The Psychological Impact of Chronic Pain: Strategies for Managing Your Mental Health

The Psychological Impact of Chronic Pain: Strategies for Managing Your Mental Health
If you live with chronic pain, then you already know firsthand how it can significantly affect your mental health. People who experience chronic pain, no matter the cause, are much more likely to also live with mental health conditions like depression, anxiety, and PTSD.

Although living with chronic pain and co-occurring mental illness can be challenging, many things can help you manage – including lifestyle changes and professional treatment. Here’s a look into the interwoven connection between chronic pain and your mental health.

Understanding chronic pain and its psychological effects

Chronic pain is any type of pain or physical discomfort lasting over three months. Some people who experience chronic pain are in pain all the time, while for others, the pain comes and goes. Chronic pain differs from acute pain, which is when you have intense pain for a short period – for example, after getting injured.

Chronic pain can happen anywhere in the body and can be caused by many different things, including illnesses and injuries. Some of the most common causes and types of chronic pain include:

• Arthritis
• Neck and back pain
• Headaches and migraine attacks
• Muscle pain due to fibromyalgia and other conditions
• Cancer pain (for example, pain at a tumor site)
• Nerve pain
• Testicular pain
• Face and jaw pain (due to TMJ and other issues)
• Pelvic pain (often premenstrual pain)
• Stomach pain due to gastrointestinal issues
• Long-term pain after an injury or due to scar tissue

Chronic pain is more common than you may think – according to the CDC, around 20% of the U.S. population lives with chronic pain so severe it affects their day-to-day living^[1]. Approximately one-third of Americans experience some type of chronic pain in their lifetime, and up to 90% have some level of back and neck pain^[2].

How does chronic pain affect mental health?

Chronic pain harms daily life, and research shows it can significantly worsen mental health. Chronic pain puts you at a much higher risk of developing several different mental health disorders and lowers your overall life satisfaction and well-being.

Depression

Depression, in particular, is highly linked with chronic pain. Studies have found a large percentage of people who live with chronic pain – some reports show up to 100% of these people – also experience symptoms of depression^[2]. People who live with chronic pain are generally three times as likely to have depression as the general public.

Suicide is also a concern for people with chronic pain. People with chronic pain are almost twice as likely to die by suicide^[3].

Anxiety

People with chronic pain are also more likely to experience anxiety. You may find yourself feeling nervous about the pain coming on or the impact it will have on your life. For example, you could have anxious thoughts like, “What if I start feeling pain during my important work presentation?” These types of thoughts can lead to increased stress and anxiety.

Substance use disorder

Chronic pain also often appears together with drug and alcohol addiction. Many people are in so much pain they feel they need to take drugs and alcohol to cope with the pain. If you’re prescribed opioid painkillers, that can lead to an opioid addiction as well. Approximately 10% of people with chronic pain misuse prescription opioids^[4].

PTSD

Chronic pain can be linked to post-traumatic stress disorder, or PTSD, as well. Up to 35% of people with chronic pain have PTSD, compared with only 2% of the general population^[2]. One theory to explain this link is events that can cause chronic pain – such as severe accidents, illnesses, or assault – can also cause a traumatic response.

The interplay between chronic pain and mental health

So why are chronic pain and mental health problems so highly linked? The answer is complex; it’s not only that chronic pain causes mental health problems, but mental health problems can also make chronic pain worse. There may also be some underlying third factors that can lead to both.

Chronic pain can lead to mental health problems in apparent ways. It’s very stressful to live with chronic pain. Not only are you in physical pain all the time, but you may also experience secondary effects in your life, such as:

• Reduced productivity or ability to work, which can lead to lower wages (or even unemployment)
• Sleep disturbances and fatigue
• Impacts on relationships which can lead to social isolation and loneliness
• Difficulties with daily living skills like bathing, shopping, and cooking

All of this can lead to high levels of stress and can understandably worsen mental health. For example, loneliness is one of the most significant risk factors for depression. Experiencing chronically high levels of stress hormones like cortisol can significantly affect both your physical and mental well-being. It can disrupt sleep patterns, exacerbate anxiety, and lead to a heightened state of alertness that makes relaxation and recovery difficult. This constant state of stress and pain can create a vicious cycle where mental health issues worsen the experience of pain, which in turn further deteriorates mental health. Recognizing and addressing these interconnected factors is crucial in managing the overall impact of chronic pain.

Research shows the impact of chronic pain on functioning, not the severity of the pain itself, is most highly associated with depression and other mental health conditions^[9]. In other words, people with chronic pain can maintain their mental health as long as they’re able to continue doing the things they usually do.

The relationship between chronic pain and mental health is bidirectional, which means it isn’t only that chronic pain leads to poor mental health because of the reasons we’ve talked about – poor mental health can also affect pain perception.

For example, people with depression are more likely to rate their pain higher than people without depression. Depression can also cause unexplained physical symptoms such as headaches and stomachaches. All of this can make the experience of chronic pain more intense^[5].

People with pre-existing mental health conditions are also more likely to develop other illnesses that cause chronic pain. One study found people with pre-existing mental illness were more likely to develop fibromyalgia after developing mental illness^[6].

In addition, the same regions of the brain that feel pain are also responsible for processing stress and emotions. Functional imaging studies show chronic pain and mental illness have the same neural mechanisms^[7].

This all means the relationship between mental illness and chronic pain can quickly become a vicious cycle that’s hard to break. Living with pain can worsen your mental health and make you feel more depressed and anxious. But feeling depressed and anxious can cause chronic pain to feel worse – and so on.

To break out of this cycle, it’s essential to make lifestyle changes that address both mental illness and chronic pain and the underlying causes behind both.

Strategies for managing the psychological effects of chronic pain

Thankfully, there are effective strategies that can help you cope with chronic pain and its related mental health struggles. There may be no cure for the underlying health condition leading to your chronic pain. Still, by addressing underlying mental health concerns, you can improve your overall well-being and functioning – and may even be able to reduce your pain.

Therapy for chronic pain

Treating chronic pain with psychotherapeutic methods doesn’t mean your pain isn’t real or it’s “in your head.” Your pain is valid. But chronic pain and depression (and other mental illnesses) can become locked in a vicious cycle, as we described above. Counseling and therapy can help you break out of this cycle. Treating only the physical pain without addressing co-occurring mental health concerns isn’t likely to be as effective as addressing them both.

Some of the most effective psychotherapeutic treatment methods for chronic pain include^[8]:

• Cognitive-behavioral therapy (CBT) can help you to challenge the unhelpful thoughts you have about chronic pain that may be making pain worse. CBT can also teach you how to make adjustments to your behavior so your pain is better managed.
• Acceptance and commitment therapy (ACT) guides you to practice acceptance of things in your life that are out of your control, which in many cases includes chronic pain. Even if pain may be an unavoidable part of life, you can focus on living in a way that aligns with your values.
• Mindfulness-based therapies teach you to be nonjudgmental and aware of the present moment, even when the present moment feels unbearable. Mindfulness can also help you with relaxation.
• Supportive therapy helps assure you that someone is in your corner and you are not alone.
• Biofeedback uses monitoring devices to help you track your physiologic process, including heart rate, breathing, muscle tension, and so on. You can learn to control some of the stress responses contributing to pain.

Self-care and lifestyle changes

You may also need to make changes in your lifestyle to live well with chronic pain, which is something a mental health professional can help you with. Some examples of self-care practices to consider include:

• Managing stress: Stress can make both chronic pain and mental illness much worse, so it’s essential to find healthy ways to relax.
• Exercising: Although it’s difficult to do when you’re in pain, moving your body is vital for your overall well-being.
• Prioritizing rest: Both chronic pain and its associated mental health problems can get in the way of good sleep. It’s critical to prioritize rest to address both concerns.
• Social connection: Living with chronic pain can be isolating, but social connectedness is one of the critical pieces of good mental health. Find ways to stay connected with your community.

Holistic mental health treatment at The Center • A Place of HOPE

At The Center, we understand that every aspect of your health is intertwined. We use a unique Whole Person Care approach to mental health treatment. We understand that treating chronic pain and mental health issues isn’t as simple as giving you a pill. We’ll work with you to address your underlying concerns to facilitate healing on every level.

If you’d like more information about admissions, you can schedule a callback with us. One of our team members will get back to you at your earliest convenience.

1 – https://www.cdc.gov/mmwr/volumes/72/wr/mm7215a1.htm
2 – https://www.ptsd.va.gov/understand/related/chronic_pain.asp
3 – https://www.pbm.va.gov/PBM/AcademicDetailingService/Documents/PAIN_Provider_AD_Chronic_Pain_and_Suicide_Factsheet.pdf
4 – https://nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-2-co-occurring-substance-use-disorder-physical-comorbidities
5 – https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/pain-and-depression/faq-20057823
6 – https://pubmed.ncbi.nlm.nih.gov/29577509/
7 – https://pubmed.ncbi.nlm.nih.gov/27344405/
8 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000182/
9 – https://www.pharmacytimes.com/view/research-finds-impact-of-chronic-pain-on-daily-life-is-biggest-threat-to-mental-health