Chronic Pain and Mental Health

The link between physical pain and mental health

Physical pain is your body's way of letting you know that something is wrong. It leads you to address ailments or seek treatment for injuries. However, there's also a psychological aspect to pain. People who experience chronic pain are much more likely to develop mood and anxiety disorders.

Persistent chronic pain can make you feel depressed and hopeless, leave you feeling anxious as you ruminate over your condition, or result in an addiction to pain medication. These feelings can then exacerbate the pain you're experiencing.

Depression can both cause and worsen pain, while stress creates inflammation and muscle tension, which increases pain. So, it’s possible to get caught in a cycle of emotional distress and physical pain, with each element magnifying the other.

How chronic pain affects your mood

Months or years of living with pain can take a heavy toll on your mental health. You may be worried about the possibility of pain flare-ups while in public or feel too irritable or exhausted to go out at all. In either case, it can cause you to isolate, which in turn can lead to depression, which only makes your chronic pain even worse.

If your chronic pain makes it difficult to contribute at work or home, you might experience low self-worth or even shame. You may feel misunderstood, rejected, or left out of activities. You might also have a hard time sleeping at night due to physical discomfort. Maybe you find it difficult to envision a future where pain doesn’t hold you back. All of this creates psychological distress, feeding the physical pain.

You’re not alone in dealing with chronic pain, though. It’s a global issue. Both in the United States and Canada, an estimated 20 percent of adults report living with chronic pain, while about 34 percent of people in England experience prolonged pain. The problem is so prevalent that it has fueled the opioid epidemic, an overreliance on painkillers that has led to widespread addiction, suffering, and loss of life.

There’s no surefire way to escape chronic pain. In many cases, it may be the result of an incurable condition. However, you can take time to better understand pain and its relationship with mental health. Then, you can identify self-help strategies and professional treatment options that can help you live a satisfying life that’s not ruled by chronic pain or a dependence on painkillers.

Causes of chronic pain

We've all experienced some degree of short-term pain. Maybe you’ve sprained an ankle while jogging, cut a finger while cooking, or bruised an arm while moving furniture. While the pain that comes with common injuries subsides in a short period, acute or chronic pain can stick around for months or even years. This pain might be a continuous feeling that takes over your life, day and night, or it could be an issue that comes and goes, never seeming to fully resolve.

Understanding the cause of your chronic pain is the first step in managing it as well as the accompanying emotional distress. Here are a few common drivers of persistent pain and how they relate to mental health:

Back/neck issues

From slips and falls to poor form when exercising, many incidents can lead to neck or back injury and pain. Lifestyle choices, such as being sedentary, can also increase the risk of pain in these areas as they become stiff and weakened. Somewhere between 60 to 80 percent of adults will experience back pain at some point in their life. Neck pain is also a widespread problem, affecting 20 to 70 percent of adults.

In chronic cases, this pain can be particularly distressing and impact your mood and well-being. Research shows a strong connection between neck and back pain and depression and anxiety. If a back injury leads to pain that keeps you up at night, for example, the lack of sleep can elevate your stress. And then, as a response to high stress levels, you develop a stiff neck. You might gradually find yourself stuck in a loop of physical pain, sleep deprivation, and psychological distress.

Arthritis

Osteoarthritis is the most common form of arthritis and is caused by the cartilage between your bones breaking down over time. Rheumatoid arthritis is also common. It’s an autoimmune condition that leads to inflammation around the joints. Either condition can have extremely painful results. You might notice a burning pain or dull ache in areas like your hips or knees. Or you might experience sharp stabbing sensations and swelling in your hands.

While the pain itself is depressing, it can also discourage you from enjoying your favorite hobbies and reduce your mobility at work and home. This, in turn, reduces your quality of life and weighs on your mental health. Research confirms that anxiety and depression are common among people suffering from arthritis.

Cancer

Cancer can cause pain as a tumor puts pressure on nerves or affects bones. Cancer treatment, including surgeries, chemotherapy, and radiation, can also cause pain as a side effect.

Research shows that many people who have cancer also end up battling a variety of mental disorders, including stress-related disorders and depression. You might fall into depression after the initial diagnosis as you question your mortality and purpose in life. Or perhaps you experience anxiety over the potential pain and discomfort of each new treatment.

[Read: Coping with a Life-Threatening Illness or Serious Health Event]

Unfortunately, when left untreated, those same mental health problems can weigh down your odds of beating cancer. For example, a growing sense of hopelessness might also lead you to refuse treatment or ignore your doctor's recommendations. The physical stress that comes with conditions like depression and anxiety can also take a toll on an already weakened body.

Migraine

A migraine comes with a throbbing or pulsating pain in the head and sometimes additional symptoms like nausea and sensitivity to light and sound. Although some people have the occasional episodic migraine, others are plagued by chronic migraines—this is when you experience more than 15 of these painful episodes within a month.

Because the pain is so debilitating, you might experience acute anxiety as you wait for the next migraine to strike. Unfortunately, stress is also a common trigger for migraines. When a severe migraine does occur, you may end up canceling plans and isolating yourself in a quiet, dark room until the pain fades.

Some people who suffer from migraines also struggle with depression and anxiety disorders, such as obsessive-compulsive disorder (OCD). Migraines are also more common in people who have been physically, emotionally, or sexually abused, suggesting a connection between past trauma and current physical pain.

Fibromyalgia

Fibromyalgia syndrome (FMS) is a chronic disorder that causes stiffness and pain throughout the body. Despite the pain, the condition doesn't come with tissue damage or inflammation. The exact cause of the condition is unknown, but it may be the result of chemical imbalances or abnormal pain messages. Fatigue is also a symptom of FMS, leading some researchers to think that disrupted sleep patterns may be the cause.

Stressful events can trigger the FMS pain, and the pain can increase stress. Perhaps you feel anxious about whether the pain is going to flare up at an inconvenient time, such as before an important work meeting. The stress itself causes the flare-up and leaves you feeling hopeless. Many people with FMS also struggle with psychiatric conditions, such as depression, post-traumatic stress disorder (PTSD), and anxiety.

Multiple sclerosis (MS)

MS is a chronic disease that damages nerve fibers, leading to symptoms like tingling, numbness, weakness, and fatigue. It can also negatively affect your vision. The severity of the condition can vary wildly from person to person. You might experience gradually worsening symptoms. Or the condition might go into remission for years, only to suddenly return.

The unpredictable nature of MS can affect your mental health. You might start each day with a feeling of uncertainty. Will the symptoms be better or worse than the previous day? That looming anxiety can negatively affect the way you make plans with other people or envision your future goals. About half of people with MS may experience depression. Depression might arise due to feelings of hopelessness and intense frustration, or it could be a direct symptom of the condition.

Premenstrual syndrome (PMS)

Many women regularly experience PMS due to hormonal changes during the menstrual cycle. PMS involves physical symptoms, such as headaches, back pain, and bloating, as well as emotional symptoms like mood swings, tension, and fatigue. PMS can also worsen depression and anxiety disorders.

Premenstrual dysphoric disorder (PMDD) is a more severe form of PMS that affects three to eight percent of women during their reproductive years. The physical pain and psychological distress that comes with PMDD is intense enough to affect the way you function at work and in social situations. It’s also tied to an increased risk of suicide.

Self-help for managing chronic pain tip 1: Perform low-impact exercises

Being active comes with therapeutic benefits for the mind and body. As you exercise, your brain releases hormones like endorphins and dopamine, which boost your mood. Physical activity has also been shown to reduce pain, improve sleep, and mitigate inflammation. All of those benefits can serve as a counter to the cycle of chronic pain and mental distress.

One 2020 study of aerobic exercise's effect on chronic low back pain showed that the more vigorous the workout, the greater the reduction in pain. But don’t feel the need to dive into routines that leave you feeling overwhelmed or worsen your physical health. Do what’s comfortable for you. Even something as gentle as a yoga routine can be helpful. Here are a few tips:

Vary your activity. Try to incorporate a mix of cardio exercises, strength training, and flexibility exercises. Depending on your chronic condition, certain activities might be more suitable than others. For example, swimming is a great option for people with joint discomfort, and yoga is useful for neck and back pain. Even if you have limited mobility, there are plenty of ways to get a workout in.

Ease into a new routine. Move at your own pace and set goals that seem achievable without overdoing it. Give your body time to adapt to the activity, and then gradually increase the difficulty. You might aim to take short walks around the neighborhood before increasing your pace and distance over time.

Know your limitations. Plan to exercise on a consistent basis, but don’t force yourself into situations that may aggravate current pain. For example, if you’re suffering from a migraine, take time to recover before you exercise.

Tip 2: Practice mindfulness

Mindfulness is the practice of focusing on the present moment with a non-judgmental mindset. When it comes to living with chronic pain, mindfulness can help you to accept unpleasant physical sensations, and that can change your perception of the pain’s severity. In other words, mindfulness may be able to make the pain seem less intense.

You can also use mindfulness to explore and accept your emotional experiences, so you can better manage the anxiety and depression that often comes with chronic pain. Studies show that mindfulness can be a particularly useful self-help measure in coping with pain from PMS symptoms, fibromyalgia, and migraines.

[Read: Benefits of Mindfulness]

To start a mindfulness practice, try one of HelpGuide’s guided audio meditations such as:

• Body Scan Meditation. This short, guided mindfulness meditation helps you tune into sensations throughout your body. The goal isn't necessarily to relax. Instead, you aim to accept a wider range of sensory experiences without labeling them “good” or “bad.”
• Coping with Uncertainty Meditation. This can help if you regularly feel stressed about the uncertainty of pain flare-ups or the progression of a condition that’s causing you chronic pain.
• Eye of the Storm Meditation can help ground yourself in the present moment even when you're experiencing upsetting thoughts and feelings about your chronic pain.

Outside of guided meditations, you can use mindfulness techniques at any point during your day. Just pause what you’re doing and allow your attention to rest on a sensation, whether it’s the food in your mouth or the discomfort in your back.

Explore it, but resist the urge to call it good or bad. Consider aspects like pressure, intensity, tension, and temperature to gain a fuller understanding and acceptance of the sensation.

Tip 3: Follow an anti-inflammation diet

In some cases, chronic pain is linked to chronic inflammation. For example, the swelling that comes with conditions like arthritis puts pressure on nerves, resulting in pain. One way to manage this problem is to reassess your diet. Certain foods have been shown to increase or decrease inflammation.

Eat more inflammation-fighting foods

Foods that can help reduce inflammation include:

• Fruits, such as berries and oranges.
• Vegetables like broccoli and dark, leafy greens.
• Nuts and nut butter.
• Tea and coffee.
• Legumes, such as peas, beans, and lentils.
• Fibrous whole grains.
• Fish, such as salmon and sardines.

Diets like the Mediterranean diet and DASH diet may offer simple paths to reducing inflammation.

Reduce foods that can increase inflammation

These include:

• Refined carbs, including white rice and white bread.
• Fried foods, such as French fries or fried pickles.
• Red meats like steak.
• Processed meats.
• Sweetened drinks like soda.

You don’t have to completely cut out these foods. However, reducing your intake might help you reduce inflammation and reduce your levels of pain.

Tip 4: Improve your sleep

You might already be well aware that lack of sleep or poor-quality sleep can worsen your mood and overall mental health. However, on top of that, one 2019 study indicated that sleep deprivation can increase your sensitivity to pain. This can be especially problematic if you’re dealing with a condition that causes varying levels of chronic discomfort. If your fibromyalgia makes it difficult to sleep, for example, that lack of sleep only worsens the pain the next day.

Practice basic sleep hygiene. Follow a consistent sleep schedule. Don't take long naps throughout the day. Avoid stimulants, such as caffeine and bright screens, before bedtime.

[Read: How to Sleep Better]

Look for a mattress that accommodates your chronic condition. For example, a latex mattress might be useful if you struggle with pain from MS. Depending on the location of your pain, you can also experiment with different sleep positions.

If you take pain medication, do so right before bed. If you take medications too early, they may wear off in the middle of the night and disrupt your sleep. You can also consider taking a natural sleep aid, such as melatonin.

Use relaxation techniques. Breathing exercises, visualization practices, and body scan meditations can be helpful ways to soothe yourself to sleep.

Tip 5: Build and maintain social support

Spending more time with friends and family can help you better manage chronic pain. Socializing calms your nervous system and decreases stress levels. It can also help alleviate feelings of depression and loneliness. As that emotional distress lessens, the severity of your pain may also decline.

But what should you do if your chronic pain seems to get in the way of socializing? Here are a few tips.

Take advantage of days when pain is low. If your symptoms seem to be easing, prioritize being social. This might require both you and your friends to be flexible, but do what you can.

Extend an invitation. Rather than wait for an invite, take the initiative and reach out to family, friends, and acquaintances. In-person interactions have the best effect on your mood, so invite people over to your home for a visit. If you go out to socialize, suggest outings that won’t aggravate your pain. For example, if you suffer from migraines, you might want to avoid loud bars or concerts.

Open up about your chronic pain. If you feel comfortable doing so, let friends and family members know about your condition and how pain affects you. If you need to cancel or reschedule plans due to a pain flare-up, they won’t take it personally.

Join a support group. Online or in-person support groups help you connect with people who are dealing with similar pain issues. These groups can provide social support, and you might learn new coping strategies from other members.

[Read: Social Support for Stress Relief]

Use technology when necessary. On days when you’re incapacitated by pain, consider calling, texting, or video chatting with friends. Virtual connections aren’t a perfect substitute for face-to-face interactions, but they can still help you feel connected to those you love.

Tip 6: Try pet therapy

A little pet therapy can reduce pain as well as emotional distress. Studies show that after chronic pain suffers spend time with therapy animals, they tend to report reduced levels of pain and distress.

Whether you’re petting a rabbit or walking a dog, animal interactions can lead to an increase in endorphins and oxytocin in your brain. The interaction can also help reduce your stress and give you a sense of companionship. All of this can result in an elevated mood, which may lessen the severity of your pain.

[Read: The Health and Mood-Boosting Benefits of Pets]

Consider your limitations before bringing home a new pet. If chronic pain reduces your mobility, a dog might not be ideal because you’ll need to walk it daily. A cat could be a better option.

Remember that you don't have to own a pet to benefit from pet therapy. You can offer to walk a friend's dog on days when your chronic pain is low. Or you can visit places like cat cafes if you want to spend some time with new furry friends or volunteer at an animal shelter or rescue group. You can also ask your doctor about animal-assisted therapy programs.

Professional treatment options

Many people turn to professional treatment options to manage chronic pain. These treatments can involve pain-relieving drugs, which take a biological approach to treating pain, and psychotherapy, which can treat physical pain as well as emotional distress and responses to pain.

Medication

Opioids are powerful pain-relieving drugs. Although they’re sometimes an effective way to manage acute pain, they come with a large downside. Heavy or long-term use can lead to addiction, and addiction can lead to fatal overdose. Many countries, including the United States, Canada, and the United Kingdom, are experiencing an opioid epidemic, as misuse of these drugs has risen.

Depending on the cause of your chronic pain, your doctor might prescribe non-opioid drugs. For example, triptans can help with chronic migraines. Chronic nerve pain might be treated with gabapentin (Neurontin) or pregabalin (Lyrica). Cortisone shots are used to relieve inflammation and pain in specific parts of the body, which can be useful if you're dealing with arthritis.

Psychotherapy

Psychotherapy for chronic pain management comes with minimal risks and side effects, especially when compared to medication. It can also be used in combination with drugs and self-help measures to achieve strong results. Two common therapy options for pain relief include cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).

CBT focuses on changing negative thinking and unhealthy behavioral patterns. It can alter your perception of pain and help you build new coping strategies, which also reduces stress. You might learn how to identify unhelpful thoughts, such as “This pain controls my life.” Then, you can replace them with more reaffirming self-talk, like “I can still live a fulfilling life.”

A skilled therapist may also walk you through relaxation techniques that you can rely on, such as diaphragmatic breathing for stress reduction.

ACT puts a heavy emphasis on accepting pain rather than avoiding pain and triggers. Mindfulness plays a role in this, as you learn to acknowledge sensations and thoughts without passing judgment. Then, you can commit to taking actions and setting goals that align with your personal values without the fear of pain hanging over you.

For example, rather than worrying about whether a migraine will trigger as you socialize with friends, you set aside that worry and leave home. If discomfort does arise during the outing, you continue to move forward, reassuring yourself that the pain isn’t the same as actual damage. You can function regardless.

How to help someone in chronic pain

People who deal with physical and mental pain are also at risk of slipping into self-isolation. They may see themselves as a burden, or fatigue and stress can lead them to forgo social events. Over time, that isolation exacerbates both their physical pain and emotional distress. If you have a loved one in chronic pain, recognize that your social support is important.

Spend time researching their condition. Maybe you have an aging parent who has developed arthritis, or a friend who experiences recurring bouts of back pain from an injury. The more you learn about what they’re going through, the better you’ll be able to support them emotionally and physically. In addition to looking at official medical resources, talk to your loved one about their personal experiences as well.

Encourage healthy lifestyle choices. You can’t control your loved one’s life, but you can offer suggestions that move them toward healthier habits. Offer to join them in light exercise or daily meditation for example, or work together to create a low-inflammation meal plan.

Be patient and flexible. Unexpected pain flare-ups may lead your loved one to cancel plans, reschedule, or leave social events early. Or maybe they seem less than engaging when you’re spending time together. Don’t take any of this as a personal rejection. Be patient, and don’t stop inviting them on outings.

Offer and accept help. Ask if they need help with specific tasks, such as shopping, laundry, or running general errands. Don’t forget that your relationship should still be mutually beneficial. If they offer to do something for you, don't question whether they can handle it. Give them space to help you. This can reinforce their sense of independence.

Acknowledge your limits. Don’t feel as if you need to “fix” your friend or loved one’s condition or shoulder all of their responsibilities. Sometimes just being present and willing to listen can help take their mind off the discomfort. Having reliable social support can also make them feel empowered to find ways to cope with their chronic condition and break the cycle of physical pain and emotional distress.