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Depression and Pain Go Hand in Hand

People who are depressed often say they are feeling sad, blue, overwhelmed or hopeless. But did you know that many who suffer from depression also complain of acute or chronic pain that in many cases is related to their depression?

“Pain frequently accompanies depression,” says Joshua Wootton, PhD, a psychologist and Director of Pain Psychology at the Arnold-Warfield Pain Center at Beth Israel Deaconess Medical Center. “There is a highly intertwined and overlapping relationship between depression and chronic pain,” he says.

For one thing, there are certain pain syndromes, such as fibromyalgia, that are not usually seen without depression.

Now, it is not surprising that people who are suffering chronic pain may also suffer from depression. Chronic pain can certainly make a person depressed. In fact, up to 60 percent of patients seen at the pain center are suffering from symptoms of depression, he notes.

But the more surprising fact is that being depressed can cause pain in and of itself. Wootton notes that people who are depressed often report insomnia, loss of appetite, fatigue, lowered sexual desire and an inability to enjoy the things they once enjoyed.

“Any of these things can lead to pain,” he says. “Being sleep deprived can lead to a number of painful conditions.”

On top of that, there is a phenomenon called somatization disorder, where a person suffers pain in the absence of any physical issue that could be causing the pain. It could be that a psychological issue — a problem at home or at work or something dating back to childhood — is so difficult or distressing to think about that the mind causes physical pain in order to deflect attention from the mental issue, says Wootton.

“The pain takes your mind off what is really the problem,” he explains.

Back pain is a common problem in those whose minds are doing this. In such cases, back specialists have been unable to find any structural problems in the backs of such patients, yet the pain is often debilitating. Still, many patients find such a diagnosis difficult to believe.

“They are bent over and can’t straighten up, but they say, ‘How can you say this is due to unresolved grief over the loss of my father? My pain is real.’ ”

It is a big step forward in the treatment of somatization when physicians can acknowledge to the patient that the pain may be real, while helping the patient to understand and accept that it may not be the result of physical injury or damage, he says.

Those who are suffering from a somatization disorder are more likely to see their pain issues resolved if they are open to the diagnosis, he points out.

“Pain may not be psychological in origin, but how we respond to it always is,” he says. “Depression and somatization can complicate and worsen a patient’s pain picture, even when there is physical injury.”

Wootton warns that patients with pain should have their backs or other pain areas checked out to make sure there is no structural deficiency before deciding that their pain is due to a psychological issue, however.

He says psychotherapy in combination with anti-depressant medication is helpful in resolving many of these problems. Many receive these therapies in addition to medically indicated procedures and therapies offered at the pain center, which may include injections, anti-seizure medications, spinal cord stimulation, physical therapy, mind-body programs and other methods.

“The best solution is for the pain physician to work with mental health clinicians to come up with a comprehensive plan,” he says.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.