Chronic Pain and Depression

A Chapter 9 excerpt from Master Your Chronic Pain: A Practical Guide by Dr Nicola Sherlock

Master Chronic Pain Book

Mental pain is less dramatic than physical pain, but it is more common and harder to bear. The frequent attempt to conceal mental pain increases the burden. C. S. Lewis

A book on pain management would not be complete without a chapter on mood management. Most of my patients have told me that their pain has a negative impact on their mood. I think that anyone who has lived with pain can understand this.

You may not be depressed, and if your mood is generally good, I still think it is important to read this chapter. It contains information that you will find helpful in maintaining good mental health.

Depression is a condition that affects millions of people. It is one of the most common mental health problems worldwide, and the number of people experiencing depression is increasing. According to statistics released by the World Health Organisation in 2020, more than 264 million people of all ages suffer from depression.

Among people who live with persistent pain, depression is even more prevalent than it is among the general population. It is estimated that between 40% and 60% of people who live with persistent pain are depressed.[1]

As I said in a previous chapter, I think it helps to consider mental health as a continuum. It is like a sliding scale, with a notch that moves up or down, indicating how good or poor your mental health is at the time. At times in your life, your mental health will be better or worse; you will move up and down the sliding scale… the ‘continuum of mental health’. If you can develop a toolbox of resources that you can use to move towards better mental health, it will benefit you – whether you are depressed or not.

What is Depression?

Depression is a mood disorder characterised by persistent feelings of sadness, a lack of motivation, and a lack of interest in things. The symptoms of depression range from mild to severe. At its mildest, you may just feel persistently low in mood. At the extreme end of the spectrum, you may feel that you just cannot go on and that life is no longer worth living. When you are depressed, the symptoms can persist for weeks or months and can be so bad that they interfere with your work, family, and social life.

The symptoms of depression can be complex and vary a lot between people. I have listed the symptoms of depression below. Even if you are severely depressed, you may not experience all of them. However, the more symptoms that you have, the more likely it is that you are depressed. If you experience a number of these symptoms for most of the day, every day, for more than two weeks, it is worth seeing your GP or doctor about them if you have not already done so.

Emotions

  • Feeling sad or low in mood.
  • Feeling guilty.
  • Feeling upset, numb, or despairing.
  • Losing interest or enjoyment in things.
  • Crying a lot or being unable to cry when a sad event occurs.
  • Feeling alone even when in company.
  • Feeling angry and irritable at the slightest thing.
  • Feeling anxious or worried.
  • Having low self-esteem.

Physical

  • Tiredness.
  • Lack of energy.
  • Restlessness.
  • Sleep problems – finding it difficult to get over to sleep and/or waking up very early in the morning.
  • Feeling worse at a particular time of the day; for example, in the mornings.
  • Changes in appetite leading to weight gain or loss.
  • Poor memory or concentration.
  • Aches and pains (even among people who don’t live with persistent pain).
  • Constipation.
  • Reduced interest in sex (low libido).
  • Changes to your menstrual cycle.

Behaviour

  • Having difficulty making decisions.
  • Lacking the motivation to do things, including everyday tasks.
  • Putting things off.
  • Not doing things that you used to enjoy.
  • Withdrawing or cutting yourself off from other people and taking part in fewer social activities.
  • Poorer performance at work.

Thoughts

  • Losing confidence in yourself.
  • Expecting the worst to happen.
  • Thinking that everything seems hopeless.
  • Thinking that you are helpless.
  • Thinking that you hate yourself.
  • Thoughts of suicide.

Depression can often come on gradually, so it can be difficult to notice something is wrong. Many people try to cope with their symptoms without realising they are depressed. I have met many people who have been struggling with depression but who had not realised that they were depressed. Sometimes, it can take a friend, family member, or professional to suggest something is wrong.

Let’s look at the physical symptoms of depression that are listed above. You will see that many of them are also symptoms of persistent pain (like sleep difficulties) and that some of them are also side effects of pain medication (for example, constipation, tiredness, changes in appetite). As a result, it can be difficult for people living with persistent pain – and for the health care professionals working with them – to recognise that the person is suffering from depression…

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To learn more about managing chronic pain, take a look at:

Master Chronic Pain Book