Is Pain Making You Depressed, or is it the Other Way Around?

Pain can lead to depression and depression increases pain. Learn how to break the vicious cycle

When you’re in pain, it’s hard to feel right with the world. So it’s hardly surprising that unrelenting pain can take a toll on your mood and even lead to depression. In fact, a study from Wayne State University found that 35 percent of people with chronic pain also suffer from major depression. Meanwhile, just as some people experience fatigue or appetite changes with depression, others feel pain. Whether one condition causes the other or they simply coexist, the relationship between chronic pain and depression is a long and winding two-way street, experts say.

“Sixty to 70 percent of people who are depressed complain of pain, even if there’s no obvious source of the pain, because depression amplifies the feeling of physical pain,” says Charles Raison, M.D., an associate professor of psychiatry at the University of Arizona in Tucson. “Meanwhile, people with chronic pain have high rates of being depressed or becoming depressed. It’s a bad round-robin: It can go from the chicken to the egg or the egg to the chicken.”

How is this possible? For one thing, “Chronic pain and depression ride on the same circuitry in the central nervous system, and the wires can get crossed,” explains Dr. Raison. “The neurochemicals norepinephrine and serotonin, which are involved in depression, play a central role in the anti-pain pathway in the brain.”

Plus, some areas of the brain that regulate pain are also involved in the processing of emotions and the regulation of moods. As a result, experiencing chronic pain can trigger changes in these brain regions, especially the limbic system and the anterior cingulate cortex, which can knock you off balance emotionally or alter your thinking abilities. “In treating chronic pain, we do more brain management than pain management,” says Rex Schmidt, Psy.D., a clinical psychologist at the Nebraska Medical Center Pain Management Program in Omaha. “If we’re not doing a good job of managing your depression, we’re not going to do a good job of managing your pain, because the two go hand in hand.”

Being in chronic pain can also change the way you see yourself. For example, if you used to view yourself as a vibrant, capable person, and you’re forced to give up playing tennis or painting because of your arthritis or running because of a disc problem, you may come to see yourself as broken or damaged or without a sense of identity or purpose.

But it doesn’t have to be that way. You can break the pain-depression cycle so the two conditions don’t continue to fuel each other. Here’s how:

Move your body. When plagued with pain and dogged by depression, it’s hard even to get out of bed, but experts say exercise is one of the best things you can do for yourself. “It has antidepressant, anti-inflammatory and anti-pain effects,” explains Dr. Raison. It also triggers the release of endorphins, one of the body’s natural (opioid-like) painkillers, and raises levels of the feel-good neurochemical serotonin. Plus, it makes you feel physically capable, which can improve your overall sense of well-being. Even if it’s just a walk to the mailbox or around the block, try to get outside and move your muscles.

Discuss antidepressants with your doctor. Antidepressants aren’t just for your mood. They are also effective at relieving pain, particularly the older tricyclic antidepressants and the newer serotonin-norepinephrine reuptake inhibitors (SNRIs) such as Cymbalta and Effexor, Dr. Raison says. That’s why tricyclic antidepressants are often used to treat migraines, low back pain and fibromyalgia, and why the SNRIs are often prescribed for neuropathic pain (such as diabetic neuropathy).

Change your thinking. Many people with chronic pain have thinking habits that exacerbate their pain, negatively affect their mood and behavior, and leave them vulnerable to depression, Schmidt says. These include rushing to the worst-case scenario in stressful situations (experts call it “catastrophizing”), considering one negative event as part of an endless pattern of bad luck, personalizing every bad moment by thinking you played a role in bringing it on and seeing the world in black-and-white or absolute terms.

Consider CBT. “If you change the way you think about your situation, you can reduce your perception of pain as well as depression,” Schmidt says. Cognitive-behavioral therapy (CBT) can help you do this. Through CBT, you learn to consciously remind yourself that one especially painful day won’t incapacitate you for life, that it isn’t necessarily the beginning of a downward spiral, that you didn’t do anything to deserve the pain and that if you banish words like “always” or “never” from your vocabulary, you’ll make your circumstances easier to deal with.

Get better snooze control. Sleep disturbances are common consequences of both chronic pain and depression, which is especially unfortunate considering that sleep is vital to improving both conditions. Sleep has powerful restorative effects on your body and mind, whereas insufficient or poor-quality sleep can lower your pain threshold and leave you cranky the next day. “Sleep loss keeps a vicious cycle going: It leads to irritability and a decrease in motivation, which leaves you more susceptible to stress from trivial matters and makes it harder to follow through with active coping skills that will help improve depression and pain,” Schmidt says.

Learn to decompress. You can’t eliminate stress in your life, but you can control your response to it. Relaxation techniques like biofeedback, progressive muscle relaxation and mindfulness meditation can “quiet the limbic system in your brain, which will help with both depression and pain,” Schmidt says.

Stay socially connected. When you’re in pain or depressed or both, it can be hard to muster the energy to socialize, but staying connected can improve your sense of well-being. Talk to close friends and family members about what you’re going through and how they can give you the support and encouragement you need. “Don’t talk excessively about the pain or depression; focus your energy on the gratifying parts of your life, and talk to family members about how they can help you engage in activities that would bring you pleasure,” Schmidt says. Distraction is very important for both chronic pain and depression, so you might tell loved ones how they can help take your mind off the hurt -- walk with you in a park on a sunny day, go see a comedy on a rainy afternoon or play an engrossing game together. It’s worth the effort for the sake of your body and mind and sense of connection.

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