Depression and Chronic Pain


Depression (and anxiety, among a host of other psychosocial factors) contribute to chronic pain. In fact, in one study in the journal PAIN, 60.8% of people dealing with long-term pain met criteria for depression (PMID: 26963849). Why might this be? Emotional distress contributes more strongly than pain intensity to key outcomes like physical disability, work disability, and healthcare costs. For example, higher levels of perceived depression before surgery predict likelihood of successfully returning to work after surgery more than any other factor (including the the intensity of pain and disability before surgery). People in the upper half of scores for the experience of depression were 1/3 less likely to return to work and in general took nearly twice as long to return if they did. Why might this be the case? Well, there are many theories out there, but the strongest one is this: depression is an otherwise appropriate response to living within an environment that doesn’t align with our deepest needs. When we’re feeling depressed, we become more “vigilant” (hyper-vigilant, to be exact) to an environment that feels more threatening, more dangerous. This increase in vigilance also increases things like inflammation, oxidative stress, muscle tension, and activity of our sympathetic (“fight-or-flight”) nervous system. All of these factors contribute to a higher experience of pain. Comprehensive care for chronic pain helps us to process these feelings more effectively, alongside all of the “physical stuff”. You’re not alone, and it is OK to ask for help. Source: PMID: 25527877.

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