How Depression and Pain Are Connected


There’s a very close relationship between pain and depression. You can think of it as Bi-directional meaning that each entity influences the other. Pain worsens or can even cause depression and depression worsens your pain tolerance.

This worsening of your pain is not just your perception because you feel down. Depression increases your sensitivity to pain. So it’s as though you feel pain more intensely when you’re depressed then you would if you were not depressed. This is related to what we call the somatization of depression or the tendency to feel depression in your body.

Depression can affect you physically. Even if you don’t have a pain problem, when you get depressed you can be more sensitive to body sensations and experience them in a negative way. So some depressed people can complain of joint pain, headaches or dizziness. You may feel bloated or constipated. It’s not because depression makes you constipated but when you’re depressed you can get neglect your fluid intake, then have slower moving bowels. Then your mental state magnifies the intensity of the experience.

The second relationship between pain and depression is chronic pain that goes unresolved for months can cause depression. Usually chronic pain is pain that lasts more than three months.

What can be done about this?
When you have a combination of pain and depression, you have to use different approaches to treat both.

As for non-medication options there is cognitive behavioral therapy that is targeted for pain and depression. The focus is usually on helping you reframe your thoughts around your pain and develop better coping skills to manage the pain.

Then there is relaxation training using things like progressive muscle relaxation, mindfulness and yoga.

Hypnotherapy is a specialized therapy where therapist gets you into a trancelike state and then speaks positive suggestions about your pain that you internalize and act on. Hypnosis is something you can learn to do yourself.

As for medications, there are 3 types of medications that have been studied to treat both depression, anxiety and pain. These are the serotonin-norepinephrine reuptake inhibitors like duloxetine and venalafaxine; the tricyclic antidepressants like amitryptline and some anticonvulsant mood stabilizers like lamotrigine.

References
Sheng J, Liu S, Wang Y, Cui R, Zhang X. The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Neural Plast. 2017;2017:9724371.

Gerrits MM, van Oppen P, Leone SS, van Marwijk HW, van der Horst HE, Penninx BW. Pain, not chronic disease, is associated with the recurrence of depressive and anxiety disorders. BMC Psychiatry. 2014;14:187. Published 2014 Jun 25.

Hermesdorf M, Berger K, Baune BT, Wellmann J, Ruscheweyh R, Wersching H. Pain Sensitivity in Patients With Major Depression: Differential Effect of Pain Sensitivity Measures, Somatic Cofactors, and Disease Characteristics. J Pain. 2016 May;17(5):606-16.

Adrienne L. Adler-Neal, Nichole M. Emerson, Suzan R. Farris, Youngkyoo Jung, Robert C. Coghill, Fadel Zeidan. Brain moderators supporting the relationship between depressive mood and pain. PAIN, 2019;

Tappe-Theodor, A., Kuner, R. A common ground for pain and depression. Nat Neurosci 22, 1612–1614 (2019). https://doi.org/10.1038/s41593-019-0499-8

Kapfhammer HP. Somatic symptoms in depression. Dialogues Clin Neurosci. 2006;8(2):227-239. doi:10.31887/DCNS.2006.8.2/hpkapfhammer

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