The emotional impact of long-term pain can be enormous. Dealing with pain on a regular or even daily basis is not only an unpleasant experience, of course, but may also prevent you from taking part in activities you enjoy. You may also have to rely more on others for certain tasks, taking away a sense of independence.
Chronic pain (pain lasting longer than 6 weeks and often for many years) can create feelings of hopelessness. You might be trying different medications and therapies, and perhaps nothing seems to take the pain away – as it usually does with acute pain (as when you have a recent injury or temporary illness). People with chronic pain may also experience gaslighting from doctors – having their experience minimised or invalidated. Feeling left with no answers, continuous pain, and no help can feel crushing.
The Link Between Chronic Pain and Mental Health
Can chronic pain lead to mental health issues?
While depression affects around 5% of the general population, of those living with chronic pain, about 30%-45% experience depression.
Can mental health issues cause chronic pain?
Similarly, pre-existing mental health issues can worsen, and in extreme cases, cause chronic pain. Chronically low levels of serotonin or dopamine – a key part of being depressed – can impair the body’s ability to repair and protect itself against pain.
A vicious cycle
If we know that chronic pain can cause mental health problems, and mental health problems can cause chronic pain, it follows that a vicious cycle can develop quite easily. Studies have indicated a bidirectional relationship between depression and chronic pain – in other words, depression is a predictor of chronic pain, and chronic pain increases the chances of developing depression.
But there is hope! Understanding pain psychology is the first step in using your thoughts and behaviour as tools to improve your pain levels, energy and quality of life.
Common Mental Health Conditions Linked to Chronic Pain
Depression
Chronic pain and depression frequently go hand in hand. A person may be diagnosed with Major Depressive Disorder when they experience symptoms such as depressed mood, lack of interest in anything they used to enjoy or anything pleasurable, feelings of unworthiness or guilt, difficulty concentrating, fatigue, trouble with eating or sleeping, and sometimes, thoughts of suicide – for longer than two weeks.
Anxiety
It’s very common to experience anxiety from pain. When stressed, the body releases a chemical called Cortisol, which in acute stress is anti-inflammatory and decreases pain. However, if stress becomes chronic, that same chemical becomes pro-inflammatory and may worsen your pain.
Clinical anxiety or anxiety disorder is a mental health condition that is different from daily stress or worry about specific situations. It creates extreme levels of anxiety that is not linked to anything in particular, resulting in interrupted focus, difficulty performing day-to-day activities, and avoidance of certain situations or people.
Generalised anxiety disorder is quite common, but other types include panic disorder, social anxiety disorder, and specific phobias. Clinical anxiety (which you can be diagnosed with by a professional psychiatrist) typically lasts several months.
Sleep Disorders
Another challenge in coping with chronic illness is difficulties related to sleeping. If you struggle to fall asleep, stay asleep, or sleep deeply with chronic pain, you’re not alone.
Besides the pain itself interfering with your sleep, several sleep disorders frequently develop along with chronic pain. Insomnia is the most common, but restless leg syndrome and obstructive sleep apnoea can occur often, too.
You CAN hack your sleep in several ways, though (these methods don’t necessarily guarantee a good night’s sleep but can help significantly):
- Keeping a strict sleep routine (most importantly getting up at the same time every day)
- To help keep your sleep schedule, don’t nap for longer than 25 minutes during the day
- Limiting caffeine levels to one cup of coffee before 10am only
- Winding down for a sleep an hour before bed with no screen light and dim household lighting, breathing and meditation
- No cardio exercise after midday
- Keep the bedroom cool, just keep warm under blankets
- Invest in a decent, medium-firm mattress and pillows that are appropriate for the needs of your condition.
Isolation and Loneliness
It’s hard to go out with friends and family when you’re in pain. You might want to lie down if you have back pain, stay in a dark quite room if you suffer from migraines, or just sit and watch a very distracting series if you’re having a bad pain flare. This often leads to extensive time alone and can create severe feelings of isolation and loneliness.
The Vicious Cycle: Pain, Mood, and Functioning
Pain-related anxiety or depression can cause more pain and so begins the awful cycle that is difficult to get out of. You may have functional problems in your day to day life, less motivation, and thus less movement and socialisiation. Not doing the things you love to do, not seeing the people you enjoy regularly, and struggling with daily tasks creates more anxiety and depression. The biopsychosocial model of mental health and pain has shown that psychological and social factors, not only genetic ones, can greatly contribute to, aggravate, or cause, mental disorders and chronic pain.
Psychological Coping Strategies
Cognitive Behavioral Therapy (CBT) is a proven treatment for clinical depression and anxiety, and chronic pain. This type of psychotherapy is structured, focuses on the present, and explores the relationships between feelings, thoughts and behaviour. It helps identify unhelpful thought patterns and behaviours and teaches you practical coping strategies, as well as new ways of thinking.
Group counselling can be hugely helpful too. Having a support system of people who can relate to your experience can make you feel more understood and less alone.
Journalling – writing down your thoughts and feelings daily – has shown enormous positive results. Sometimes, we just need to get things out of system a little by “releasing” them onto the page!
Mindfulness and meditation help to regulate the nervous system, thereby helping to regulate chronic pain, which is often intrinsically tied up in the nervous system. Along with meditation, breathing exercises, movement and singing help to stimulate the vagus nerve which also helps this process.
Medical and Therapeutic Support Options
There are numerous practical therapeutic treatment options for pain-induced anxiety and depression. Mindfulness, meditation, breathing, gentle movement, and exercise can all help lower cortisol levels (to lower anxiety) and increase serotonin and dopamine (to help fight off depression).
A psychiatrist can give you a formal diagnosis (depression, anxiety, or panic disorder, for example), and then prescribe medication to help. Antidepressants such as SSRIs and SNRI’s have shown significant levels of success in treating both chronic pain and depression – killing two birds with one stone. Anxiety medication can lower cortisol levels, and help you feel more able to perform daily tasks, as well as other parts of your treatment (for example, gentle exercise, if that previously made you anxious).
Supporting a Loved One with Chronic Pain
It can be incredibly difficult to support a loved one with chronic pain and mental health challenges.
You need to avoid burning yourself out, so try to take regular breaks and schedule some “me time” and see what aspects of care you can delegate to another loved one or even hire professional help for. You could also consider joinging a community support group – connecting with others going through the same challenge.
When chatting to your loved one with chronic pain about their difficulties, try to find a balance of validating their experience, acknowledging their of pain, anxiety and depression as very real, while also encouraging them to stay proactive in their own care - physically, practically and emotionally. Make sure to read up on your loved one’s condition, so that you can understand better, too.
When to Seek Help
Warning signs of mental health decline can include (but are not limited to) suicidal ideation, unmanageable anxiety, substance misuse, and self-harm (or thoughts of hurting oneself). The affected person may also not want to eat, move, or do the things they usually do.
Ask for help, speak to specialists, and be proactive
Whether you’re someone with chronic pain or a heath professional, it’s vital to be aware of the mental health part of the picture in the diagnostic, treatment and pain management processes. Those struggling with mental health conditions need to seek professional care from a psychiatrist, as well as engage themselves in proactive self-care through multi-modal chronic pain management and mental health management strategies.
Mental health support for chronic pain patients is one of the things we do. Make an appointment to start your multi-disciplinary chronic pain treatment with the Pain Collective now by calling 087 550 0644 or emailing info@healthcollectiveheal.com.
If you or a loved one is struggling with mental health and needs support urgently, consider contacting SADAG, Lifepath Health or Lifeline where you can receive free councelling over the phone.