If depression is classified as a “mental illness,” why do so many people living with it also experience physical pain as part of their symptoms? The answer is complicated, as pain is much more than just physical sensations. It also has emotional, behavioral, and cognitive aspects.
Vicious Cycle of Pain and Depression
Depression can cause physical pain. People living with chronic pain are at high risk for becoming depressed. Research based on 376 studies (50 countries and 347,468 participants) found that clinical depression was present in 39.3 percent of individuals.
Let’s say a professional athlete becomes severely injured in a game. Their injury is severe enough that they will be living with chronic pain for the rest of their life. Not only is their career over, but they must adjust to their “new normal,” which includes living on much less money than they were used to previously, living in a body that doesn’t necessarily do what they want it to do all the time, and adjusting to pain management. It means their medical team can make them a bit more comfortable, but the athlete will always be dealing with pain to some degree.
Depression also occurs in people living with pain resulting from heart disease, cancer, or diabetes. The affected person’s pain and depression can create a vicious cycle where their pain makes depression worse. The resulting depression worsens their pain.
Chronic Pain and Depression
Pain and the issues it creates can wear someone down over time. Chronic pain (pain that lasts for six months or more) causes several problems that can cause depression, including stress and sleep difficulties.
This level of disabling pain can cause self-esteem issues due to work issues. The person living with chronic pain may no longer be able to work at their previous position. They may no longer be able to work, period. Financial stress definitely affects self-esteem, since many people link their worth to their occupation.
When pain gets in the way of being able to participate in social activities and hobbies that someone previously enjoyed, their self-esteem takes another hit.
Why Depressed People Experience Pain
There are several reasons why people living with depression may also experience physical pain, and vice versa, such as:
1. Psychological pain and physical pain activate some of the same brain regions.
The areas of the brain that “fire” when someone experiences psychological or physical pain include parts of the frontal cortex, including the anterior cingulate cortex (the part of the brain responsible for managing higher cognitive functions – organizing, planning, motivation, problem-solving, self-control, discipline, and emotional regulation).
2. Physical and emotional pain involve the same neurotransmitters.
As their name implies, neurotransmitters carry signals between neurons (nerve cells) and specific cells (other neurons, glands, or muscles).
Neurotransmitters affect a person’s mood, sleep, focus, energy levels, and appetite. Common neurotransmitters include dopamine, serotonin, epinephrine, norepinephrine, endorphins, and glutamine. Endorphins are the body’s “feel-good” hormones that make someone feel good and decrease pain. Low levels of endorphins could make someone feel depressed and experience more physical pain.
3. Pain sensitivity increases.
People who are depressed are more likely to be sensitive to their body’s pain signals. The chronic stress that comes with depression makes us notice minor pains that would otherwise be easy to ignore.
Where do People with Depression Experience Pain?
People living with depression may experience general aches and pains in their limbs, joints, and back. Some people experience body pain “all over” that is chronic and debilitating (weakening). In contrast, others report headaches that over-the-counter remedies don’t help. Back pain, which doesn’t show up on X-rays or an MRI, is another common complaint for people living with depression.
Unexplained Physical Pain and Major Depression
Researchers know that about two-thirds of people with major depression experience unexplained physical pain (UPP). This physical pain makes it challenging for doctors to diagnose them properly. When the UPP is present, it is a predictor of a “poor response to treatment and a more chronic course of depression.”
Doctors know that when pain is present, it negatively impacts a patient’s functioning. It also affects the patient’s quality of life. UPP may lead to the patient catastrophizing
(viewing their situation as much worse than it is). This factor may be present in both depression and chronic pain and requires treatment with medication and/or cognitive therapy.
Self-medicating Pain and Depression
Since depression makes those living with it feel hopeless and worthless, and physical pain takes away energy, someone living with both conditions is much less likely to reach out to a healthcare professional for help. They may feel that no one can help or that they won’t ever get better.
This mindset is ripe for self-medication. Someone in this situation is looking for a way to relieve their symptoms and may turn to alcohol or drugs to feel better. Any relief they experience from chemicals is temporary (and may even be made worse). The depressed person only knows that using drugs and/or alcohol makes them feel better for a short time, and they grasp onto those experiences. Suppose they continue in their drug and alcohol use. In that case, they are at risk for developing a substance use disorder (formerly known as drug or alcohol addiction).
Get Help for Depression and Pain
Why don’t people living with depression and pain reach out for help? For one thing, their depression makes their mood so low that all their energy is taken up trying to get through the day.
Someone who isn’t living with depression may think, “It’s just making a phone call. How hard can it be?” For a depressed person, it can be a challenging task that takes all of their energy for the entire day.
Family and Friends Have a Role in Getting Help for a Loved One
Someone who is living with depression may not be able to ask for help themselves. Family members and friends can act as a group to get them the help they desperately need.
Instead of having an entire group of people confront the depressed person, similarly to an intervention, decide on who will talk to the depressed individual on behalf of the group. Ideally, this should be no more than two people.
Approach the depressed person when they have the most energy. They may have the most energy in the morning, and their pain levels may be easiest to manage then, too.
1. Start the conversation from a place of concern.
Say that you have noticed they haven’t been themselves lately and you are concerned. You care about them, and you want to help. The depressed person may respond that
they don’t deserve help or that no one really cares about them. That is their mental illness talking. Don’t argue with them; instead, reinforce the idea that they are loved and that people care about what happens to them.
2. Offer to make an appointment with the person’s primary care doctor.
If the person is too overwhelmed to make a medical appointment, offer to contact their doctor on their behalf. When you call to make the appointment, it’s the perfect opportunity to let the doctor know that you are concerned about your friend’s mental health, pain, drug and alcohol use. Then the doctor is aware of the situation before your friend arrives for their appointment.
If your friend feels they can’t keep their appointment because getting dressed and leaving their home is too overwhelming, go with them. You may end up sitting in the waiting room, but having someone’s support to get to an appointment can be a big help to a person living with depression.
3. Ask to speak to your friend’s doctor before leaving the appointment.
The doctor can’t reveal anything your friend told them in confidence. However, the doctor can tell you about the treatment plan (whether your friend has follow-up appointments or needs to fill prescriptions). You can also ask if the doctor recommends that your friend enter a behavioral health treatment center.
Willow Creek Behavioral Health for Clients with Depression and Chronic Pain
When clients come to Willow Creek, our team sees them as individuals with their own history and treatment goals. Our medical and psychological team conducts a thorough evaluation of each client on arrival. Based on the evaluation information, our team develops a treatment plan that considers the client’s physical, mental, and emotional needs.
Clients who have been self-medicating with drugs and alcohol have their substance abuse issues addressed with a program that includes detox.
