The Link Between Chronic Pain, Anxiety And Depression

Chronic pain takes a huge toll on the body, and it’s a widespread problem. According to the CDC, Roughly 50 million Americans have chronic pain at any given time, and 19.6 million have “high impact chronic pain,” or pain that interferes with daily activities or work obligations.  

It would be nearly impossible to imagine that round-the-clock physical pain—a migraine every morning, or back pain everyday—would not have emotional repercussions. Researchers are starting to uncover the links between chronic pain and mental health issues like anxiety and depression. Not only are chronic pain sufferers more prone to mood disorders, there may be a link in the central nervous system.

The potential connection has to do with neuroplasticity, or the way the brain passes signals and creates connections. “It’s helpful to make the distinction between pain and nociception,” says David A. Williams, PhD, Associate Director of Chronic Pain and Fatigue Research Center at the University of Michigan. “We have sensors in the body to recognize things like heat, or sharpness—a threat to the body. That process isn’t pain. It’s nociception. It doesn’t become pain until it reaches the brain.”

In those with chronic pain, signals often get crossed on the way to the brain. “The link between mood and pain occurs when nociception gets mixed with other emotions that may be happening,” says Williams. “It may be interpreted as more intense pain, and the whole experience becomes worse.” He says it’s a kind of “chicken and the egg” scenario; if you’re prone to anxiety or depression, you could be prone to chronic pain or vice versa. “People who are hardwired to be more sensitive to the affect side of life, they may have more vulnerabilities there,” he says. 

Williams points to the International Association for the Study of Pain (IASP)’s definition of pain, which originated in the 1960s: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage,” they state. “Their definition of pain is both sensory and emotional experience,” he says. “The link has always been there.” 

As such, if you have chronic pain, it’s important to treat both—but separately. Go see your primary care physician to work on bettering physical pain symptoms, as well as a psychiatrist to evaluate for a mood disorder. “So many of the drugs we use for pain are antidepressants,” he says. “Pain is just treated with a lower dose when compared to a mood disorder.” A physician or psychiatrist can work with your existing treatments to potentially affect change in both areas of health.

Beyond that, adjusting lifestyle factors to combat mood and pain symptoms is also crucial. “We are seeing a lot more emphasis on wellness these days,” says Williams. “There’s a lot you can do for yourself. Many pain clinics focus on improving sleep. In particular, with pain, if you’re sleeping better, signals are processed against a rested individual who has more fortitude for the day than someone who is low on sleep. They are likely to experience less pain.”

The National Sleep Foundation calls pain and sleep “a vicious cycle.” One bad night of sleep can lead to pain, and pain can lead to restless sleep. However, you can focus on having quality sleep; those who emphasized getting quality sleep tended to get about 36 more minutes of rest per night and over four more hours per week. Want more zzz’s? Limit caffeine and alcohol, especially in the evening hours, and practice relaxation methods before bedtime like deep breathing and meditation. 

On top of that, Williams says physical activity can improve chronic pain symptoms. “It can feel challenging when you’re in pain, but it’s a really positive thing,” he says. “We just don’t want you to be sedentary. You can start with just a few minutes of activity and build up, if needed.” Research has also shown that exercise can improve symptoms of depression, completely separate from the physical benefits; just focus on getting up and out there as frequently as you can, not on the intensity of your walk or workout.

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