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The Depression-Chronic Pain Link

Science shows that treating these two conditions together can bring relief

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When you are suffering from constant pain, it interferes with your sleep, your daily function and your ability to do the things you enjoy — so perhaps it’s not surprising that chronic pain can cause depression.

But the opposite is also true: If you’re depressed, you are at higher risk of developing chronic pain.

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In one study published in the Archives of General Psychiatry, researchers looked at data from 18,980 people and discovered that 43 percent of those with major depression also suffered from chronic pain, compared with only 17 percent of those who weren’t depressed.

It’s only in recent years that scientists have started to realize just how tightly depression and chronic pain are intertwined, says internist Kurt Kroenke, a professor and pain researcher at Indiana University. “If you have one, it is quite common to suffer from the other,” he says. “It can be hard to know where one begins and the other ends.”

About 30 to 50 percent of those with chronic pain also have depression, he says.

Not long ago, Vera Schtakleff, 81, of Torrance, Calif., was one of them. A failed surgery had left her with an aching knee, and arthritis caused pain to radiate into her back when she walked. What's more, the physical demands of caring for her ailing husband made her back pain worse, with the pain only becoming more severe, she says, after her husband died eight years ago.

“I had headaches and my whole body ached — my back, my knee, my shoulders — everything hurt,” she recalls. “It got so bad that I couldn’t do the things I enjoyed. I just wanted to sleep all day.”

After several years of being nearly housebound from pain, she tried to take her own life. “I felt so alone,” she says.

The links between pain and depression appear to be at least partly physiological, says Robert D. Kerns, a clinical psychologist at Yale University who specializes in pain and pain management. Studies have found that chronic pain and depression are based in the same area of the brain and share the same neurotransmitters and nerve pathways.

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The good news is, if you suffer from both conditions, there is help. Experts recommend looping in your medical doctor as well as a mental health professional (or visiting a pain rehabilitation center that has both kinds of providers) and treating long-standing pain and depression concurrently.

“It’s important not to rely on the idea that if you get your pain treated, your depression will go away,” Kerns says. “There’s no evidence of that. These conditions are so bundled that you need to treat both.”

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The following treatments can help if you suffer from chronic pain and depression. Many patients benefit from a combination of two or more treatments, Kerns says:

  • Antidepressants. In addition to improving your mood and treating depression directly, these medicines alter your perception of pain so it’s easier to bear. Keep in mind that an antidepressant won’t work instantly; you need to take it for a few weeks to experience the full effect.
  • Psychotherapy. The most commonly available type of psychological therapy for chronic pain is called cognitive behavioral therapy (CBT). It is also a psychological treatment for depression and helps you change negative thoughts and develop coping skills. Research indicates it is just as effective as medication in easing pain and alleviating depression. “When you are always thinking, This is awful, and there’s nothing I can do about it, that actually magnifies the intensity of your pain and leads you toward depression,” Kerns says. CBT helps you confront your own irrational negativity and gives you ways to take action so you feel less helpless.
  • Physical activity. You may be tempted to avoid exercise. But research shows staying active actually helps with both pain and depression, partly by releasing endorphins and other feel-good chemicals in the brain. Exercise also relieves stress, helps you sleep and keeps your muscles and joints active and healthy. A physical therapist can be key to helping you find the right exercise plan and managing your pain and any discomfort as you begin it.   
  • Mindful meditation. This practice teaches you to focus on the present moment and become more in touch with your emotions and feelings in a nonjudgmental way. In a 2015 study, chronic pain sufferers who were taught how to practice mindful meditation experienced  noticeable  improvement in depression, anxiety  and  pain.  
  • Reduce stress. Tension and stress increase your sensitivity to pain and deepen depression. Try deep breathing, get a massage, or listen to music — anything that will help you to relax.

In California, Schtakleff says she was fortunate to get the help she needed after her suicide attempt.

Her doctor prescribed an antidepressant that immediately improved her mood. He also connected her to a nonprofit called Independence at Home that supports her in different ways, including providing free visits from an in-home therapist. “I know now that my mental state really affects how much my pain bothers me. When I’m feeling down, the pain seems worse. When I feel happy, I can overcome it,” she says.

“He lifts me up. He gave me hope,” Schtakleff says of her therapist. “I feel much better now — physically, mentally and emotionally.”

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