How Pain, Depression and Anxiety Intersect
By Shelly L. Curran PhD, LP
Help understanding the pain-anxiety-depression connection
Getting pain relief fast is a top request from many dear people suffering from depression in the United States.
There are questions about depression that the MN Head & Neck Pain Clinic (MHNPC) has answered many times over the years. While they are all important, we’ll address many of them for you in this article.
Does Pain cause Depression or Does Depression cause Pain?
Our Health Psychologists who treat patients with various pain conditions know that people with chronic pain often experience anxiety and depressive symptoms. In the review article by Jiyao Sheng and Yicun Wang, expert depression researchers noted that “up to 85% of patients with chronic pain are affected by severe depression”. The link between Depression and Chronic Pain: Neural Mechanisms in the Brain, published June 19, 2017, discusses that one of the most common and disabling mental disorders, depression is identified as the third leading contributor to the global disease burden.
Is my Pain Real or is it Anxiety?
Neural mechanisms exist in our human brains that link depression and chronic pain.
Questions such as “is my pain physical” vs “all in my head” or due to depression etc., have shifted. What we now know is that the mechanisms in our body that are involved with how we experience pain largely overlap with the systems of depression and anxiety.
It is widely known that patients seeking treatment for depression often experience real pain. According to Lepine and Briley, “over 75% of depressed patients in primary care complain of painful physical symptoms such as headache, stomach pain, neck and back pain as well as non-specific generalized pain.”
What Body Systems are Involved in Pain and Distress?
Pain itself is a stress on our bodies as well as fatigue, worry, sadness, conflict in relationships, and in the world around us. The system in our body that helps to regulate stress is called our Autonomic Nervous System (ANS) which includes the Sympathetic and Parasympathetic systems. Our ANS controls many processes in our body including our heart rate, breathing, digestion, metabolism, muscles, and our sleep patterns.
Pain, stress, and the Autonomic Nervous System can be defined as stresses that involve a physical, mental, and/or emotional factor that generates physical or mental tension. Stresses can be external, such as those from the environment, psychological, or socially-induced situations. Existing illness, a recent medical procedure, work, or relational stresses also impact our stress and depression levels. Pain and stress can change the way our ANS works to manage these systems in our body.
The Fight or Flight Response to Depression: Pain, Anger, & Anxiety
What is the Fight or Flight response?
Our human bodies are made with a sophisticated yet normal built-in response to sudden potentially dangerous happenings. While vital to our well-being, it may become triggered.
Depression may settle in when we perceive something to be a threat to us that feels out of our control. Think of your smoke alarm. Its function is to alert us to risks of sudden fire, smoke, or fumes but it cannot distinguish between steam from an oven broiler or a house on fire. When something becomes irritating, uncomfortable, and difficult for you, it’s best to heed the alarm!
Medically, a Sympathetic Nervous System or Fight/Flight response is activated with perceived threats to our body such as worry, pain, anger, fear, financial stressors, and more. The systems that allow our bodies to fight or run (flight) to protect ourselves are automatically activated in response to danger. The fight/flight stress response may cause changes in our body such as an increase in heart rate and blood pressure, muscles tighten or become twitchy, and hands and feet may feel cold and clammy.
These body mechanisms also are involved in the experience of anxiety. The systems that allow our bodies to fight or run (flight) to protect ourselves automatically start up in our bodies in response to feelings of danger. The fight/flight stress response can cause changes in our body such as an increase in heart rate and blood pressure, muscles tighten or become twitchy, and hands and feet may feel cold and clammy. These stress changes overlap with what happens in our bodies when we experience anxiety.
Symptoms of anxiety include:
- Tense and painful muscles
- Teeth clenching
- A racing heart beat
- Feeling restless or agitated (flight)
- Shortness of breath
- High levels of worry
- Frustration and irritability (fight)
The Impact of the Fight/Flight Stress Response: Pain, Anger, and Anxiety
Anger and frustration (fight), as well as feeling, pressured or anxious (flight) can be linked in many ways. Tense tight muscles can cause pain such as neck pain and back pain symptoms. Behaviors such as clenching your jaw when frustrated or anxious can lead to jaw pain symptoms. Racing thoughts and worries such as the pressure of daily to-do lists can make it hard to focus and take the time we need to care for ourselves such as taking breaks during the day or using pain management tools.
It is also easy to feel stuck when trying to do the things we need to do in order to decrease pain symptoms. For example, feeling angry or anxious can make it difficult for our bodies to relax. Problems with relaxation can get in the way of using pain management tools such as physical therapy stretches. These are needed to help release and relax tight, painful muscles. Potential hurdles in treating pain that are linked with the stress of anger and anxiety highlight the importance of working with an interdisciplinary pain management team. It may include a health psychologist, chronic pain physician, physical therapist, or orofacial pain specialist. How your body responds to stress and pain influences the specific tools best suited for your health needs.
The Freeze Response: Depression and Pain
What is the freeze response when struggling with painful depression?
The wiring in our bodies can understand the mechanisms of the freeze response (dorsal vagal nerve) of the parasympathetic nervous system and social behavior, according to Stephen Porges, PhD.
The freeze response is our most primitive defense response. It is an involuntary human reaction that occurs when we perceive life-threatening danger. Another part of our ANS involved with stress is called the parasympathetic nervous system in which the freeze response is located. According to Stephen Porges, Ph.D., the freeze response is our most primitive defense response.* This response can occur with severe pain, loss, trauma, or chronic illness. Our bodies become immobile, numb, and shut down. These symptoms overlap with the symptoms of depression such as: exhausted, surprising sleep disturbances, appetite changes, poor concentration, despair, hopelessness, withdrawn from others, suicidal thoughts, and pain.
What is the impact of the freeze response on my pain and depression?
When our body is in the freeze response it is shut down. We are so overwhelmed that our body becomes immobile, no energy, feeling stuck or trapped. We often feel alone and isolated from others. Engaging in day-to-day tasks in our lives feels impossible. Participation in pain management can be difficult with no energy for self-care pain management tools such as physical therapy or exercise.
We can feel hopeless about the possibility of the pain getting any better. Daily tasks such as taking a shower or making meals can be painful, exhausting, and overwhelming. It is important to recognize if our bodies are stuck in this kind of response to pain and stress when seeking treatment. Working with an interdisciplinary team to address these issues can help prevent feeling overwhelmed and hopeless when seeking treatment for pain.
What is the impact of the pandemic for people with pain, depression, and anxiety?
The stress of the pandemic is impacting people in many ways. Our pain specialists are tracking how people with chronic pain and stress may have immune systems more vulnerable to the COVID-19 virus.
The fears and frustrations experienced while watching the news, going to the grocery store or pharmacy, or talking to others about the virus can activate the fight/flight stress response leading to increased pain, anger, and anxiety. The need to social distance from others can lead to feelings of loneliness, isolation, and despair which can trigger the freeze response. This often leads to increased pain and depression. Feeling trapped in our homes and hopeless about the uncertainty of the virus with no end in sight can also trigger the freeze response.
What Are the Best Ways to Help My Pain, Anxiety, and Depression?
Minimize pain, depression, & anxiety during a fight/flight stress response by:
- Try relaxed breathing strategies
- Get active – dance, stretch, bike, yoga
- Take a walk with someone
- Talk to a friend or family member in person or virtually via phone/video
- Hobbies such as gardening, cooking, creative tasks, etc.
Minimize pain, depression, & anxiety during a freeze stress response by:
- Adequate levels of rest
- Meditation, prayer, hypnosis
- Engage in creative activities such as coloring, painting
- Get out in nature; enjoy a walk
- Relax to Music
- Small, gentle movements (e.g., restorative yoga)
- Grounding techniques (e.g, 5-4-3-2-1 technique **)
How do People with Depression Benefit from Medical Advice?
Emotional pain-like sadness, crying, and feelings of hopelessness are normal for many experiencing depression.
MHNPC provides the training and experience to help you understand how your body is reacting to stress in your life. This typically manifests in pain, other chronic illnesses, worries, relationship issues, and depression. A Health Psychologist uses strategies such as relaxation exercises, hypnosis, cognitive-behavioral tools, talk therapy, and more. It will help you to listen and connect to your body and learn which tools are right for you.
We need to use different tools to help our bodies gently move out of a freeze response; others help release and relax out the fight/flight response in our bodies. This enables you to feel more in control, connected with others, and engaged in life. Talk therapy may be very beneficial.
The pandemic and social distancing make it challenging to connect with others. Globally, current lifestyle changes are causing added stress in many ways to our bodies. These changes can be worse for people already struggling with pain, anxiety, and depression; they already often feel isolated. Isolation may add additional struggles to life’s daily tasks. It is important to connect with friends, your children, and family either in person (if safe to do so) or via phone/video. Reach out to someone you know who may be struggling or isolated. Mayo Clinic offers an online support group for those with COVID-19.
When Treating Depression is Critical to Protect Someone’s Mental Health
Clinical depression and major depression are both a serious medical condition and may have critical side effects. This is when a person not only can feel sadness, but find it to hard to climb out of. Mood disorders, mental illness and suicidal ideation need to be identified and treated – even if it may seem unnecessary to prevent suicide at the moment.
If you know of someone who has made a suicide attempt and needs help, tell them about the National Suicide Prevention Lifeline at 800-273-8255. It is better to be safe than sorry, as they say. Call even if you suspect a pending suicide attempt.
The MHNPC has an interdisciplinary team of pain specialists in Health Psychology, Medicine, Orofacial Pain, and Physical Therapy. We offer a professional mind and body approach to pain management and an emphasis on integrated self-care management strategies. Our MHNPC Health Psychologists help patients identify and address potential psychophysiological factors of pain and distress through self-regulation strategies including relaxation training, hypnosis, and talk therapy.
Telemedicine healthcare services are a safe and convenient way to connect and are available here at MHNPC.
Gain help for painful depression.
If you are experiencing higher levels of emotional pain like sadness and depression, whatever the cause, seek help. Waiting until your symptoms worsen only leaves you miserable. You can gain the right treatment and start enjoying life more. for individuals with a medical condition that produces side effects of mood disorders, clinical depression, or major depression, do reach out and speak to someone qualified.
Call 763-577-2484 and request your Pain Depression Consultation with a Health Psychologist
Shelly L. Curran PhD, LP has nationally published research and lectures on mind and body factors that are commonly associated with: facial pain, headaches, chronic pain, fatigue and cancer. She is available for services at the MN Head and Neck Pain Clinic.