Epidemiologists estimate that pain, caused by various conditions, affects 76.2 million people in the United States, according to the American Pain Foundation. Depression, the leading cause of disability among young adults, may afflict 14.8 million American adults, according to the National Institute of Mental Health. Depression and certain kinds of chronic neurological pain often occur together, due to origins in the same nervous system pathways. According to a 2002 Psychology Today article, up to half of depression sufferers may also suffer from physical pain. As a result, pain and depression can be treated through similar methods.
Causes
Depression can cause pain and pain can cause depression. People with chronic pain are three times more likely to develop depression than the general public, and people with depression are three times more likely to develop chronic pain, according to the Harvard Health Letter. Many different conditions can lead to feelings of both pain and depression simultaneously, such as some pain disorders like fibromyalgia and arthritis, as well as other conditions like cancer.
The causes of physical pain that occur in some cases of depression are often unclear. Complaints are often vague and diffuse, with multiple pain sites throughout the body. The lack of a clear pain origin has caused researchers to focus on the neurological pathways shared by emotions and pain symptoms, according to the article "When Depression Hurts" by Hara Marano, published in a 2002 edition of Psychology Today magazine.
Physiology of Depression and Pain
Scientists have discovered that brain pathways regulating the perception of pain are the same pathways regulating mood, according to the Harvard Health Letter. Neurons send signals throughout the nervous system using chemical messengers called neurotransmitters. Several different neurotransmitters exist and serve different functions. Two neurotransmitters have been identified as critical in both pain and mood regulation--serotonin and norepinephrine.
Medications
Most psychiatric medications can also treat pain conditions, according to the Harvard Health Letter. Two classes of antidepressant medication, tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) both appear to affect levels of norepinephrine and serotonin, thus affecting both mood and pain regulation. Amitriptyline (Elavil), a TCA, is commonly prescribed for chronic pain conditions. However, some psychiatrists consider SSRIs a better first-line chronic pain treatment due to less severe side effects.
Therapeutic Treatments
Cognitive therapy and cognitive-behavioral therapy are commonly used to treat both depression and pain conditions, according to the Academy of Cognitive Therapy. This treatment grew out of observations that the more patients attend to their pain, the more pain they report. Therefore, thinking patterns can affect pain perception. Cognitive behavior therapy focuses on reframing the patient's perception of pain and developing coping mechanisms including deep breathing and relaxation skills.
Research suggests that individuals with chronic back pain can benefit as much from cognitive therapy as they do from physical therapy, according to Dr. Smeets and colleagues in a 2006 issue of the journal Musculoskeletal Disorders.
Ongoing Research
Scientists still do not completely understand the exact relationship between depression and pain. Clinical trials are continuing to investigate the exact nature of pain perception in patients with depression and anxiety, determining the best psychological treatments and whether treatments can be combined for depression and unrelated chronic pain conditions such as lower back pain, according to the U.S. National Institutes of Health Clinical Trials.
References
- "Psychology Today" magazine; When Depression Hurts; Hara Estroff Marano; July 01, 2002
- Harvard Health Publications: Depression and Pain
- "Musculoskeletal Disorders"; Active rehabilitation for chronic low back pain: Cognitive-behavioral, physical, or both?; R. Smeets and colleagues; vol 7; 2006
- Academy of Cognitive Therapy: Cognitive Therapy of Chronic Pain
- American Pain Foundation: Pain Facts and Figures
