At some point in our lives, we all experience pain—physical and/or emotional discomfort caused by illness, injury, or a disturbing event. Although most of us would rather avoid it, pain does have a practical benefit in that it is good and is seen as "protective". For example, when you feel pain, your brain signals you to stop doing whatever is causing the pain to prevent further damage to your body.
However, pain is not meant to last long. Pain that usually lasts less than 3 to 6 months is called acute pain, and it is the form of pain that most of us experience. For some people, the pain may persist, or it may go away and come back again, lasting longer than the usual 3 to 6 months and having a negative impact on a person's health. This is called chronic pain or persistent pain. Simply put, chronic or persistent pain is pain that should not last.
Chronic pain is often associated with other health conditions such as anxiety and depression, resulting in lower health-related quality of life.
Living with pain every day can be physically and emotionally stressful. Chronic stress is known to alter levels of stress hormones and neurochemicals within the brain and nervous system. These can affect your mood, thinking, and behavior. Disrupting the balance of these chemicals in the body may cause depression in some people.
The chronic pain associated with these conditions can interfere with your daily life in many ways. It affects your ability at home and work. You may find it difficult to participate in social activities and hobbies, which may lead to lower self-esteem. Sleep disturbances, fatigue, difficulty concentrating, decreased appetite, and mood changes are also common for people with chronic pain. These negative changes in lifestyle can increase your pain and lower your overall mood; the frustration of dealing with the problem can lead to depression and anxiety.
Prevalence of mental health conditions among patients with chronic pain
Chronic pain is one of the most common reasons adults seek medical care and is associated with activity limitations, dependence on opioids, anxiety and depression, and reduced quality of life.
Studies show that people with chronic pain are four times more likely to suffer from depression or anxiety than people without pain.
In 2016, approximately 20% of U.S. adults (approximately 50 million people) lived with chronic pain, and 8% of U.S. adults (approximately 20 million people) lived with severe chronic pain.
High-intensity chronic pain is pain that lasts three months or longer and is associated with at least one major activity limitation, such as being unable to go out to work, go to school, or do household chores. Compared with those with chronic pain who do not have these activity limitations, these individuals report more severe pain, more mental health problems and cognitive impairment, more difficulty caring for themselves, and higher rates of health care utilization.
Common chronic pain and its relationship to mental health
Arthritis: Arthritis is inflammation of one or more joints that can cause disabling pain. There are more than 100 different forms of arthritis. The most common types include:
- Osteoarthritis (OA): The protective cartilage within the joint breaks down, making movement more difficult and painful - Over time, the bones of the joint may rub directly together, causing severe pain.
- Rheumatoid Arthritis (RA): Joints and organs are attacked by the body’s own immune system; ongoing inflammation can destroy joints and cause permanent damage.
- Psoriatic arthritis (PsA): The immune system attacks the body, causing inflammation and pain; joints, connective tissue, and skin are all affected by psoriatic arthritis.
Osteoarthritis is the most common type of arthritis and typically affects the hands, knees, hips, and spine. However, osteoarthritis can affect any joint and lead to joint deformity and chronic disability.
People with arthritis have higher rates of certain mood and anxiety disorders than people without arthritis.
Osteoarthritis may reduce a person's ability to complete daily activities due to pain, limited movement, and joint damage, sometimes preventing people from participating in social activities. Feeling depressed about not being able to meet life's demands, and feeling isolated about being unable to participate in social activities, can lead to the development of mental health conditions such as depression, which can occur at any age.
Fibromyalgia: Fibromyalgia (FM) is a chronic, multi-symptomatic disease in which the brain and spinal cord process pain signals in different ways. If you have FM, touches or movements that don't cause pain to other people may hurt you, or things that may be slightly painful to someone without FM may feel more intensely to you. FM is associated with widespread pain, tender areas, and general fatigue in the muscles and bones. FM affects approximately 2-3% of the general population (more than 90% of patients are women), and pain is probably its most important symptom.
FM often affects your mental health, social functioning, energy, and overall well-being. Studies have found that women with FM appear to be at approximately five times greater risk than the general population of developing anxiety disorders, particularly obsessive-compulsive disorder.
Multiple sclerosis: Multiple sclerosis (MS) is a type of nerve damage that disrupts communication between the brain and body. It is the most common chronic disabling central nervous system (CNS) disease in young people, affecting 1 in 1,000 people in Western countries.
Three common mental health issues when treating multiple sclerosis include depression, anxiety, and pseudobulbar affect. When you have multiple sclerosis and suffer from depression, your social support and family systems can be disrupted. Depression can also have adverse effects on functional status, such as increased work hours.
People with MS are almost twice as likely as people without MS to develop major depressive disorder (MDD) within a year.
Generalized anxiety disorder appears to be the most common anxiety disorder among people with multiple sclerosis. Panic disorder and obsessive-compulsive disorder (OCD) may also be more common in people with MS than in the general population. Studies have found that 36% of people with MS will experience some form of anxiety at some point in their lives, compared with only 25% of people without MS.
In addition to mood disorders, some people with MS may experience a phenomenon known as "pathological laughter and crying" or pseudobulbar affective affect (PBA). It occurs when a person laughs or cries excessively because of a feeling or in inappropriate situations. For example, you might laugh or cry in situations that other people don't think are funny or sad. About 10% of people with multiple sclerosis develop PBA.
Back/neck pain: The most common back/neck pain is a mild pain that may be caused by muscle strain, sleeping in an uncomfortable position, handling heavy objects, trauma, and/or stress. While back/neck pain is uncommon, it can be a sign of a serious underlying medical problem, such as meningitis or cancer.
Some symptoms associated with this type of pain may indicate risks to the health of your nerve roots or spinal cord. These symptoms may include pain, tingling, numbness, or weakness in the shoulder, arm, or hand; nerve problems with balance, walking, coordination, or bladder and bowel control; fever or chills; and other troublesome symptoms. However, these symptoms are also common symptoms of other serious health conditions, such as heart attacks in women, so it's best to talk to your doctor first about any symptoms you may be experiencing.
Mental health problems are more common in people with back/neck pain than in people without back/neck pain.
In a study of adults with depression and chronic pain, those with back pain and headaches had the highest rates of major depression. Studies also indicate that depressive symptoms persist longer in people with chronic pain conditions than in people without pain conditions.
Chronic migraine: Migraine that lasts for 15 or more days per month for more than three months is called chronic migraine. Chronic migraines often co-occur with mental health problems; people with migraines have higher rates of major depression and anxiety disorders than those without migraines.
Growing evidence also suggests that living with migraine and a mental health condition is associated with poorer health-related outcomes, such as disability, limited activity, and greater utilization of mental health services.
Menstrual-related pain: While some pain during your period is normal, conditions like endometriosis and uterine fibroids can be debilitating. Endometriosis is a disease in which tissue similar to the tissue inside the uterus (endometrium) grows outside the uterus. One in 10 people who menstruate has endometriosis. Uterine fibroids are non-cancerous growths on the wall of the uterus that usually appear during the childbearing years. Fibroids are very common - as many as 70% of white menstruating people and 80% of black menstruating people have fibroids by the age of 50. While many people have no symptoms, research shows that fibroids are more severe in black people than in white people. The prevalence of both is likely an underestimate because figures generally do not include transgender or non-binary menstruators, those who fall outside a certain body mass index (BMI) range (those considered underweight or overweight based on their height) ), and people who are unaware that their experience is diagnostic.
Endometriosis and uterine fibroids share many symptoms, including fatigue, heavy and/or inter-cycle bleeding, frequent urination, and severe pelvic pain or cramping. This pain is often invalidated—many people still think it's inappropriate to talk about menstruation, so people with uteruses often think their pain is illegal.
Endometriosis patients with pelvic pain (approximately 80% of those diagnosed) have significantly higher prevalence of emotional distress, including depression and anxiety, compared with healthy people. Most people with uterine fibroids experience severe emotional reactions, leading to depression and anxiety, and one study found that half of those surveyed felt helpless, as if they had no control over their uterine fibroids. Both conditions can reduce overall quality of life - some people may experience debilitating pain that leaves them bedridden, feel embarrassed and ashamed if menstrual products are not on hand, or refuse invitations because they are worried about going to the toilet.
Treatment/Therapies for Chronic Pain and Mental Health
Diagnosing and treating pain can sometimes be a tricky process because pain is a subjective experience, and there are no tests that can accurately measure and localize it. Often, chronic pain can be treated with medications that are taken orally, applied directly to the skin (creams and patches), or injected. If you are taking opioids (pain relievers) or discussing this treatment option with your doctor, be sure to plan to use these medications safely as they are highly addictive. As always, it’s important to remember to continually work with your doctor to determine the right treatment plan for you.
Although treating pain and mental health issues sometimes uses separate therapies for each condition, there are methods that can help relieve both conditions at the same time.
Ways to Help
- Antidepressant drugs can relieve pain and depression because of the presence of common chemical messengers in the brain.
- Talk therapy , also known as counseling (psychotherapy), can be effective in treating both conditions.
- Stress reduction techniques physical activity, exercise, meditation, journaling, learning coping skills and other strategies may also be helpful.
- Pain rehabilitation programs typically provide a team approach, including medical and psychiatric care.
Treatment is most effective when these therapies are combined.
Mental health check-ups can help
Effective chronic pain treatment relies on regular screening and includes appropriate referrals to mental health treatment. Screening provides a quick, easy way to detect the first signs of serious illness and initiate linkage to care at an early stage.
