How is chronic pain associated with depression and anxiety?

How is chronic pain associated with depression and anxiety?

Self-treatment for chronic pain
According to the American Psychiatric Association, people living with chronic pain are at a heightened risk for mental illness and substance use disorders.
Lauren Owens Lambert/Reuters

Living with chronic pain on a daily basis is extremely debilitating, as well as physically and emotionally stressful. Chronic stress, for instance, is known to negatively change the levels of stress hormones and neurochemicals found within the brain and nervous system.

Chronic pain has long been associated with deep-rooted mental health conditions such as depression and anxiety. It can even heavily affect a person’s quality of life.

There are many ways for chronic pain to interfere with your everyday life, such as affecting your ability to work. Performing simple tasks at home. Taking care of yourself. You may even find it difficult to participate in social activities with friends and family.

It is also very common for prolonged chronic pain to lead to sleep disturbances, fatigue, struggles with concentration, mood changes and decreased appetite.

But why is chronic pain often associated with depression, anxiety and mental illness in general?

Kurt Kroenke, M.D., from the Regenstrief Institute and Indiana University School of Medicine recently discussed this in an invited commentary, which was published in detail in JAMA Network Open, an online medical journal.

During the commentary, Dr Kroenke discusses this complex relationship between pain, the most common symptom for which individuals visit a physician, depression and anxiety.

Dr Kroenke especially highlighted the crucial importance of not neglecting the psychological symptoms of those experiencing chronic pain.

« One of the reasons for the bi-directional linkage between pain and depression, as well as anxiety, is the existence of a feedback loop, » Dr Kroenke stated.

He continued: « Individuals with pain don’t sleep well and their resulting tiredness affects their mood, making them vulnerable to depression and anxiety. Having problems with depression or anxiety can increase susceptibility to pain. »

Whilst noting that anxiety and depression are associated with an improvement in pain, Dr Kroenke observes that treating pain may not improve mental health to the same degree.

He added, however, that this observation does not negate the benefit of identifying and treating both the physical and psychological symptoms.

« Symptoms of the body and the mind are frequent fellow travellers, » said Dr Kroenke. « And physicians don’t always ask about symptoms beyond the ones which brought the patient into the office. »

Additionally, Dr Kroenke noted that patients who visit their physician for pain (i.e. headache, back pain and stomach ache) will often neglect to mention the symptoms commonly associated with depression and anxiety.

It is also rather common for physicians to refrain from asking about the symptoms that go beyond the ones which their patients brought into the office.

Dr Kroenke continued: « These emotional symptoms can cause long-term suffering and impaired quality of life. If clinicians measure and monitor both physical and mental symptoms they will be more able and likely to treat them. »

« But there is no blood pressure cuff, lab test or X-ray for symptoms. We don’t have a way to measure symptoms other than from what the patient tells us, yet screening and diagnosis are crucial to improving patient outcomes, » he concluded.

In a review article that was published back in 2014, Dr Kroenke and his colleagues reported that one in three common symptoms do not have a clear-cut, disease-based explanation.

According to Dr Kroenke, that percentage is now thought to be more than one in two.


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