How Are Chronic Pain And Depression Related?

Updated February 15, 2023by BetterHelp Editorial Team

If you experience chronic pain and depression, you know that these situations can make daily living a unique challenge. Chronic pain creates physical discomfort that's short- or long-term. You may be required to do certain activities or take medication regularly to minimize pain levels. 

Depression is a different story, and while some use treatment options like psychotherapy and antidepressants to manage their symptoms, its presence alongside chronic pain may seem unbearable. Here is what you need to know about depression and pain, as well as how each situation is related, in order to understand effective methods for coping.

Chronic Pain Explained

What If My Chronic Pain Never Goes Away?

Chronic pain is experiencing prolonged periods of physical distress that may include more than just feeling pain or discomfort. The pain may last for months, with some being sensitive to pain more than others. The level of pain is different from the pain experienced from an injury. At times it is intolerable when accompanied by one or more of the following:

  • Mood disorders such as depression or anxiety

  • Muscle pain and discomfort

  • Limited physical or mental performance

  • Lack of energy

  • High stress levels

As your body gets older, you may tend to feel more sensitive to aches and pains. You might feel discomfort or hurt in an area that has never experienced pain in the past. You can also experience difficulty sleeping at night, leaving you feeling tired or fatigued during the day. Your level of productivity is prone to decrease as the pain becomes a nuisance. Daily tasks such as caring for children, completing house chores, and managing job duties at work may feel like they have an added layer of challenge. Feelings expressed during these situations may lead to depression.

What Happens When Depression Is Present Alongside Chronic Pain?

Studies show the most common mental health issue people are coping with when experiencing chronic pain is depression. If you have other medical conditions or taking other medications, it complicates the situation. Many living with symptoms of depression may experience aches often, referring to them as depression pains. Research has shown that a lot of people get depressed because their physical performance is limited or reduced because of persistent pain.

People may experience pain symptoms long before realizing they are depressed. Then, symptoms such as lack of appetite, loss of energy and sleep, and withdrawal from physical activity can increase pain intensity. These examples are common complaints people report when visiting their doctor.

Navigating loss related to chronic pain increases the chances of clinical depression, also known as major depression. These symptoms may last for two weeks or more daily and consist of the following:

  • Experiencing constant sadness with periods of crying, being irritated, or feeling despair

  • Eating too little or too much (appetite changes)

  • Sleeping too little or too much (sleep changes)

  • Having difficulty concentrating or recalling past events (poor memory)

  • Feeling restless or tired often

  • Losing pleasure or interest in activities you used to enjoy

  • Feeling guilt or worthlessness

Sometimes depression is severe enough to affect the outcome of your treatment. In such cases, psychological, biological, and social issues will be assessed closely to understand how they affect your pain.

Pain Influences How The Body Responds

Pain can create feelings of irritability and anxiety. While these feelings are normal, levels of stress in the body are affected and prone to fluctuation. Stress and tension influence chronic pain, and over time, these elements may affect how your body emotionally responds. It's like a cycle that repeats because stress brings emotional concerns experienced with chronic pain and depression, such as:

  • Anger

  • Mood swings

  • Lack of interest in sexual activities

  • Confusion

  • Weight loss or weight gain

  • Fatigue

  • Sleep problems

  • Isolation from others

There is also a risk for other problems related to personal finances, weight, work, and social isolation. More potential risks may include family relationship problems, low self-esteem, and legal issues. Many are fearful they will experience an injury leading to additional anxiety.

Studies show chronic pain and depression affect the brain consequently because certain nerves carry chemical hormones throughout the body using the same pathways. It may be why people experience migraines and depression or a specific form of pain regularly with depression systems. For some, not being able to engage socially, emotionally, and physically in daily activities because of chronic pain is a huge loss-making their situations more difficult to bear.

What Are Treatment Options When Symptoms Overlap?

Depression magnifies discomfort associated with chronic pain. People with chronic pain and depression experience higher levels of pain than those without depression. Those living with both are also more likely to engage in unhealthy lifestyle habits affecting their ability to cope effectively. Some feel they have little control over what they can do in their lives. It is difficult to consider exercise or physical activities to help reduce stress. While these options are helpful in minimizing pain and symptoms of depression, there are other alternatives to consider that may help both.

  • Antidepressant medication. There are medication options available to relieve symptoms of chronic pain and depression. Nerves in the brain affected by both conditions may benefit from certain medications. They also help reduce pain intensity while treating certain types of aches, such as migraines and backaches. Many antidepressants are effective for treating multiple symptoms at the same time with limited side effects.

  • Physical activity. Discuss possible activities to engage in on a regular basis with your doctor. People with chronic pain may choose not to exercise for fear of injury or additional pain. An exercise plan can be created to meet your physical needs based on your capabilities. Staying focused helps you stay in shape and reduces injury risk.

  • Cognitive behavioral therapy or talk therapy. Talking about your feelings and emotions creates coping skills through dialogue to manage your pain. Psychological counseling or psychotherapy is an effective way to help understand personal thoughts and how they affect anxiety levels. Therapy for depression has proven to help reduce anxiety related to chronic pain.

  • Stress reduction methods and relaxation training. Reduce stress response levels associated with anxiety and pain by learning ways to keep stress levels down and how to relax. Learning to meditate, writing about your feelings in a journal, and practice other coping skills and strategies encourages favorable results, and at your own pace. Certain forms of exercise and physical activity, such as walking, bike-riding, performing deep breathing exercises, and practicing yoga are great ways to help the body calm down and relax.

  • Pain rehabilitation. Pain rehab includes comprehensive support by medical and psychiatric professionals. This option may be suitable for people with chronic pain along with another medical condition or injury. In most cases, it depends on the level of pain you're experiencing and how it affects your ability to complete daily tasks. Immediate and long-term support is also available through local inpatient and outpatient pain programs providing support for severe depression or chronic pain.

  • Hypnosis. Some may not think about this option when considering treating for chronic pain or depression, but it helps an individual to relax and receive positive suggestions for coping with their symptoms.

  • Support from family, friends, and peers. There are local groups providing support to people experiencing both conditions. If you can't find a group to meet with an in-person search online via social media. Having people who are close to you show their support is encouraging and helpful on many levels because they can help you be accountable.

What If My Chronic Pain Never Goes Away?

Take control by comparing options and setting goals. Being in control of your symptoms is important because they affect how you see yourself and how you live your life. Treatment options for both conditions may overlap depending on your symptoms. Continue to educate yourself about depression and chronic pain and help others close to you understand what you experience. If you feel like you're not achieving the results you want, talk to your doctor or specialist about making changes to your treatment plan. Combining treatments options is most effective for gaining lasting results.

Tips On Managing Depression And Chronic Pain

When depression hurts, how do you manage your feelings and physical discomfort? You might try creating a treatment plan with your doctor or specialist. Because symptoms of depression and chronic pain intertwine, it is important to find methods providing relief and support for your symptoms. A pain management plan may be created to help reduce physical discomfort. A detailed plan will help you focus on how to cope with the symptoms of both while encouraging you to be active daily. Be committed to following your plan and communicate your feelings and concerns to ensure your plan reflects actions you can complete to achieve favorable results.

Learning about how to manage your pain includes creating a plan to follow daily that incorporates methods to help you cope with pain and depression. It is important to understand how they affect you physically, socially, and mentally. Don't be afraid to tell your concerns with your doctor or mental health professional. There are other support options available, including online therapy and support groups to help you learn available treatment options. Remain committed to achieving personal goals to stay in control of your symptoms so you can live comfortably doing what you enjoy the most.

The Benefits Of Online Therapy For Chronic Pain

An obvious advantage of online therapy for people experiencing chronic pain is that participants are not required to make the physical journey or a long commute to visit a therapist’s office in person. Through online therapy platforms like BetterHelp, you can attend a therapy session from the comfort of your favorite chair, your bed, or a standing desk – wherever is most comfortable for you and connected to the internet. Additionally, the flexibility to schedule appointments at convenient times has several benefits. On the one hand, you can schedule a session when you are less likely to be struggling with chronic pain, which can sometimes worsen throughout the day. Alternatively, it might make sense on some days to schedule a session when you are experiencing pain, so you can better articulate the sensations in the moment to a caring, concerned, and qualified online therapist.

Online therapy has shown efficacy in treating people who are grappling with chronic pain, depression, or both conditions. In a randomized controlled trial comparing an internet-based cognitive behavioral intervention with email therapist contact to face-to-face CBT, evidence showed significant improvements for those in the first cohort. Specifically, positive changes were observed with regard to reductions in pain intensity, diminishments in catastrophizing behavior, and improvement in pain coping decisions and quality of life. Not only was the online CBT intervention at least as effective as the face-to-face method; on some outcome measures, iCBT appeared to be even more effective.


At BetterHelp, your therapist will empathize with how frustrating it can be to seek answers for chronic pain that seem evasive. When there is no apparent illness or injury serving as a pain source, that may leave the mind to wonder, “What is wrong with me?” “Will I always feel this way?” “What can I do to make the pain stop?” Empathetic and experienced online counselors are ready to guide you in exploring the source of your pain, and any depressive symptoms that you may be feeling. Take the first step in managing your pain, instead of letting it manage you, by completing the initial questionnaire on BetterHelp.

You Don’t Have To Face Depression Alone. Our Experienced Counselors Can Help.

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