Both chronic pain and mental health problems occur quite often in the general population. There is significant overlap – patients with symptoms of chronic pain may concurrently struggle with mental health symptoms, such as depressive or anxious symptoms, while mental health patients are more likely to report recurring and chronic pain, and are also likely to seek medical help specifically due to physical symptoms rather than mental health symptoms.
The relationship between pain and mental health begins in the brain and has much to do with how we process pain signals, how they affect mood and health, and how our mood in turn further sensitizes us towards pain and discomfort. Like a cycle, chronic pain and certain mental health symptoms feed one another – and in cases where patients are diagnosed with both mental and physical conditions, one cannot be treated without the other.
Mental and Emotional Anguish: A Neurological Cycle
There are many ways in which a person’s neurological health affects their psychological state and health, and prolonged sadness, stress, and trauma can have an altering effect on the way we process experiences and generally perceive the world. Similarly, stressors – such as recurring and constant pain – can worsen psychological symptoms and make it harder to manage and treat them.
The physical and psychological are very much intertwined in the brain, and pain is one of the best ways of explaining that intersection. Cognitive and emotional perceptions alike can have a significant effect on pain: the effects of some analgesic drugs can be counteracted by the expectation that they won’t work, and the expectation of feeling better makes analgesic placebo possible. Similarly, mood affects pain.
A generally positive mood makes for less pain, while a negative mood often heightens and highlights discomfort and pain. Anxious thoughts – such as expecting pain management techniques and medication to fail, not expecting pain to get better, worrying about more pain, and struggling with positive thinking – can have a massively negative impact on pain management and can greatly increase chronic pain symptoms. Similarly, general depression and depressive symptoms can make pain worse.
However, the shared neural mechanisms behind both pain and mental health means that there can be ways to treat both through pharmacology and therapy that aims to address them together. A pain management program that incorporates mental health treatment can be more effective, not just by managing accompanying mental health symptoms, but by targeting mental health symptoms to improve pain symptoms, and vice versa.
When Depression Is Mistaken for Pain
Chronic joint pain, limb pain, gastrointestinal problems, tiredness, appetite changes, back pain, and more – while these are all physical complaints, they are quite common among patients with depression. Often minor and inexplicable, some of these symptoms may present long before a patient gets a mental health diagnosis, and many who seek medical help for their depression do so due to seemingly unrelated aches and pains.
The physical signs of depression cause the mood disorder to often go unnoticed. Neurotransmitter dysregulation, underlying endocrine conditions, and chronic stress are just some of the potential causes for both chronic pain and mental health issues with no immediately apparent physical cause such as injury, infection, or neuropathy. This link can be particularly insidious, because if one or the other is left untreated, any treatments that aim to solely address physical or mental health symptoms will end up seeming ineffective.
This in due to the complex nature of how these two conditions interact. When a patient struggles with chronic pain and concurrent mental health issues, addressing any one symptom will not be enough to treat them in the long-term. Breaking the cycle requires an approach that takes both pain management and mental health needs into consideration.
The Importance of Holistic Treatment
A holistic approach simply describes a treatment plan that takes the “whole” of a person into consideration, and it often includes both traditional and alternative treatments, from a first-line medication against pain and depression such as analgesics and antidepressants, to CBT, therapy, physical therapy, dietary counsel, journaling, other forms of talk therapy, non-surgical or minimally-invasive interventions, acupuncture, massage, and more. Holistic treatment does not do away with any evidence-based treatment approach, nor is it the same as naturopathy or other forms of alternative medicine.
It is simply an approach to co-occurring disorders that allow specialists and physicians to treat all symptoms by developing an individualized treatment plan based on thorough diagnostic work, to establish potential causes and underlying factors, from diet and family history to recent injuries, cancer, and more. When treating chronic pain with mental health issues, it is important to address both the pain and any psychiatric symptoms. Newer anticonvulsants, SSRI antidepressants, beta blockers, and even certain herbal remedies may play a role in treating both pain and mental health issues.
Treatment plans may seek to induce immediate relief, provide a long-term prognosis, or both. Because of the shared mechanisms behind certain kinds of pain and mental health symptoms, some drugs may help both pain and depressive or anxious symptoms. Even when patients with chronic pain do not present with a psychiatric disorder, they may still struggle with a prolonged depressive mood and signs of anxiety due to their pain. Addressing these issues alongside their pain symptoms can aid in pain management, as pain treatments are more likely to work when the patient is in a better mood and expects a good prognosis.
An Ongoing Process
Chronic pain management and mental health treatment both share a need for continuous monitoring, frequent follow ups, and an evolving treatment program. In many cases, both chronic pain and mental health issues require a long-term approach that sees their treatment as an ongoing process, where the goal is simply to improve quality of life. Many conditions, like depression or fibromyalgia, do not have an outright cure.
Instead, their respective treatments rely on mitigating symptoms and allowing patients to live their lives as best as possible, within the limits of what modern medicine can achieve. If left untreated, mental health issues and pain symptoms can be additive, with one set of symptoms making the other much worse over time. But with an individualized treatment plan that addresses the patient, takes into consideration their needs and circumstances, and is regularly updated, most people with both pain and mental health issues can lead fulfilling lives.
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