by Dr. David Schopick
According to the American Pain Foundation, about 32 million people in the United States report pain lasting longer than one year. Anywhere from one quarter to one half of patients suffering from pain issues told their doctors that they felt depressed. This is especially true of those whose chronic pain incapacitates them.
Can chronic pain cause depression?
Yes, pain and depression can go hand in hand. When you are in pain, it is normal to feel irritable, anxious or agitated. Usually, as a patient’s pain subsides, these symptoms go away. But if the pain never goes away, the heightened stress response can cause depression, and the problems associated with it. Constant pain can wear people down over time.
People suffering from chronic pain may also experience chronic anxiety, confused thinking, fatigue, irritability, sleep disturbances and weight gain.
Sometimes patients get caught in a vicious cycle in which pain worsens symptoms of depression, and depression aggravates feelings of pain. Many times, the pain that they are feeling is also the pain of losing the life they used to lead. If the pain is causing a person to be disabled, then financial woes, loss of physical ability, loss of self-respect, and possible limited social interaction can worsen feelings of sadness, isolation, and fear for the future.
Why do so many patients suffering from chronic pain have untreated depression?
The short answer is because it often goes undiagnosed. Patients in chronic pain frequently focus on their pain symptoms when seeing their doctors, and omit the fact that they are losing sleep, have loss of appetite, loss of energy, or other symptoms of depression. Reporting these issues to your doctor is key because depression can make pain worse. In fact, those suffering from both chronic pain and depression frequently have more intense pain, feel less in control of their lives, and are more apt to cope with the pain by self-medicating through drug abuse or alcohol abuse.
How is depression associated with chronic pain treated?
Sometimes, both causes may need to be treated separately in order to achieve real success. A pain management clinic can help with issues of chronic pain, while a psychiatrist can address depression. However, there are some treatments that can assist with both issues.
• Antidepressant medications may relieve both pain and depression because they affect the same chemical pathways in the brain.
• Psychological counseling can also help patients get to the root causes of their depression and learn coping techniques. Cognitive therapy can also help patients learn how to use the power of their mind to combat chronic pain.
• Stress-reduction efforts, such as exercise, meditation, yoga, journaling and other activities may help. Exercise is very important. The better fitness level you can maintain, the less likely you are to suffer injury or from other physical difficulties. Exercise also releases endorphins, the “feel good” hormone. Gentle, regular physical activity helps chronic pain; your physician can help you devise an appropriate plan.
Treatment for chronic pain and depression may be most successful when a combination of methods is used, which address both the physical and mental aspects.
Anyone suffering from chronic pain should not hesitate to report any symptoms of depression to their doctor. The sooner the depression is treated, the better they will feel–both physically and mentally. 
