There are many people in our world that deal with chronic pain of many different types.   Pain is a daily part of life for them. The pain can be from migraines or other types of headaches, arthritis, fibromyalgia, old sports or car accident injuries, lower back pain, cancer pain, multiple sclerosis, shingles, psoriasis, and many other causes.

According to the World Health Organisation study in primary care settings across the world, approximately one-fifth of all primary care patients suffer from persistent debilitating pain, and they are four times more likely to have co-morbid anxiety or depression than pain-free primary care patients.

And even with all of the advancements in modern medicine and all of the pharmaceutical options for pain management, only 58% of chronic pain is managed with prescription options; leaving many people suffering with little relief in sight.

A vicious cycle

Interestingly, people with only depression and not chronic pain often still have symptoms of headaches, chronic body aches, and pain.   There is really an intricate and complicated connection between depression and chronic pain.   Depression can worsen how we perceive any existing chronic pain and it’s well known that suffering persistent or severe pain can cause us to feel depression.   This can lead to a circumstance where pain and depression create a vicious cycle where pain worsens the symptoms of depression, and the resulting depression can then worsen the feelings of pain.

What does the research say?

Why do pain and depression often create this vicious cycle?    A recent and quite excellent review of the research looks at the complicated relationship between pain and depression.     According to researchers Han and Pae (2015) many psychological factors are at play regarding pain and depression.   Most importantly they identified the following important connections between chronic pain and depression.  When people display these behaviours and act in these particular ways it can make their chronic pain and their depression worse.

Pessimism and negative thinking:  can affect a pain sufferer by increasing their perceived pain levels and also decrease the ability to manage it.  Whereas actively trying to think more positively and optimistically can actually lessen pain, improve mood and help us to manage the pain more effectively.   This isn’t just about thinking positive thoughts.  It’s about gaining acceptance of the actual situation over time and “making the best of it”.   Accepting that this is what life has given and “it is what it is” without putting a negative or limiting value judgement on it.    It’s about concentrating on what we have and what we can do rather than a negative focus on what we’ve lost or what we can’t do.

Fear-avoidance beliefs: which have to do with a person avoiding doing things in their life because they fear that the activity will make the pain worse, whereas, in fact it may actually make them feel better!   Pain can make people feel and act overly fearful and they then avoid movement and activity so as to not cause themselves more pain —  this in turn leads to disengagement from life’s meaningful activities, causing further disability and depression.   A perfect example is physical exercise.   Physical exercise approved by your doctor can often improve pain levels and improve mood, but people often have an unfounded fear that it will make pain worse, when in fact is may improve their mood and help actually lower pain levels.

Perceived control of the pain:    People with chronic pain and depression often feel helpless and hopeless about their situation because they don’t feel they have any level of control over their pain.   This can actually increase the pain they feel.   When in fact, they may actually do have some control through proactively making a regular effort in changing how they think! or by taking control of their treatment they may gain some control.  This is also about maybe realising that through developing better coping mechanisms like using exercise, meditation or actively being aware of and changing their “self-talk” and self-beliefs they can gain some control and reduce pain levels.

Perceived social support:  is about how we actually recognise how much support we are getting from other people, including things such as help with practical things like transportation and help with cleaning or cooking when pain levels are high.   It can also include emotional support, like having others listen to us, show empathy, show interest in our lives and feelings.   The more social support a person with pain believes they have, the less isolated and alone they feel and this can actually affect their perceptions of levels of pain.

This review of the research showed that these psychological factors play a very crucial role in how someone with chronic pain thinks about and feels regarding their pain and life circumstances.   These factors can play into the vicious cycle that can often make chronic pain much worse than it has to be.

In a nutshell…  when it comes to managing pain the research shows that…

How a person chooses to “think” about their pain can actually affect and lower the levels of pain they feel and can even reduce their feelings of depression!   This is huge for someone with pain!   By learning how to think about their pain and life differently…  they can actually feel less pain and improve their mood!

Most importantly Han and Pae (2015) found that a key factor in dealing with pain and depression was how much the person participated in the maladaptive and unproductive way of thinking called “catastrophizing“.

What is catastrophizing?

In psychology, catastrophizing is seen as a “faulty thinking pattern” where we fall into firmly believing “the worst case scenario” about any situation.   When we are catastrophizing, we act “as if” that catastrophic outcome has already occurred creating much helplessness and hopelessness.

Catastrophization with chronic pain is largely about magnifying the pain felt, where thinking and concentration is centred on the feelings of helplessness, hopelessness, where we centre much thinking on how the pain feels and all of the negative ways it can limit and affect our lives.    People with the combination of pain and depression often magnify and “over-feel” their feelings of pain and helplessness.

People who catastrophize tend to assume the worst possible outcome will always occur even when it might not.     

It can also be about feeling totally sorry for ourselves… that the absolute “worst thing in the world” has happened to us and there is no way out! 

Catastrophizing leaves us with a deeply hopeless, sad and negative mood.  Research shows if a person ‘catastrophizes” their pain they may even experience higher pain levels and can even be more incapacitated than someone who doesn’t catastrophize and keeps a more positive view of their situation.

Feeling better

If you deal with chronic pain how can you start to feel better?

A good place to start feeling better is to try to make sure you are getting enough sleep, eating well, and hydrating.  Avoid alcohol and junk foods as they can both affect our pain levels and worsen our moods.

Keep a daily journal with all of your thoughts emotions and feelings.  Be honest with yourself and use it a place to let out the negativity, stress and worry.

Being kind to yourself with good “emotional self-care” can also be a good place to start.

Try to get re-engaged with your life.   Get out as much as you are able,  connect with your friends and family, join a club, join a team, volunteer, find a new hobby.   Do something to connect you to life!

Get active.   Exercise as much as you can as approved as by your doctor.   Physical exercise an excellent way to improve pain levels and to improve our mood.   There is a good deal of research showing that even a small amount of regular movement and exercise can help mediate depression and lower pain.

Find a support group.   If you can’t access or find one in your community — look for one online, like the ones on Facebook Groups 

Lower your stress levels.  Too much stress can exacerbate both pain and depression.   Try yoga, meditation, progressive muscle relaxation, deep breathing or meditation strategies.   Some research also shows that acupuncture can also be helpful as a way to reduce stress and pain.

Think constructively and try to use positive thinking. By focusing on the bigger picture you can make a big difference in your perceived pain level.   For example, instead of considering yourself powerless and thinking that you absolutely cannot deal with the pain, remind yourself that even though you have pain, you’ve been dealing with it already and you’ve done pretty good so far!    Accepting your situation for what it is can be a huge step to moving forward emotionally.  You have chronic pain… so what?  Use positive self-talk to tell yourself… it is what it is, and you can, and will deal with it.  Positive thinking and distracting ourselves with other activities can lessen the pain and improve our mood.

If you find yourself catastrophizing and feeling that the worst case scenario has already happened because of your chronic pain?   Try to write down and then really look at and challenge those negative thoughts.

Use more balanced and positive self-talk to honestly look at your life and concentrate on what is positive and what you have to be grateful for rather than the “woe is me” attitude that chronic pain can lead us into.

Don’t let the pain define you!!   You are more than your pain.

Finally, going to therapy/counselling with a therapist knowledgeable about depression and pain management can be an excellent way to manage your depression and pain.