The Link between Chronic Pain and Depression

Dr Christopher Jenner and Dr Ivan Ramos-Galvez will often suggest the support of a Clinical Pain Psychologist, to assist other ongoing multidisciplinary methods of treating a Claimant’s chronic pain. Psychological treatment may include various ‘self-help’ techniques, such as mindfulness or goal setting and pacing, to help with the daily management of chronic pain. Talking therapy, such as Cognitive Behavioural Therapy (CBT), can help with the anxiety and depression that is often secondary to a chronic pain condition.

The idea that pain can lead to feelings of frustration, worry, anxiety and depression is an obvious one, particularly in the case of chronic pain. However, there is also evidence for a reverse causal relationship whereby negative mood and emotion can lead to pain or exacerbate it.

There is increasing evidence that chronic pain problems are characterised by alterations in brain structure and function. Neuropathic and musculoskeletal pain are associated with substantial neurological changes.

Whether there is a link between pain and depression is a controversial topic, but any link is highly unlikely to be simple cause and effect. Pain which cannot be attributed to a physical disease or injury is difficult to substantiate beyond reasonable doubt, but there are some well-documented factors involved.

In our experience, depression does make a patient potentially more vulnerable to the development of a pain condition. However, not all patients suffering from depression develop chronic pain conditions and not all patients with chronic pain suffer from depression.

There are many well-established phenomena which lead to persistent pain without any identifiable signs – so many in fact that chronic pain is now seen as a disease in its own right. Outside the speciality of pain medicine, this is still poorly understood and appreciated, leading to misdiagnosis as a somatoform disorder – widely referred to as ‘psychosomatic pain’.

As depression and pain share a common neurochemical pathway in that they are both influenced by serotonin, depression and associated painful physical symptoms, they must be treated together in order to achieve adequate treatment. Research has shown that physical symptom improvement was correlated with the improvement of other symptoms of depression, which suggests that the patient’s ability to achieve a remission in their depression may be directly related to the reduction of painful physical symptoms.

Dr Chris Jenner is a Consultant in Pain Medicine and Honorary Lecturer at Imperial NHS Trust. He runs a weekly pain clinic at Charing Cross Hospital in London and a private practice in Harley Street, Dr Jenner has been a medico legal expert for over 14 years and deals with over 90 different types of pain. He has extensive experience treating Complex Regional Pain Syndrome and Fibromyalgia, as well as post surgical mastectomy pain and phantom limb pain. Please call us if we can assist with your medico legal case on 0207 118 0650.