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The Link Between Chronic Pain and Depression
Daniel Hageman
Pain is a depressing experience, and depression can cause and/or intensify pain. In fact, over 66% of individuals diagnosed with Major Depressive Disorder (MDD) also suffer from chronic pain, and depressed patients are three times more likely to develop chronic pain.
We all experience pain of some kind from time to time – we stub our toe, pull a muscle, suffer with a headache, etc. But the American Chronic Pain Association estimates that one in three Americans (over 50 million people) suffers from some type of chronic pain 1 . Chronic pain is described as ongoing or recurrent pain which lasts beyond the usual course of acute illness or injury and adversely affects an individual’s well-being. Simply put, chronic pain is pain that continues when it should not. It may present as pain in the lower back, abdominal region, joints, neck, and even headaches, depending on the individual. Pain may be felt as aching, burning, shooting, or electrical and can affect sleep, cause fatigue and weaken the immune system. Beyond the physical discomfort and stress upon the body, chronic pain also affects thought, mood and behavior, and can lead to isolation, immobility and drug dependence. If those symptoms sound familiar, it may be because there are many similarities and connections between chronic pain and depression.
Pain is a depressing experience, and depression can cause and/or intensify pain. In fact, over 66% of individuals diagnosed with Major Depressive Disorder (MDD) also suffer from chronic pain 2 , and depressed patients are three times more likely to develop chronic pain 3 . Depression can cause a variety of physical symptoms even including affecting the body’s natural sleep cycle. This minimizes the amount of restorative sleep realized each night and exacerbates both chronic pain and depression symptoms. With 80% of depressed individuals complaining of insomnia 4 or general body fatigue, it’s no surprise that this accumulation of stress on the body contributes to chronic pain.
Studies show that people with severe depression feel more intense pain which may be due to higher than normal levels of cytokines 5 , a protein that affects how the immune system responds to infection and disease. Cytokines also affect the strength and length of the immune system’s response, triggering inflammation as a cellular response to infection or injury, thus causing physical pain. In addition to causing pain, inflammation can also cause swelling, redness, heat and even loss of function.
Chronic pain and depression share overlapping processes in the brain and while not yet conclusive, there is increasing research supporting that both conditions may cause neurodegeneration of gray matter, regions of the brain essential for sensory perception, muscle control, memory, speech, and mood regulation. However, unlike other neurodegenerative conditions like Parkinson’s or Alzheimer’s Disease, there is evidence that treatment of chronic pain and depression may reverse gray matter loss 6 .
Treatment for chronic pain coupled with depression often focuses on first addressing the depression by reducing the length and duration of depressive episodes or eliminating them entirely, thereby often times resolving the chronic pain as well. Additionally, because chronic pain and depression exhibit remarkably similar symptoms, similar treatments such as cognitive behavioral therapy, medication, Transcranial Magnetic Stimulation Therapy (TMS Therapy), meditation, and/or exercise can be helpful in treating both conditions simultaneously. Medications may be prescribed by a physician, both analgesics for the pain (e.g., acetaminophen, or in severe cases, opiates) and psychiatric drugs (e.g., tricyclics and selective serotonin reuptake inhibitors (SSRIs). Dependency on analgesics for pain relief can become problematic, especially if the symptoms of depression are not also being addressed. As referred to above, TMS Therapy is a newer and non-drug option prescribed by physicians to treat depression.
If you’re experiencing depression and/or recurrent pain, speak with your doctor or contact TMS NeuroHealth Centers to learn how TMS Therapy might be able to help you.
- http://theacpa.org/uploads/documents/Nurses_Toolkit_2007.pdf
- http://www.aapainmanage.org/resources/articles/microglia-pointing-us-toward-a-new-paradigm-for-understanding-and-treating-chronic-pain-and-depression/
- http://www.health.harvard.edu/mind-and-mood/depression_and_pain
- https://www.psychologytoday.com/articles/200207/when-depression-hurts
- Hartman JM, Berger A, Baker K, Bolle J, Handel D, Mannes A, Pereira D, St Germain D, Ronsaville D, Sonbolian N, Torvik S, Calis KA, Phillips TM, Cizza G. Quality of life and pain in premenopausal women with major depressive disorder: the POWER Study. Health and Quality of Life Outcomes. 2006; 4:2.
- Phillips JL, Batten LA, Aldosary F, Tremblay P, Blier P. Brain-volume increase with sustained remission in patients with treatment-resistant unipolar depression. J Clin Psychiatry. 2012 May;73(5):625-631.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. 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Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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