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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