Chronic pain, anxiety, depression & addiction

I wasn’t planning on covering this topic, since it was sort of discussed earlier. But, I wrote this piece for someone else and it wasn’t used. Since I spent a decent amount of time researching I didn’t want this to go to waste. So, here you go:

When I first meet with a patient who suffers from chronic pain, I always explain how pain is related to psychology. I often say, “Pain is real. Suffering is real. This is not in your head.” We know that when people experience pain for a long time, it can create a myriad of negative emotions or moods.  In fact, research shows that chronic pain is associated with several mental health conditions including anxiety, depression, and addiction (Outcalt et al., 2015).

Anxiety

While anxiety may take different forms (e.g., phobias, generalized anxiety, social anxiety, etc.), symptoms may include uncontrollable worry, feeling keyed up, inability to concentrate, muscle tension, restlessness, and being easily fatigued (DSM-5). Worry is a common theme with chronic pain. I have heard some people express worry about not being able to predict when their pain will occur. Or, some worry about medical treatments. Will this new medication or injection sufficiently treat the pain? Will the pain come back? If so, how soon? Then, there are the changes in lifestyle. Many people with chronic pain have to quit a job and go on disability. As a result, they may have to change their spending habits or worry about paying daily expenses. It is no wonder that anxiety and chronic pain go together!

Depression

Depression is also a mood that runs with chronic pain. When one is “depressed” they may suffer from weight loss or weight gain, insomnia or hypersomnia, hopelessness, worthlessness, feelings of death or wanting to die, lethargy, difficulties with concentration, and/or lack of interest in activities (DSM-5). According to researchers, up to 85% of patients with chronic pain suffer from severe depression (Bair, 2003; Sheng, 2017). The idea that chronic pain can be a cause of depression has been known at least since the 1990s (Fishbain, 1997). In therapy, I often hear that people feel worthless because they can no longer work. Some cannot engage in every day house hold chores that were once completed so easily (e.g., unloading the dishwasher or vacuuming). Others have been to countless doctors for years without ever receiving consistent diagnoses or appropriate medical treatment. So many people are forced to relinquish their life dreams, goals, and plans due to chronic pain.

Addiction

Not surprisingly, people who suffer from chronic pain may become addicted to their medications. Pain is awful and frequently the first line of defense is medication. Unfortunately, the body can develop a tolerance to certain medications (Volkow & Koroshetz, 2017). When this occurs, the dose of medication no longer addresses the pain and more is required to feel an effect. Therefore, some patients take more medication than prescribed. In 2015, authors (Vowles et al, 2015) completed a systematic review of studies on chronic pain and substance abuse/addiction and found that rates of addiction averaged between 8% and 12%. Among some of the best studies they analyzed, the highest rate of addiction fell at 23%. According to the CDC, there were 63,632 drug overdose deaths in 2016; 42,249 (66.4%) involved an opioid.

While I’ve heard a few people complain about the new regulations on opioid prescriptions, these medications can be dangerous. Addiction is a real problem and people have died from overdoses. It’s important to take medications as they are prescribed and always speak with doctors if they aren’t working. And, there are alternative treatments to opioids (e.g., suboxone, injections, chiropractic, physical therapy, water therapy, etc).

Final thoughts

Chronic pain is one of the worst conditions. It can be difficult to diagnose and treat. With so many complications and complexities, it is no wonder that those who suffer from chronic pain are at risk of developing anxiety, depression, or addiction. If you or anyone you know is in this position, please consider seeking out a mental health professional who can provide evidenced-based treatments (e.g., Cognitive Behavioral Therapy or Neurofeedback).

 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Bair, R. L. Robinson, W. Katon, and K. Kroenke, “Depression and pain comorbidity: a literature review,” Archives of Internal Medicine, vol. 163, no. 20, pp. 2433– 2445, 2003.

Fishbain, D. A., Cutler, R., Rosomoff, H. L., & Rosomoff, R. S. (1997). Chronic pain-associated depression: Antecedent or consequence of chronic pain? A review. The Clinical Journal of Pain13(2), 116–137. https://doi-org.paloaltou.idm.oclc.org/10.1097/00002508-199706000-00006

Outcalt, S. D., Kroenke, K., Krebs, E. E., Chumbler, N. R., Wu, J., Yu, Z., & Bair, M. J. (2015). Chronic pain and comorbid mental health conditions: independent associations of posttraumatic stress disorder and depression with pain, disability, and quality of life. Journal of behavioral medicine38(3), 535-543.

Sheng, J., Liu, S., Cui, R., Zhang, X., & Wang, Y. (2017). The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Neural Plasticity, 1–10. https://doi-org.paloaltou.idm.oclc.org/10.1155/2017/9724371

Seth, P., Scholl, L., Rudd, R.A., & Bacon, S. Overdose Deaths Involving Opioids, Cocaine, and Psychostimulants — United States, 2015–2016. MMWR Morb Mortal Wkly Rep 2018;67:349–358. DOI: http://dx.doi.org/10.15585/mmwr.mm6712a1. https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a1.htm

Volkow, N. D., & Koroshetz, W. (2017). Lack of evidence for benefit from long-term use of opioid analgesics for patients with neuropathy. JAMA neurology74(7), 761-762.

Vowles, K. E., McEntee, M. L., Julnes, P. S., Frohe, T., Ney, J. P., & van der Goes, D. N. (2015). Rates of opioid misuse, abuse, and addiction in chronic pain: A systematic review and data synthesis. Pain, 156(4), 569–576. https://doi-org.paloaltou.idm.oclc.org/10.1097/01.j.pain.0000460357.01998.f1