emotional triggers that affect the pain is the first step in helping manage pain—at least in part—by avoiding or eliminating specific stress triggers. For example: 

  • A person does not plan ahead for appointments causing s/he to be habitually late due to traffic and other unforeseen problems. This type of  situational “stress” may result in increased pain.
  • A couple develops a pattern of bringing up, and discussing, stressful issues just before bed. The individual with chronic pain gets “stressed,” sleep poorly, and wakes up in increased pain. A simply behavioural prescription of prohibiting these types of discussion in the evening (e.g. the finances), could help avoid this trigger.

Patients can monitor how their own stress and anxiety affects their back pain by keeping a diary of when their back pain changes and what kinds of stress could be triggering the pain. This exercise can provide and identification of the elements in one's life that affects the pain.

Depression and an emotional reaction to chronic pain are to be expected; they are understandable. 
Many patients do not speak to their clinicians about their depression because they believe that once the initial pain problem is resolved, the depression, anxiety, and stress they are feeling will go away. However, secondary losses from a chronic pain problem, such as the loss of the ability to do favourite activities, disrupted family relationships, financial stress, or the loss of a job, can continue to contribute to feelings of hopelessness and depression even beyond the resolution of the pain problem.  Getting simultaneous back pain and depression treatment will give the patient a better chance of a full recovery.

In addition, it's important to note that some common treatments for pain (e.g. opioid pain medication, activity restriction, bed rest), can actually make depression worse. This worsening depression can then affect the physical presentation of the pain. If both physical and mental well-being are being monitored closely by medical experts, treatment and medication recommendations, including antidepressants, can be made that take both the physical pain and the emotional health of the patient into account.