Can Depression Cause Physical Pain?
The Link Between Pain and Depression
Pain and depression are connected in the human brain, and many people who experience one will also feel the other.
By Dennis Thompson Jr.
Medically Reviewed by Pat F. Bass III, MD, MPH
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Deep connections exist between chronic pain and depression. A person experiencing chronic pain is more likely than a well person to be depressed. And the connection runs in the other direction, too — depressed people are more likely to complain of chronic aches and pains.
Studies have found that people dealing with chronic pain run three times the risk of developing a mood disorder such as depression or anxiety. About a third of people with persistent pain experience clinical depression.
What’s more, people with depression have three times the risk of chronic pain. "When people have chronic depression over a long period of time, about half of them will develop chronic pain problems without any clear injury to explain that pain," says Michael Moskowitz, MD, assistant clinical professor for the department of anesthesiology and pain medicine at the University of California, Davis and a board member of the American Pain Foundation.
Pain and Depression Connections
Doctors believe the structure and function of the human brain form the basis of the link between chronic pain and depression:
Brain structure.There is a lot of overlap among the parts of the brain that deal with pain signals and the locations where mood disorders develop. "If you look at the nine places in the brain where pain occurs, six of them are where we experience mood disorders like depression and anxiety," Dr. Moskowitz says.
Brain function.Some of the neurotransmitters that the brain uses to receive and process pain signals also are used to regulate mood. These include serotonin and norepinephrine. It's no coincidence that most drugs used to treat mood disorders have been found to be effective when used for pain relief.
Chronic pain and chronic depression both can alter your brain structure and chemistry, with each condition influencing the other. As Moskowitz explains, "Your brain changes every day of your life, with connections made and broken all the time. The brain remodels all the time due to the stimulus it gets."
"What actually happens in the brain is a kind of expansionism," Moskowitz continues. "The nerve cells dedicated to pain branch into a new area when there's chronic pain. With mood and pain sharing so many areas, sometimes they're kind of encroaching into each other's areas."
How to Manage Pain and Depression
How do you manage pain in the face of chronic depression, and how do you treat depression in someone who is experiencing chronic pain? Medical experts believe you need to treat both conditions simultaneously, with initial emphasis on whichever one occurred first.
"You have to look at what the person presents with," Moskowitz says. "If it comes from the mood, you start with the mood first. If it started from an injury, you start with the cause of the pain first."
Pain management can be achieved through the use of pain medications and physical therapy, while also tackling depression through exercise, psychotherapy, and antidepressant drugs. Some techniques like progressive muscle relaxation, cognitive-behavioral therapy, and meditation can help with both manage pain and depression.
The goal is to help the brain rewire itself out of both chronic conditions. "You're retraining the brain to move back to a more normal state," Moskowitz says.
Video: Depression and Chronic Pain
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