Understanding the Link Between Chronic Pain and Mental Health

Pain is an intrinsic aspect of the human condition. It manifests in various forms, from physical joint aches to emotions we deem painful, like grief, betrayal, or shame. Pain developed in our brains and bodies as a protective force; a signal for us to get out of a dangerous situation or appropriately understand a threat to ourselves or loved ones. As we’ve evolved, however, so too has pain. For many, what was once an acute signal has culminated in lifelong conditions called chronic pain, which persistently challenge one's physical and emotional equilibrium. Often underestimated is the connection between physical chronic pain and mental health conditions, where each intricately influences the other, shaping the experiences of those affected. 

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The Science Connecting Chronic Pain and Mental Illness

Chronic pain transcends mere physical discomfort, often intertwining with mental health disorders. Samantha Kluger, Psy.D., a psychologist with a background in pain psychology at Colorado University Medicine, sheds light on the bidirectional nature of their interaction.

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"Pain and emotions can trigger each other," she explains. “Pain can mess with our mood and having strong emotions can mess with our pain.” In other words, individuals grappling with chronic pain may find their mood affected, while heightened emotional states can exacerbate physical sensations. 

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Research corroborates this connection, revealing a high prevalence of mental health disorders among individuals with chronic pain. A study conducted by Mental Health America found that individuals with chronic pain, such as those with arthritis or fibromyalgia, are more likely to suffer from severe anxiety, depression, bipolar disorder, and post-traumatic stress disorder (PTSD). Among those screened for depression in the study, 47% of individuals with chronic pain screened positive for severe depression compared to 36% without chronic pain.

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The Mechanisms That Help Pain Talk to the Brain 

Our brain plays a central role in interpreting sensory inputs and determining whether they are good, bad, painful, meaningful, and so on. 

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“Pain is 100% produced by the brain,” Kluger says. “The body receives information from the environment—a cut on your arm for instance—and sends the information up the spinal cord to the brain. The brain then interprets the signal as pain.” It’s a neurological process and one that underscores the profound link between physical stimuli and emotional responses. There are shared neural pathways and neurotransmitter systems between pain processing and emotional regulation. In sum, we can’t have one without the other. 

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So let’s think of this in terms of prolonged or chronic pain. Our brain is getting pain signal after constant pain signal, and this wears down these mechanisms and pathways, literally impacting our mental health. Living with daily pain is physically and emotionally stressful, and chronic stress is known to change the levels of hormones and neurochemicals found within the nervous system. Disruptions to these chemicals can affect your mood, thinking, and behavior.

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Dealing with the actual pain compounds with how it affects your ability to socialize, work, sleep, or concentrate. What results from this cycle are co-occurring pain and mental health conditions. Anxiety, depression, and other mood disorders are common alongside chronic pain conditions like fibromyalgia, back problems, migraines, and arthritis.

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Hacking the Pain Brain

Living with chronic pain, for many, isn’t entirely fixable; the discomfort of arthritis or migraines doesn’t have a magic, no-more-pain pill. But as Kluger says, ever pragmatically, “pain does not have to control you.” We can cope with these co-occurring mental health concerns through effective strategies. 

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She says seeking support—from everyone from your doctors to colleagues and friends—can go a long way in combating the emotionally isolating and frustrating aspects of living with chronic pain. Specifically, when dealing with health providers, make sure your primary care physicians are proactive in their conversations about mental health and chronic pain. Patients should be actively involved in decisions around any long-term care, with their needs, goals, and preferences tailored to them in a personalized treatment plan. 

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Some treatments may help both mental health and pain conditions, including psychotherapy and relaxation techniques. Medications, including some antidepressants and some anticonvulsants, can be useful in treating both conditions, too. Lifestyle changes, such as exercise, good nutrition, and getting enough sleep, can also be helpful for both managing pain and improving mental health symptoms.

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Conclusion

In understanding the link between chronic pain and mental health, we unravel a profound connection that extends beyond the physical realm. Chronic pain, once a protective mechanism, has evolved into a persistent challenge, intertwining with our emotional well-being. This intricate relationship manifests in various forms, from heightened anxiety to deep-seated depression, affecting millions worldwide. Through the lens of neuroscience, we discern how pain communicates with the brain, shaping our perceptions and emotional responses. 

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Yet, amid this complexity, there is hope. By embracing a holistic approach that integrates medical, psychological, and lifestyle interventions, individuals can reclaim agency over their well-being. Together, we embark on a journey toward understanding, resilience, and healing in the face of chronic pain and its profound impact on mental health.

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Sources

American Psychiatric Association

Mental Health America

The Ochsner Journal

CU Medicine

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