The Link Between Chronic Pain and Depression — and How to Cope

Is chronic pain causing you to become depressed? Read this to learn about the link between the two.

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Chronic pain is a common reality for many people, affecting roughly 1 in 4 (24.3%) adults in the United States, according to the Centers for Disease Control and Prevention. That’s almost one in four people. Globally, chronic pain is thought to affect more than 1.5 billion people, which is about 20% of the world’s population.  

Chronic pain affects more than just your body; it also affects your mental health. Whether you’re dealing with neuropathic pain, musculoskeletal pain, inflammatory pain, or nociceptive pain due to an injury, seemingly ever-present chronic pain can take a major toll on your well-being, even leading to depression. 

Read on to learn more about how chronic pain and depression are connected, why chronic pain contributes to mental health struggles, and how to manage your symptoms.

Understanding the link between chronic pain and depression

“Chronic pain and depression have a bi-directional relationship, meaning each can cause or worsen the other,” says Meghan Jensen, LPC, a clinical supervisor at Charlie Health. There are a few reasons why this is the case, including the following,

Shared brain pathways

“Pain and mood regulation involve many of the same brain regions and neurotransmitters, including serotonin, norepinephrine, and dopamine,” Jensen says. “When these systems are disrupted, pain feels more intense, mood lowers, motivation decreases, and fatigue increases.”

The functional impact of chronic pain

Chronic pain, especially when untreated, can significantly interfere with daily functioning and quality of life. Jensen says chronic pain often leads to: 

• Loss of independence
• Reduced overall activity
• Sleep disturbances
• Social withdrawal
• Feeling like a burden to loved ones

Over time, these impacts can lead to hopelessness, low self-worth, and anhedonia (an inability to feel pleasure), which are core depression symptoms, Jensen explains. 

The pain-depression cycle

“Depression lowers pain tolerance and increases pain perception,” Jensen says. For example, she explains that people with chronic pain and depression may experience:

• Pain that feels like it’s “everywhere”
• Increased sensitivity to pain
• Less resilience in coping

Ultimately, this becomes a pain-depression cycle that continuously fuels itself if someone doesn’t seek treatment. 

Can chronic pain cause depression and anxiety?

Yes, on top of causing depression, chronic persistent pain commonly causes anxiety or even an anxiety disorder. 

Jensen says chronic pain creates uncertainty and fear, leading to thoughts such as:

• “What if this never gets better?”
• “What if it gets worse?”
• “Will I lose my job?”
• “What if I can’t function?”

These thoughts can spiral and create further anxiety. Jensen says this can lead to:

• Health anxiety
• Catastrophizing (assuming worst-case scenarios)
• Hypervigilance to body sensations
• Panic symptoms 
• Avoidance behaviors

On top of these thought patterns, there’s a physiological explanation behind increased anxiety, too. “Chronic pain keeps the nervous system in a prolonged stress response,” Jensen says. This can increase your cortisol levels (the stress hormone), increase muscle tension, and activate your sympathetic nervous system (AKA fight-or-flight mode). All of this physiological arousal further fuels anxiety, she adds.

How to treat chronic pain and depression

“Treatment works best when it addresses both pain and mood together,” says Jensen. This typically includes therapy and medication. It’s also important for your healthcare provider who treats your pain to be in the loop of your mental health care treatment plan. 

Therapy for chronic pain and depression

If you’re dealing with depression, therapy is a cornerstone of treatment. Various modalities can improve your symptoms, including the following.

1. Cognitive behavioral therapy (CBT)

One of the primary therapy modalities for comorbid chronic pain and depression is cognitive behavioral therapy (CBT), says Jensen.

CBT helps you address unhealthy and unhelpful thought patterns. In the case of chronic pain, Jensen says you might work on pain-related thought patterns like, “I’ll never function again.” CBT can also help you reduce catastrophizing, she says, which refers to jumping to worst-case scenarios. You’ll also learn countless other coping skills to manage depressive symptoms in CBT.

2. Trauma-informed therapy

On top of CBT, another option is trauma-informed care, since many chronic pain patients have trauma histories, Jensen says. She adds that trauma can increase central sensitization (where your nervous system becomes more sensitive to pain signals and amplifies them) and increase somatic symptoms (AKA physical symptoms) in general. 

Research shows that up to 70% of chronic pain patients have experienced trauma. “Addressing trauma can significantly reduce pain-related depression,” Jensen says. 

Some types of trauma therapy include:

• Trauma-focused cognitive behavioral therapy (TF-CBT)
• Eye movement desensitization and reprocessing (EMDR)
• Prolonged exposure therapy
• Narrative therapy
• Somatic therapy

3. Mindfulness-based interventions

One type of mindfulness-based intervention specifically for coping with pain is called mindfulness-based pain management (MBPM), which research shows can lead to less pain, more pain acceptance, fewer negative thoughts related to pain, and improved quality of life. 

This modality helps you develop awareness of sensations and learn how to observe pain from a non-judgmental stance. “Pain intensity may not disappear, but suffering often decreases,” Jensen says. 

Best medication for chronic pain and depression

There are some types of medications that can treat both pain and depression by affecting shared neurotransmitter pathways, Jensen says. These include some serotonin and norepinephrine reuptake inhibitors (SNRIs) and some tricyclic antidepressants (TCAs).

For example, the SNRI duloxetine (brand name: Cymbalta) can help with pain relief for:

• Chronic musculoskeletal pain
• Osteoarthritis
• Neck pain
• Chronic back pain or lower back pain
• Fibromyalgia

On top of bringing pain relief, duloxetine can also improve depression and anxiety symptoms.

Additionally, the TCAs amitriptyline and nortriptyline are prescribed for chronic migraine and chronic headache syndromes. TCAs may also help treat:

• Neuropathic pain
• Chronic low back pain
• Fibromyalgia
• Abdominal and gastrointestinal pain

These TCAs can also be part of depression treatment, helping to relieve depressive symptoms. 

Ultimately, your healthcare provider who is treating your chronic pain should collaborate with your psychiatric provider to determine which medication (or combination of medications) will best improve your mental and physical health.

How to live with chronic pain and depression

On top of treatment (through therapy, medication, or both), you can also make lifestyle changes and practice self-care to improve your symptoms. Here are six tips:

1. Social connection 

Pain and depression both can lead to isolation, Jensen says. However, it’s important to maintain social connections and avoid isolation, which can further fuel depression. Plus, research suggests that having stronger social connections is linked to greater chronic pain relief. 

You can keep socializing with low-pressure options, like just hanging out with a friend at home and watching a movie. You might also consider joining virtual support groups or chronic pain communities, Jensen says.

2. Practicing self-compassion

Chronic pain often creates shame, guilt, and self-criticism, Jensen says. These feelings can cause you to speak unkindly to yourself. You can combat this by practicing self-compassion, which refers to speaking to yourself kindly and with compassion, the same way you would talk to a loved one. 

Research shows that practicing self-compassion can both reduce pain intensity and depressive symptoms. 

3. Gentle movement

Gentle movement, as medically appropriate, can help, even if just for a few minutes a day, Jensen says.  For example, you can try walking, stretching, yoga, or water therapy. 

She says movement can:

• Improve circulation
• Release feel-good hormones (endorphins)
• Reduce stiffness
• Improve sleep
• Boost mood

When in doubt, contact your healthcare provider to see what type of exercise is suitable for you.

4. Mindful pain observation

Mindfulness is the practice of being fully engaged in the present: noticing what’s going on in the current moment without judgment. You can put this into practice with mindful pain observation. 

Jensen says instead of saying something like, “I hate this pain. It’s ruining everything,” you can try:

• Noticing sensation qualities, like warm, tight, dull, or sharp
• Observing these sensations without judgment
• Breathing into the sensation 

This helps reduce “secondary suffering,” which refers to the extra emotional distress you add on to physical pain (the primary suffering) through negative thoughts or judgments about it.

Research suggests that practicing mindfulness more frequently can reduce chronic pain. 

5. Activity pacing

Many people with chronic pain symptoms overdo it on “good days,” and then crash for days after, Jensen says. By pacing yourself, you can increase your sense of control and prevent pain flare cycles. 

She recommends:

• Breaking tasks into small chunks
• Scheduling rest before you get exhausted
• Stopping at 70% capacity

6. Behavioral activation with micro-goals

Behavioral activation is a technique to combat depression by encouraging small, meaningful activities that help improve mood and motivation, rather than waiting for motivation to strike before taking action. 

Jensen says you can use this technique when your depression says, “I can’t,” and your pain says, “It’s too much.” She suggests using these guidelines:

• 5-minute rule
• 1 small task per day
• “Minimum viable effort”

An example of this would be:

• Sitting outside for 5 minutes
• Texting one friend
• Gentle stretching

Doing these small acts builds momentum and can keep you moving in the right direction.

How to help someone with chronic pain and depression

If you’re reading this because your loved one faces chronic pain symptoms and depression, here are some ways you can help.

1. Educate yourself

Whatever condition or type of chronic pain your loved one has, learn about it so you can better understand what they’re going through. It’s also helpful to read up on depression so you can understand the different ways that depression manifests — it’s more than just sadness.

2. Take depression seriously

“Avoid framing depression as ‘just a mindset,’” Jensen says. It’s not something someone can snap out of or “just think positive” to get out of. 

3. Offer practical support

Both chronic pain and depression can make it hard for someone to carry out daily tasks. Offering help with errands, groceries, meals, or picking up prescriptions can make a big difference.

4. Listen without going into fix-it mode

Many people with chronic pain feel dismissed or misunderstood, so simply listening empathetically can be powerful. “Validate pain first — never minimize it,” Jensen says. Ask open-ended questions to better understand what your loved one is going through. 

How Charlie Health can help

If you’re struggling with chronic pain and depression, Charlie Health is here to help. Charlie Health is a virtual behavioral health provider delivering high-acuity treatment for kids, teens, and adults facing serious mental health conditions and substance use disorders. Our innovative treatment model combines clinical expertise, group connection, and measurement-based care to support long-term healing. With the right support, managing your physical and mental health is possible. Fill out the form below to start healing today.