The Mental Health Effects of Chronic Pain

person on sofa with leg pain

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Chronic pain affects more than one in five adults in the United States. It can interfere with many different aspects of life, including mental health. 

While pain may be physical in nature, it can take a toll on how a person feels and thinks. Prolonged pain often contributes to feelings of stress, anxiety, and depression. It can also interfere with sleep, relationships, work, and other aspects of a person's life.

This can have an adverse effect on emotional and psychological well-being. This article explores chronic pain and its complex relationship with mental health. It also covers treatments and coping strategies that may help.

What Is Chronic Pain?

Everyone experiences pain during their lives. In many cases, such pain is short-lived. However, there are also conditions that can result in pain that is more prolonged, lasting for months or even years.

By one definition, chronic pain refers to persistent pain that lasts three months or longer. Such pain interferes with daily life and can also lead to mental health symptoms including anxiety, depression, and sleep issues. The mental health effects can then exacerbate pain and make it more difficult to manage.

The 2019 National Health Survey found that 20.4% of adults experience chronic pain, and about a third of those individuals experience high-impact chronic pain that limits their daily activities. People most affected by chronic pain are women (21.7%), non-Hispanic white adults (23.6%), and people over the age of 65 (30.8%).

Impact of Chronic Pain on Mental Health

Chronic pain can interfere with a person's daily life in a number of different ways. It can make it difficult to get to and from work. It can also affect a person's ability to concentrate and be productive. At home, it can create challenges with preparing meals, caring for children, or engaging in self-care. It can also cause disruptions in sleep, changes in appetite, feelings of fatigue, and changes in mood.

According to the Centers for Disease Control and Prevention, chronic pain is associated with opioid dependence, decreased quality of life, and poor mental health.

The exact effects can vary from one person to the next. Some of the mental health effects that may occur include:

Anxiety

Anxiety has a complex relationship with chronic pain. Experiencing chronic pain can contribute to the onset and worsening of anxiety, but anxiety can also play a part in the development and aggravation of pain. Research suggests that people who have a greater fear of pain are more likely to develop chronic pain.

One study found that people who experience chronic pain are more likely to hold fear-avoidance beliefs. One possible reason for this is that if someone is more afraid of experiencing pain, they often minimize or avoid movement. However, such behavior then serves to worsen strength and flexibility, which then plays a part in making pain more severe and lasting.

Cognition

Chronic pain can also take a toll on a variety of cognitive functions, including a person's ability to concentrate and recall information. In one study, people who had chronic pain performed significantly worse in terms of executive functioning, long-term memory, processing speed, and selective attention.

When a person is in pain, they often find it difficult to think, remember, and concentrate. Related symptoms such as anxiety, depression, and emotional distress that are linked to chronic pain can also contribute to cognitive impairments.

Depression

Depression is strongly associated with chronic pain. Estimates vary, but research suggests that the co-occurrence of chronic pain and depression may be as high as 85%.

Research has found that having chronic pain leads to a three-fold increase in the risk of developing depression and that this risk increases with the number of pain symptoms that are present.

The relationship between depression and chronic pain appears to be bidirectional. In other words, depression not only emerges as a result of chronic pain, but can also contribute to the development of pain itself. Unfortunately, depression often goes unrecognized, undiagnosed, and untreated. 

Stress

It is perhaps not surprising that experiencing constant, relentless physical pain is a significant source of stress. Being in pain also makes it more difficult to cope with stressful experiences.

People who live with chronic pain also often experience prolonged exposure to stress hormones, including cortisol. Chronic exposure to these hormones has been shown to affect the brain and body in detrimental ways, often contributing to mental health conditions and diseases such as diabetes, cancer, and heart problems.

Stress also plays a role in the experience and perception of pain, so the more stress people are experiencing, the worse their pain often becomes.

Chronic Pain Conditions That Affect Mental Health

Certain medical conditions are commonly linked to the occurrence of chronic pain. And in some cases, people may experience one or more of these conditions along with mental health symptoms.

Some of the chronic pain health conditions that can negatively affect mental health include:

  • Arthritis: This condition involves painful inflammation of the joints. Research has found that people with arthritis have a higher risk of developing psychological conditions including depression and anxiety.
  • Back and neck pain: This type of pain can result from a variety of causes including injury, poor sleeping position, muscle strain, heavy lifting, and medical conditions. Research has found that people who have chronic neck or back pain are more likely to experience symptoms of mental health conditions than people who did not have such pain.
  • Endometriosis or uterine fibroids: These are conditions that affect people who menstruate and can cause significant and debilitating pain. These conditions have been linked to increased emotional distress and a higher risk for anxiety and depression.
  • Fibromyalgia: This is a condition that affects how the brain and spinal cord process signals, leading to pain and other symptoms such as fatigue and problems with memory, sleep, and mood. The condition is associated with a higher risk for generalized and other anxiety disorders, depressive disorders, bipolar disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).
  • Migraines: Chronic migraines are headaches that can be painful and incredibly debilitating. People with chronic migraines experience these headaches 15 or more days a month for three months or longer. Evidence suggests that people who have chronic migraines have a higher prevalence of depression, anxiety, and PTSD.
  • Multiple sclerosis (MS): This is a condition in which the immune system attacks and destroys the protective covering on nerves, leading to damage, pain, and disrupted communication between the brain and body. People with MS are more likely to also have mental health conditions including elevated stress, anxiety, depression, and suicidal thinking.

One study found that among people who reported having chronic pain, 28.3% had no co-occurring mental or physical illness. Slightly more than 35% reported having one physical or mental illness, while 36.3% reported having two or more conditions.

Treatments That Can Help

Comprehensive and effective relief of chronic pain often requires addressing mental health symptoms in addition to treating the underlying medical conditions and providing medications to control pain.

Treatments for the psychological aspects of chronic pain may take an integrated approach, drawing on different techniques in order to address specific symptoms. Treatment approaches that may be helpful include: 

  • Cognitive-behavioral therapy: (CBT) To address negative thought patterns and maladaptive behaviors that may be contributing to depression, anxiety, worsened pain, and reduced coping abilities
  • Interpersonal therapy: (IPT) To improve social relationships and increase social support to help improve mood and accompanying pain.
  • Medication: Certain medications such as the serotonin and norepinephrine antidepressants help with psychiatric symptoms and may improve pain directly.

Tailoring treatment to address different aspects of symptoms, including those related to mood, anxiety, addiction, and other areas, can improve functioning and the ability to cope.

Because of the two-way nature of the relationship between pain and psychological health, some experts recommend screening people with chronic pain for mental health conditions, as well as screening for chronic pain in individuals with mental health conditions.

Coping With the Mental Health Effects of Chronic Pain

In addition to seeking medical attention to help manage pain, there are also things you can do that may help you manage the mental health effects of chronic pain. Some of these include:

  • Finding a support group: Chronic pain can be isolating. Living with pain can make it more difficult to do the things you used to do, including spending time in social activities. Finding others who are going through similar experiences can help you feel less alone and provide valuable support and advice. 
  • Exercising: Studies have shown that exercise can help treat and prevent symptoms of anxiety and depression. It’s important to start slowly and build up gradually to avoid injuring yourself, especially if you have a health condition that causes chronic pain. Some conditions may affect your ability to engage in physical activity, so always check with your doctor first to determine if exercise is safe for you.
  • Practicing relaxation techniques: Mindfulness meditation, deep breathing, and progressive muscle relaxation are all relaxation techniques that can help you manage symptoms of stress that accompany chronic pain.
  • Eating a nutritious diet: Eating healthy foods and avoiding trigger foods can help you feel better and might help you better manage pain. In some cases, you may find that certain foods, such as sugar, caffeine, alcohol, and gluten, can affect your health in negative ways.
  • Getting enough sleep: When you’re in pain, it can be difficult to get a good night’s sleep. But getting enough rest is important for managing chronic pain. Talk to your doctor about ways to manage your pain at night and practice good sleep habits such as avoiding caffeine late in the day and going to bed at the same time each night.
  • Positive self-talk: Pain can make you feel discouraged and more pessimistic about yourself and the world. Talking to yourself in a positive and encouraging way may help you better cope with chronic pain.
  • Finding things to enjoy: When you’re in chronic pain, it’s easy to focus on all the things you can’t do. But finding things that bring you joy can play an important part in improving your quality of life.

A Word From Verywell

Chronic pain has a multifaceted relationship with mental health. Experiencing persistent pain can contribute to mental health conditions, but mental health conditions can also have a detrimental impact on pain. 

Because of this, it is important to seek help from a mental health professional. Persistent pain can take a toll on your mental health. If you're struggling to cope, don't hesitate to reach out for help.

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Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Kendra Cherry
Kendra Cherry, MS, is an author and educational consultant focused on helping students learn about psychology.