Pain is a physical sensation and an emotional experience that affects mood, thought and behavior. Ongoing pain can intensify these effects. A circular relationship exists between pain and depression. Individuals with ongoing pain have an increased risk of developing depression, and individuals with depression have an increased risk of developing chronic pain. Pain and depression frequently coexist.
Chronic Pain
Chronic pain is defined as lasting longer than six months, according to Dr. Robert Gatchel in "Clinical Essentials of Pain Management." As pain persists, biochemical changes in the body increase sensitivity to pain and worsens the sensation of pain. Sometimes, people begin to experience pain in other parts of the body that do not typically hurt.
Symptoms of Depression
Feeling sad or hopeless is assumed to be a common reaction for a person who has chronic pain, so depression may be unnoticed. Depression is a mood disorder, according to the American Psychiatric Association. Symptoms of depression include feeling sad or down, lack of enjoyment in activities, changes in sleep, low energy, changes in appetite, impaired concentration, and having thoughts about death or suicide.
Relationship Between Pain and Depression
Depression is a common psychological concern of people with chronic pain. According to a classic study in the January 1985 issue of Psychological Bulletin, between 40 to 50 percent of people with chronic pain have depression. Individuals with chronic pain may have anxiety and feel stressed and tense about having pain. Chronic pain may interfere with mobility and the engagement of pleasurable activities. The constant stress and interference of usual activities may result in a sense of hopelessness and despair.
Reciprocally, pain is a common symptom of depression. According to a review of research in the November 2003 issue of Archives of Internal Medicine, about 65 percent of people with depression complain about having pain. Depression intensifies pain and contributes to the disabling effect of such pain conditions as back pain, arthritis or headaches. A person with depression may isolate from others or stop doing enjoyable activities. This isolation and inactivity leads to further depression and may exacerbate pain.
Recognition of Depression
Depression is often overlooked when pain is present. Thus, depression is often undertreated. At least 75 percent of primary care patients who have depression only present physical complaints to their health care providers, according to the "Archives of Internal Medicine" article. As a result, health care providers frequently assess for physical causes of pain and treat the pain through medical means instead of treating both the biological and psychological aspects of pain.
Treatment
Treatment of depression and pain involves treating both the physiological and psychological aspects of these conditions, as noted by Dr. Gatchel. According to the review of research in the Archives of Internal Medicine, the combination of antidepressants and cognitive behavior therapy is also effective in treating chronic pain and depression. Researchers are still exploring whether pain lessens as depression improves, or whether depression improves as pain lessens.
References
- Archives of Internal Medicine; Depression and Pain Comorbidity; Matthew Bair, M.D., Rebecca Robinson, Wayne Katon, M.D. and Kurt Kroenke, M.D.; November 2003.
- Clinical Essentials of Pain Management; Robert Gatchel, Ph.D.; 2004.
- "Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision"; American Psychiatric Association; 2002.
