Mental Illness and Chronic Pain

Mental Illness and Chronic Pain

By Darisse Smith

Darisse Smith

Darisse Smith

When you have chronic pain, life can be difficult to manage. You do not feel well either in your body or your mind, despite our efforts to remain positive and proactive.

What if you have chronic pain and a major depressive disorder, anxiety disorder, bipolar disorder or another mental illness?

It can seem that the world is stacked against you. General depression is strongly associated with those who suffer from intractable pain since the experience of pain can make someone feel helpless and uncertain about the future. There are also high rates of bipolar disorder and anxiety disorders amongst pain patients, especially those suffering from migraines, fibromyalgia and arthritis.

Anyone who has experienced depression knows that depression is more than just feeling sad for a few days. Symptoms of major depression include, fatigue, loss of interest in your daily activities, feelings of worthlessness or guilt—wait a second, do these symptoms also sound familiar to pain patients?

There is evidence that depression and pain share similar biological pathways, meaning that it can be difficult for a doctor to discern between symptoms of depression and symptoms of feeling hopeless in pain. Other shared symptoms of chronic pain and depression include: insomnia, weight and appetite changes and changes in energy and libido. Sometimes this leads to either a patient’s pain not being taken seriously or it leads to a doctor missing an underlying psychiatric disorder. Because of the similar symptoms, researchers can’t accurately determine the overall number of Americans who are suffering from chronic pain and depression. It is estimated that 15 million Americans, or 6.7% of the population suffer from depression.1 The rates of depression among pain patients is estimated to be approximately 35%.2

Chronic pain and anxiety disorders share similar symptoms, too. Muscle tension, body soreness and headaches are common physical symptoms of certain kinds of chronic pain and anxiety disorders. Anxiety disorders are common among those suffering from arthritis, back pain and migraines in particular. Just as in depression, the concurrence of chronic pain and anxiety disorders make each difficult to treat. One good bit of news with anxiety disorders, though, is that treating either the chronic pain or the anxiety disorder can ease the most troublesome symptoms.

Another common disorder among pain patients is bipolar disorder. There are two types of bipolar disorder: type I and type II. Bipolar I disorder is what most people think about they hear the diagnosis, “bipolar disorder.” Bipolar I disorder is characterized by periods of severe mood episodes, ranging from very high sometimes psychotic highs, and then other periods of depression. Bipolar II disorder involves milder periods of mood elevation with periods of more severe depression. Research suggests that both fibromyalgia and migraine disorders have a large comorbidity with bipolar disorder. According to a University of Alabama research study, 13% of patients with fibromyalgia had bipolar disorder, compared to just 1% of the general population. 25.9% of bipolar patients suffer from migraines, compared to just 10.3% of the population.3

All of these statistics should not lead you to believe that you will inevitable also develop a mental health disorder. Just what you need, right? Also, these high rates of mental illness do not mean that the pain is all in your head. What pain patient wants to hear that? In fact, there is a lot of evidence that suggests depression and anxiety can impact your experience of pain. Because certain mental illness and pain share similar mechanisms, the two together can be complicated to treat. The best method of treating both disorders is to create an inclusive team of doctors that include a psychiatrist, psychologist or both. There are many psychiatrists and psychologists who are qualified to treat the mental impact for those who are suffering from a chronic condition as well as their mental illness.

If you are struggling with any mental health symptoms and chronic pain, consider adding a psychologist or psychiatrist to your treatment team.

Also, always know that you are not alone. There are thousands, if not millions of us, struggling along with you. Reach out. We are here.

Darisse Smith is a contributor to the National Pain Report and an Army veteran who has suffered from chronic pain for over a decade.


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Peter Smith, marijuana is NOT addictive! You may become dependant on the relief you get from using it!

Peter Smith

I’ve been suffering from a back injury for months now, and been dosing my self with a lot of pain relievers. I’m starting to think that I might take away the pain of my back with the meds but at the same time punishing my liver slowly. So I started reading articles about marijuana and it’s medical aspect and found this along the way
I am already 34 years old and haven’t tried smoking or any other means of using marijuana and I have nothing against it. My question is that if i try it would I be dependent at the same time addicted to it? And will it really ease the pain? Thanks in advance to those who’ll answer

Eric Smith

Hi, I am new here. My name is Eric and I live in Alaska. I have been diagnosed with fibromyalgia, severe recurring depression, obstructive sleep apnea and insomnia. I am currently seeing a Osteopathic Manipulation Specialist and a family councilor with my wife (only one visit so far). My wife has already left me once and taken our beautiful daughter with. We are back together now but she is making my life a living he**! I have tried to involve her as much as possible, even the doctor has tried to get her involved. She was in agreement but at home she is so angry with me because of our economic situation that she doesn’t even talk to me. I can barely play with my little girl, I barely sleep and my job requires me to get up at 5am, which I have not been able to do for several weeks because of the meds they gave to try to help me sleep. There is more, much more, but this is the basic situation. I just needed to voice this to others who know what I’m going through.

Thanks to you all for being there and fighting this stuff!



Leah, if you want someone to talk to email me
I will give you my phone number. We moved to Alaska from Atlanta 15 years ago. I had a great doctor (neuro/psych) who made sure I had medication for severe chronic headaches. He’s still in practice as far as I know. I hope you can hold on and get treatment but if you can’t I sure understand. Not all the good pain meds have tylenol/ibuprofen/aspirin in them. Mine don’t. Hope to hear from you via email. (((Gentle Hugs))))


Leah I am so sorry you aren’t getting medication if you desire to use it. It’s just not right to refuse medication and expect us to survive on the possibility that some other practices MIGHT help SOMEDAY if you put enough of your life and money into it. My medications have been severely cut and changed against my will making what little life I have a lot less liveable.


Leah I was on a stable dose of meds for 8 years. 225 mcg fence and 4 mg dilauded every four hours for 8 years. It was still an effective dose. Not everyone builds a tolerance and those who do have it happen at various rates. There is no “absolute” on pain management!


I feel if pain was treated correctly I wouldnt have depression. I really don’t have a social life, everything has to be planned. I would have hope for my future, maybe a career, not be in financial straits. I have anxiety because of all of the above, panic attacks now which I didnt even realize that is what they were, the way the medical community has treated me, all the surgeries, doctor visits, procedures and now I have to worry if my meds will be cut off. And now a diagnosis of PTSD. And a profound sadness in the way my fellow pain suffers are being abused and abandoned
I guess 15 years of chronic pain does quite a number on your mental functioning.

Leah Salby

You of all people should know how quickly pain medication tolerance builds up. You have to keep taking more and more. There’s no way out of it. Check yourself into a clinic and get over it all. You have probably made yourself worse because once you try and get off the pain meds it will magnify. If I were you I would try an SNRI. I know of a magnificent psychiatrist in the Georgia area if you live in the area. Only he would be able to take care of you. He works on both the body and the mind and he has 4 degrees.

You are in a pickle. No one is going to keep up that level of narcotics. I have spinal injury and other injuries from an accident myself. I have to live with my pain. I have taken oxycodone before after surgery and it was hell to get off of. When I was hit by a retired policeman while bicycling I woke up in the ambulance thinking oh no I have to take pain meds and get off of them again. It’s pure hell. They are going to cut back on narcotics and you will have quite a problem so you may want to get a clinic set up so you can get off of all this and have something done. There are other medications that are not narcotic for pain. That’s all I can tell you. It’s only going to get worse.

Excuse me for asking but how did you get so many narcotics for this? Most people have nothing like me. You and I both know it’s a fact that medical professionals are more addictive than any other group of people. I’m surprised how you obtained so many different narcotics. You’re going to be scared straight. They just closed down some dental practice where a physician was handing out narcotics left and right and now he’s in jail.

Good luck.


Does anyone else feel that taking the CDC reccomended dose and not nearly enough to actually do anything for the pain is just feeding your body enough opiates to actually cause an addiction that wasn’t there in the first place? Constantly chasing the pain and not getting relief just doesn’t feel right. I never felt that I could possibly be addicted when I was taking medication at a dosage appropriate to treating my pain but just taking a drug that does almost nothing just feels different. It could be the different medication, I was on fentanyl and dilaudid now with severely lowered dosage of both medications the dr has added oxycontin. I never felt side effects from my previous,admittedly high doses, but just feel mentally off taking the oxys at a much lower dose and am depressed in a way I hadn’t been previously. I do hope I’ve made sense, I am never sure anymore

I.M. Suffran

I have suffered from chronic pain patient for 20 years. I did everything that my physicians advised me to. I did not want to have surgery but I was advised to have surgery OR face the possibility of being paralyzed. Regardless, after a few months of continuous disabling pain, I would have ate a muddy pair of tennis shoes to get 24 hours of sufficient pain relief. One year after the first surgery, I had to have another surgery, more invasive, a fusion. It does NOT matter how we come to be in chronic pain. What matters is that there IS treatment.for chronic pain …….NOW. In the furture, if there is one, no doubt that medicine will continue to improve (if money can be made from it) to the point that opioids may become obsolete for pain control. Depression WILL accompany chronic pain. CLINICAL depression will make pain feel worse. If there was a treatment other than opioids for chronic pain, those who HAVE to be prescribed opioids for pain would opt for alternative treatment. There is NO euphoria after we have been prescribed opioids for just a short period of time. A recreational opioid user will get their euphoric feeling because of infrequency of use. Everyday use of opiods unfortunately need to be increased to sufficiently suppress chronic pain. I, after 5 years of being treated for chronic pain, ever increasing in dosage, adding different opioids to help suppress pain finally found the opioid MEDICATION that works best……..for me. Methadone oral medication. Now according to the new CDC “guidline” a conversion chart has been established even for a pain “specialist” to prescribe opioid medication by. It is MANDANTORY, not a “guidlne” punishable to the physicians who are trying to help chronic pain patients by license suspension or revocation. My personal pain specialist is reducing my daily methadone medication from 100 milligrams per day down to 20 milligrams per day. 20 milligrams per day is the dosage I was started on 15 years ago! I had gotten up to 160 milligrams per day up until 5 years ago. I have reduced myself to 100 milligrams per day and have been at the 100 milligrams per day for about 5 years and do not feel that I would ever have to increase dosage barring further injury or different disease circumstances. I still have days that I can hardly function but, thank the good Lord I have not had the depression that accompanies pain since I was placed on methadone for my chronic pain. The CDC has targeted methadone patients to be reduced to 20 milligrams per day. I take no other medication other than the methadone. Now, if I can not function on 20 milligrams per day I will NOT be able to earn a living for myself and my wife. Thus I will be discharged from treatment for the physicians fear of license revocation. Where does that leave the patient? I tell you where, disabling continuous pain and clinical depression.… Read more »


It’s amazing to me that most any cpp can understand the different types of depression and very few others can’t, don’t or won’t get it!

Jean Price

I think there are several issues here in this article…the “normal” depression we can have living with pain, the mental health condition of clinical depression (without a focal reason), and clinical depression combined with persistent pain from a disease or a trauma. A lot to sort out and understand…and it’s important to do so. Depression is really a normal, natural feeling that comes with loss. It’s one of many feelings…such as frustration, anger, sadness, feeling isolated, having a lowered sense of worth, being anxiousness, overwhelmed, unable to concentrate, being afraid, having sleep issues…and many others like these which normally arise after a life change resulting in a loss. And of course, pain is a huge change, and we have major losses resulting from pain, then ripple losses later on, and also disability stemming from the diseases or traumas that caused the pain! So it’s understandable that those in pain can be depressed, especially in the beginning and also when further losses occur, as they surely will! In fact, it would seem abnormal, even possibly considered unhealthy, to NOT BE DEPRESSED at some point, with long term, daily, life limiting pain! That would seem a denial of what is happening more than a degree of mental healthiness….especially at the start of the life changes from pain. I think people with pain learn over time how to deal with this simple depression from the changes and losses, for the most part. They get support from others, read self help books, find ways to cope, process these feelings…. and the depression doesn’t erode their whole life (if they are receiving adequate medical care for their pain)!! Plus, the depression they have does have a reason behind it, unlike the type of depression that is a mental health disorder. I find it interesting and appropriate that many grief counselors are not usually in favor of medicating normal depression…unless a SHORT course is needed for the initial crisis time right after the loss, or if the depression is overwhelming from multiple losses and grief is complicated. It is best to process these feelings without interference from medication….that’s part of grief work and learning to live with all the changes and the resulting losses. This is also so important when pain and illness or injuries brings change to our lives. It all takes time and support, yet this isn’t a type of mental illness, it is merely simple depression. It is not the type that TOTALLY interferes with life and Is a complex, long term condition. That type of depression IS an illness in and of itself…usually referred to as clinical depression. This does call for targeted medical care and is seen as a mental health issue, needing specialist care and possibly even pharmaceuticals to help treat the patient. Many think of this kind of depression as a chemical imbalance and there are several types of these disorders with varying symptoms besides depression. These are serious conditions and definitely need the care of professionals. When those… Read more »


I don’t feel like I can admit to any depression or fear because if I do my pain will be totally negated instead of mostly negated. I would also be taking the chance of losing my concealed carry permit. Even being on opiates for pain control could affect my legal ability to own or carry a firearm! My constitutional rights are very important to me because a freedom you don’t use you lose!

Bob Schubring

Kathy C, your comments are very insightful. Mental illness, in our culture, has dangerous political implications. Beginning with the inter-racial rape scene in DHGriffith’s 1915 propaganda hit piece, “Birth of a Nation”, Americans have been conditioned by the Hollywood media to fear the “uncontrollable urges” that allegedly are associated with mental illness or “mental defect”, as it was called then. This belief is highly-destructive of democratic institutions, because it demands that people yield their freedom to a powerful elite who have the mental capacity to make our decisions for us. While anyone can become mentally disabled by an illness…a head injury that knocks a person unconscious, requires the rescuers to make life-affecting medical decisions for the victim until the victim regains consciousness, for example…the legitimate practice of medicine works to restore the person’s functionality as quickly as possible. Politics corrupts this process by using the alleged “mental defect” as an excuse to strip the person of the right to make decisions for himself or herself. Most critically, this includes the right to make economic decisions for oneself. Where to work. What to do. How much one is paid. What working conditions appear unsafe. Where one can spend one’s pay. What one may buy with it. Every one of these economic decisions is legal for a free person, to decide for himself or herself. But by applying the label of “mental defect”, a person can be stripped of the right to make those decisions, and put into a life of being forced to do what the political class demands. When we hear people labeling us as “drug-seekers”, as “mentally ill”, or any number of other labels, our concern must be with their intention in applying that label, and how they intend to abuse us, because of it. I am a frustrated drug seeker. As I write this piece, I’m suffering the nasty cough that lots of people have, from the virus that’s going around. I used to be prescribed a cough medicine that contained hydrocodone, for cough. But thanks to the Bushes, Clintons, and Obamas’ choice of Drug Czars and drug policies, that drug is now a Schedule II narcotic. My old doctor retired. My new doctor is scared of his own shadow. Because I used to be on hydrocodone, he won’t put me on a Schedule III narcotic for cough, either. DEA might be watching. (The scheduling of hydrocodone is itself absurd. Codeine is a Schedule III. It works for cough, but the effects are faster. It wears off faster. And it induces a greater feeling of euphoria than does hydrocodone. And the trap we will step in, if we argue that hydrocodone shouldn’t be on Schedule II, is that someone will seize upon the excuse to put codeine on Schedule II alongside it. We cannot argue with these people using reason. Their goal is to win the argument, despite being factually wrong.) Thanks, politicians. This cough’s for you.

Donna Rubinetti

Mark Ibsen:
If you’re responding to me, I have no idea what you’re talking about. What does your comment even mean???

Renee I don’t have the answers you probably want. But I must tell you a short story. I was in the hall of the ER, outside of my hubby’s room because he was there for a GI emergency. I couldn’t believe what I heard! There what a poor woman writhing in pain in the room across the hall! She was crying and she was really in pain and I could tell that she was telling the truth I just could tell. The nurses were in the hallway and they said “oh she’s just faking she has bipolar, nothings wrong with her she’s just faking”. I was fuming I was so upset. My brother has that and he doesn’t fake illnesses. you can tell when someone’s in pain they can check blood pressure and things like that and they can tell! Doctors are not stupid. The nurses shouldn’t be so rude and I heard it and it was just awful it made me so sad!
I also want to share that I suffer from PTSD. I was hit by a car In 2002! While I Was in the hospital, Aside from intractable pain, multiple injuries and very badly hurt; I wasn’t acting like myself! My husband kept telling them that “something is wrong! My wife is not herself”! Instead of finding out why, instead of putting 2 and 2 together -because I’d been unconscious for 20-30 mins.! They sent up a Psych consult!! They told us that all of my injuries and pain are “because I was abused as s child and because of my PTSD”! Omg!! My husband signed me out AMA! He took me to my own GP & Neurologist. They found that I have suffered s TBI /Traumatic Brain injury!!! I was in brain injury rehab for 3+ years! I ended up with multiple surgeries and a pacemaker and 2 screws in my shoulder! I ended up with prisms in my glasses and 2 hearing aids! I ended up with 2 AFO’s (leg -foot braces) and I was hurt terribly and luckily we found a great brain injury PMR specialist! Thank God so got help because they wanted to try and blame my pho abuse and PTSD and phonAnorexia because I was starved and more! Feel free to email me, we can chat more and I’m so sorry that happened to you!

Mark Ibsen

You are clearly confronted by something
This is often the case when a spiritual conversation is called for.
Transformation, so to speak.
Grief can manifest in all these ways.
Good luck on your spiritual quest.

Kathy C

The Industry now describes the narrative. They decided that treating the pain was inconvenient. Obfuscating chronic pain, with drug abuse, or Mental health is just more profitable. The Pharmaceutical Industry has a big stake here, along with the medical industry, they want no accountability. Even the Insurance Industry, if Workmen’s Comp can deny a small percentage of claims due to “Mental Issues,” they can make billions.

We are in the Post Science Post Fact World. The Studies that get funded are the ones that support Industry. There is not much separation between Academia and Industry anymore. The Research that gets funding is the Research that supports the Industry. Corporate Media determines which Studies are promoted by the Media, only the over simplistic ones that don’t conflict with the current narrative, and ensure future profits.
It has been very profitable for the Industry to obfuscate the current Pain narrative. We saw the discussion of pain turn from treating it and improve people lives, to the Horrors of Drug Addiction. By conflating these two issues, they put pain patients in the category of Mentally ill, or Drug fiends. They are no longer credible, they now have an ulterior motive, and they need “Mental Health Treatment.” Instead of treating the pain, they don’t even have to diagnose it anymore. This saves the Industry billions in the short term. They no longer have to concern themselves with the pain patients quality of life or even their humanity, because they could be mentally ill, or drug Addicts.
There are no studies on the Trauma Pain Patients go through when they can’t even get a Physician to acknowledge that they are in pain. Most Physicians are under Gag Orders, they have to monitor every word they say, the Big Corporate HMOs monitor every word. They are not allowed to mention anything to do with pain. They are told it might encourage the patients, or reinforce the pain or other Pop Pseudo Science. The mention of a previous surgery could reflect badly on the Industry so that is not allowed either. They are now Corporate Pod People, they can be fired and have their careers ruined for the wrong word or straying from the narrative.
For a lot of Physicians every day is Groundhog Day, , they react like each patient, just developed the pain. Duration, previous surgeries Imaging, have no relevance. They are now directing patients to Alternative care, there is no Scientific Evidence that is works, the only thing that can be inferred form any of these Studies is that they are Subjective, and any perceived benefit can be explained by Circumstances and the Placebo effect.

PGH girl (HJ)

I had a psychologist say some wonderfully validating words. I was worried I wasn’t “normal” because I was depressed.

She said, matter-of-factly, “You have the burden of complex chronic illnesses. Don’t you think it’s NORMAL to be depressed?!?”

Validation helped tremendously. I still do get depressed on and off, but I want to slap ANY doctor who dares to say to me, “You’re ‘just depressed'” as a way of writing off my physical symptoms. I had one very abusive, very unprofessional moron of a doctor tell me that nobody wants to treat depressed patients, that doctors see them and want to run in the other direction.

Well, guess what, doc? I ran away from you and I’m not looking back. I’ve got doctors who had a genuine inclination to want to help me, to DO NO HARM… who offered me medications to treat my physical symptoms instead of just my choice of different anti-depressants, and I’m able to be more engaged in my life, I’m still able to work full-time (thankfully, not something I take for granted and not without difficulties), I exercise regularly and you can’t take ANY credit for helping me no matter what your biases may be.

Renee Mace

Any (EMPTY NESTERS) women out there, have you noticed that we too are put on the (She’s faking it or she’s depressed and is looking for attention? When I was in my car accident back in 2001, I already suffered from PTSD from childhood abuse and I suffer with depression and
anxiety, I have been seeing a psychiatrist for many years and in the beginning of 2001, he released me from his service saying that I had good control over my anxiety and to take my depression medication. I was doing really well, then the car accident, which caused CPS, Central Pain Syndrome in both my legs. For the first two years, I was told that the only thing wrong with me is I am an empty nester looking for attention. Mental Illness is a horrible condition to start with, but because you are a women in chronic pain that children are all grown up and moved away, that it’s just you making it up. Sorry about all my whining but has any other women been treated like that?

Donna Rubinetti

I suffer from intractable chronic pain and major depressive disorder. I have a psychiatrist, psychologist, pain mgmt physician and a host of other doctors/practioners. So far nothing is helping me. I know that there is a circular effect. I have been helped in the past with these issues. Now nothing is helping. I’m trying everything. I have full body crps and it’s spreading even more. I am terrified. I too am a mental health provider. I’ve had to give up my practice. This has been going on for four years. It’s hard to be positive.

Michael G Langley, MD

I have been unable to figure out why, with all of the geniuses involved in medicine, why have they not figured out that the 24/7 misery of chronic pain does not lead to depression and other related mental illness! Why was it was so completely ignored, up to now.!