Chronic pain and mental health: why treating both makes a difference

Living with pain every day doesn’t only wear out the body. The NIH note that chronic pain may be accompanied by difficulty moving around, disturbed sleep, anxiety, depression and other problems.^[2] And the link runs both ways: according to the National Institute of Mental Health (NIMH), people with depression are at higher risk of developing chronic conditions, including pain, and people who have both tend to have more severe symptoms of each.^[3]

What the data shows

A study published in 2023 in the journal Pain, using data from nearly 32,000 adults in the U.S. National Health Interview Survey (NHIS 2019), found that:^[1]

• About 12 million adults (4.9% of the adult population) have both chronic pain and symptoms of anxiety or depression.
• 23.9% of adults with chronic pain have symptoms of anxiety or depression, compared with 4.9% of adults without chronic pain.
• Chronic pain is present in most (55.6%) adults with ongoing anxiety or depression symptoms.

Adults with anxiety or depression symptoms, U.S. 2019

With chronic pain

23.9%

Without chronic pain

4.9%

Together, the impact on daily life grows

The same study showed that limitations in daily life were more likely when pain and anxiety or depression occur together than when only one is present. Among people with both:^[1]

Limitations among adults with both chronic pain and anxiety or depression

Work limited by a health problem

69.4%

Difficulty taking part in social activities

55.7%

Difficulty running errands alone

43.7%

Signs to watch for

NIMH lists several symptoms of depression, including:^[3]

• A persistent sad, anxious or “empty” mood
• Feelings of hopelessness or pessimism
• Loss of interest or pleasure in hobbies and activities
• Aches or pains, headaches, cramps or digestive problems without a clear physical cause

Not everyone has every symptom. And most importantly, according to NIMH, depression is treatable, even if you have a chronic illness.^[3]

Therapies backed by evidence

According to the NIH’s National Center for Complementary and Integrative Health (NCCIH):^[2]

• Cognitive behavioral therapy (CBT) is the prevailing psychological intervention for chronic pain.
• Both mindfulness-based interventions and CBT help decrease pain intensity, with no important difference between them.
• For chronic low back pain, mindfulness-based stress reduction is associated with a small improvement, and yoga and tai chi may also help.

The CDC’s 2022 clinical guideline also includes psychological therapy and mindfulness among the non-drug options for chronic low back pain, and CBT for fibromyalgia.^[4] For depression, NIMH says treatment typically involves psychotherapy, medication, or both.^[3]

Asking for help doesn’t mean it’s “all in your head”

Getting psychological support when you have chronic pain doesn’t mean the pain is imaginary. It means treating the whole person: body, sleep, emotions and the way you cope day to day. That’s why the best results often come when pain management and mental health care work together.

If you are in crisis or thinking about harming yourself, in the U.S. you can call or text 988 (Suicide & Crisis Lifeline), available 24/7, free and confidential. Text and chat services are also available in Spanish.^[5]

A comprehensive plan that combines pain treatment and psychological support can help you regain not just mobility, but quality of life.