by Shelly Mcrae

Created on: July 18, 2007

The connection between chronic pain and depression may be bilateral. Brain pathways that transmit pain signals use some of the same neurotransmitters as those used that affect mood, such as serotonin and norepinephrine. The presence of chronic pain creates an environment in the brain very much like that of depression. The presence of depression opens the door to chronic pain.

In the 2004 issue of the Harvard Mental Health Letter, an article entitled Depression and Pain, puts it this way: "People with chronic pain have three times the average risk of developing psychiatric symptoms usually mood or anxiety disorders and depressed patients have three times the average risk of developing chronic pain."(1)

If the pain takes the form of a back injury, for instance, the ensuing depression can be treated as part and parcel of the injury. Once the internal environment is corrected, that is, once the injury is healed and the brain pathways no longer transmit pain, the depression is likely to cease as well.

But chronic pain is not always a temporary state. By definition, the implication is that it is ongoing. In such conditions as arthritis the presence of depression can aggravate the pain, but the sufferer doesn't associate the pain with depression, but with the arthritis. The importance of this distinction lies in the effectiveness of the treatment. The underlying depression interferes with the patient's response to treatment, both physically and psychologically. It is difficult to alleviate physical pain when the patient still experiences pain from the mood disorder.

The reverse is also true. If depression is left untreated, the sufferer becomes susceptible to chronic pain. Treating the pain without treating the depression will result in frustration at the lack of relief.

Michael Clark, M.D., M.P.H., writing for John Hopkins Arthritis Center, states, "Many factors can interfere with the successful treatment of chronic pain including undiagnosed diseases, mental disorders, emotional distress, personality traits, and personal beliefs. These factors must be addressed directly to ensure that every barrier to the relief of chronic pain is addressed. Depression is one of the most common problems experienced by patients with chronic pain."(2)

In the situation then in which the chronic pain brings on depression it is necessary to understand not only the physiological cause and affect, but the psychological as well. Dr. Clark goes on to say, "If pain resulted in a loss of independence or mobility that decreased an individual's participation in social activities, the risk of depression was significantly increased."

While inside the brain the pathways used for both pain and depression are at work, environmental conditions are exacerbating the conditions. The chronic pain is creating a circumstance of isolation and inactivity. Even without the presence of the chemical imbalances associated with depression, such lonliness and inertia can lead to symptoms experienced with depression. This causes in the patient a lack of will, a serious deterrent to a positive outcome of treatment for pain.

The treatment of depression is necessary, then, if the treatment for pain is to be successful.

Chronic pain leads to depression, but is not a physical cause of depression. Sufferers of depression are more susceptible to chronic pain, but treatment of depression reduces this susceptibility.

Sufferers of chronic pain should be aware that their treatment is closely tied to their psychological health. Chronic pain treatments are more successful if secondary depression is treated as well.

1)http://www.health.harvard.edu/newsweek/Depres sion_and_pain.htm

2)http://www.hopkins-arthritis.org/ mngmnt/depression.html

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