The Link Between Anxiety, Depression, and Pain

pain and depressionAccording the International Association for the Study of Pain, pain is defined as:

“an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

This is one of the best descriptions of what pain is and is used worldwide to explain the experience of pain.

Pain and Emotion

Pain is an emotional experience.  Emotions such as happiness, sadness, and anxiety are generated in the brain.  Thus, pain and anxiety are intimately linked in the brain in terms of the locations that generate these perceptions.  As noted in the definition, pain has unpleasant emotional components, which most people perceive as anxiety.

The link between pain and anxiety is, in reality, more than just theoretical.  Sensation that is interpreted as pain is processed in several areas of the brain.  Some of the main regions of pain sensation are in very close proximity to the regions that process emotions of anxiety and depression.  When there is prolonged activity in the areas that process pain sensation, the areas nearby that process depression can be activated.  The areas then can spontaneously interact, pain sensations can be interpreted as anxious emotions, and anxiety can be misinterpreted as pain.

Anxiety and Chronic Pain

Those who have chronic pain often become depressed and anxious.  The two sensations become intermingled, and often the pain is greatly amplified by the depression.  Treating the emotional consequences of pain is often as important as treating the physical causes of pain.  If the depression and anxiety are not controlled, the pain is not controlled.  Once the depression and anxiety are controlled, insight into pain can occur and pain often becomes manageable.  There may be a physical cause to the pain, but if the emotional components are not controlled, then the pain is not controlled.

Comprehensive Treatment

Since pain, anxiety, and depression are intimately linked in the brain, comprehensive pain care involves treatment that is aimed at all aspects.  A comprehensive pain program looks at both physical control of pain and emotional control of the consequences of pain.  These programs link psychological approaches to pain, with physical methods.  A pain psychologist is often involved in patient treatment.  Medications for chronic pain that affect both physical signals of pain and emotional components then become understandable in their effectiveness.

Pain is a complex medical issue.  It has both physical and emotional components.  The physical side is the tissue damage and perception of signals.  The emotional side is the anxiety and depression that is linked to the chronic pain signals.  Treating chronic pain, due to its emotional components has long involved a multidisciplinary approach that includes psychological management.

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Thomas Cohn, MD

Interventional pain doctor helping Minnesotans manage back, neck, foot, and other pain. Board-certified in physical medicine and rehabilitation with additional board-certification in pain management from the American Board of Anesthesiology (ABA), the American Board of Interventional Pain Physicians (ABIPP) and the American Board of Pain Medicine (ABPM).