Pain serves an important function in our lives. When
you suffer an acute injury, pain warns you to stop the
activity that is causing the injury and tells you to take
care of the affected body part.

Chronic pain, on the other hand, persists for weeks,
months, or even years. Some people, often older
adults, suffer from chronic pain without any definable
past injury or signs of body damage. Common chronic
pain can be caused by headaches, the low back, and
arthritis. Unfortunately, there is scant objective evidence
or physical findings to explain such pain.
Until recently, some doctors who could not find a
physical cause for a person’s pain simply suggested
that it was imaginary—“all in your head.” This is unfortunate
because we know that all pain is real and not
imagined, except in the most extreme cases of psychosis.
Emerging scientific evidence is demonstrating
that the nerves in the spinal cord of patients with
chronic pain undergo structural changes.
Psychological and social issues often amplify the
effects of chronic pain. For example, people with
chronic pain frequently report a wide range of limitations
in family and social roles, such as the inability to
perform household or workplace chores, take care of
children, or engage in leisure activities. In turn, spouses,
children, and co-workers often have to take over
these responsibilities. Such changes often lead to
depression, agitation, resentment, and anger for the
pain patient and to stress and strain in family and other
social relationships.

How is depression involved with chronic
pain?
Depression is the most common emotion associated
with chronic pain. It is thought to be 3 to 4 times more
common in people with chronic pain than in the general
population. In addition, 30 to 80% of people with
chronic pain will have some type of depression.
The combination of chronic pain and depression is
often associated with greater disability than either
depression or chronic pain alone.
People with chronic pain and depression suffer dramatic
changes in their physical, mental, and social
well-being—and in their quality of life. Such people
often find it difficult to sleep, are easily agitated, cannot
perform their normal activities of daily living, cannot
concentrate, and are often unable to perform their
duties at work. This constellation of disabilities starts
a vicious cycle—pain leads to more depression, which
leads to more chronic pain. In some cases, the depression
occurs before the pain.

Depression associated with pain is powerful enough to
have a substantial negative impact on the outcome of
treatment, including surgery. It is important for your
doctor to take into consideration not only biological,
but also psychological and social issues that pain
brings.

What is the treatment for chronic pain
and depression?
The first step in coping with chronic pain is to determine
its cause, if possible. Addressing the problem
will help the pain subside. In other cases, especially
when the pain is chronic, you should try to keep the
chronic pain from being the entire focus of your life.
• Stay active and do not avoid activities that
cause pain simply because they cause pain.
The amount and type of activity should be
directed by your doctor, so that activities that
might actually cause more harm are avoided.
• Relaxation training, hypnosis, biofeedback, and
guided imagery, can help you cope with chronic
pain. Cognitive therapy can also help
patients recognize destructive patterns of emotion
and behavior and help them modify or
replace such behaviors and thoughts with more
reasonable or supportive ones.
• Distraction (redirecting your attention away
from chronic pain), imagery (going to your
“happy place”), and dissociation (detaching
yourself from the chronic pain) can be useful.
• Involving your family with your recovery may be
quite helpful, according to recent scientific evidence.

Feel free to discuss these or other techniques with
your doctor of therapist. He or she may suggest
some simple techniques that may work for you or may
refer you to another health care provider for more indepth
training in these techniques