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Pain Management

Chronic Pain and Depression

05/16/2007

Question:

My boyfriend has been suffering from chronic pain for about a year and a half. He has seen a number of specialists in search of a diagnosis with little success. My concern is that his condition is getting worse. Recently, I've read information about how depression can cause physical pain. My question is, can chronic pain (and the accompanying frustration) cause depression? If so, might that be compounding the problem? Would consultation with a psychologist or psychiatrist for depression evaluation be in order? Thanks for your time.

Answer:

Chronic pain and depression often go hand in hand. First of all, as you mention, someone with chronic pain experiences daily frustration as the pain interferes with activities, work, hobbies, and sometimes even basic self-care. Then there's the frustration and disappointment of seeking a diagnosis so you can finally understand the pain and hopefully treat it. All this frustration certainly can result in negative, hopeless thinking. Such negative thinking couples with functional impairment, limited pleasures, and social isolation to develop clinical depression.

Depression can be difficult to recognize. The primary symptoms of depression include feeling sad, down, depressed or experiencing lost pleasure in activities one used to enjoy. Other symptoms may include changes in appetite, changes in sleep, restlessness, fatigue, worthlessness, hopelessness, guilt, irritability, difficulty concentrating, indecisiveness, and thoughts of death. Anyone with suicidal thoughts should seek immediate help.

Depression certainly compounds the problem with chronic pain. Researchers have found the pain pathways that carry pain messages from the body to the brain are influenced by mood. Depression seems to allow more of the pain messages to reach the brain, intensifying the pain experience. Conversely, a positive mood seems to reduce this transmission of the pain messages, in turn reducing the pain experience. Sometimes chronic pain and depression involve similar neurotransmitters in the brain. Therefore, the medications sometimes used to treat certain chronic pain conditions also can be used to treat depression.

Chronic pain and the associated depression also often have a negative impact on relationships. The relationship may also undergo a shift in roles as the usual breadwinner is no longer able to provide financially. The partner of someone with chronic pain may end up in a caretaking role, acting a nurse rather than partner. The person in pain may feel like a powerless "patient" completely dependent on his/her partner while the "caretaker" may feel exhausted and unappreciated. Both people tend to resent this power imbalance over time and develop hostility. Furthermore, children may take on caretaking behavior, feeling responsible for the wellbeing of a parent with chronic pain. Couples and family therapy is often an important part of learning to live with chronic pain in a way that maintains a healthy relationship and family.

Consulting a psychologist or psychiatrist for evaluation and treatment of depression would be appropriate for someone with chronic pain. Psychotherapy and antidepressant medications have both proven effective in treating depression most of the time. As depression improves, many people report their chronic pain and functional impairment also improve.

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Response by:

Suzanne J Smith, PhD Suzanne J Smith, PhD
Clinical Associate Instructor of Psychiatry
School of Medicine
Case Western Reserve University