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Karlie Hopping

Professor Loudermilk

English 1201

26 April 2020

Why does chronic pain have such a big impact on your mental health?

Many individuals struggle with chronic pain. Although each individual's location of their

chronic pain may differ, they can all agree that their mental health has been affected because of

it. For many people, chronic pain is usually associated with other health conditions such as

anxiety and depression. Living with daily pain is emotionally and physically stressful, which can

lead to chronic stress. Chronic stress is known to disrupt the balance of several chemicals in your

body, which could affect your mood, thinking, and behavior. However, there are many reasons

why someone’s mental health could be affected by their chronic pain. The frustration of dealing

with chronic pain can result in anxiety and depression, and after dealing with chronic pain for

several years, psychologically driven pain could potentially develop, also, when getting treated

for chronic pain, opioids may be prescribed, which could lead to potential mental health issues.

Everyone experiences pain within their lifetime, whether that’s physical or emotional

discomfort due to an illness, injury, or upsetting event. It is inevitable. Despite most wanting to

avoid it, pain can be a good thing, serving as something that is seen to be “protective”. When you

experience pain, your brain sends signals for you to stop doing whatever you’re doing that is

causing the pain, which prevents your body from further harm. Pain should not last for a long

time, although for some people, pain can be ongoing, go away, and then come back, which can

last longer than 3 to 6 months, the amount of time that typical pain can last, also known as acute
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pain, which is the type of pain that most people experience. When it goes beyond 3 to 6 months,

it is then known as chronic pain or persistent pain, pain that continues when it should not (

Mental Health America ).

For several reasons, chronic pain can interfere with your everyday life. “It can affect your

ability to function at home and work. You may find it difficult to participate in social activities

and hobbies, which could lead to decreased self-esteem. It is also common for people with

chronic pain to have sleep disturbances, fatigue, trouble concentrating, decreased appetite, and

mood changes. These negative changes in your lifestyle can increase your pain and dampen your

overall mood; the frustration of dealing with this can result in depression and anxiety” ( Mental

Health America ). One of the most common reasons that adults seek medical care is because of

chronic pain. Chronic pain has been linked to activity limitations, dependence on opioids,

anxiety, and depression, and an overall decreased quality of life.

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Fig. 1. This chart acknowledges the way a percentage of individuals have felt because of their

chronic pain (“Pain Management Associates”)

Those suffering from chronic medical conditions should be provided mental health help

as well due to the impact that chronic medical conditions have on a person’s mental health.

“Research shows that those with chronic pain are four times more likely to have depression or

anxiety than those who are pain-free. In 2016, approximately 20 percent of U.S. adults had

chronic pain (approximately 50 million), and eight percent of U.S. adults (approximately 20

million) had high-impact chronic pain” ( Mental Health America ). Some of the most common

chronic pain conditions that are associated with mental health are Arthritis, Fibromyalgia,

Multiple Sclerosis, Back/Neck Pain, Chronic Migraines, etc. To treat those struggling with

anxiety and depression due to their chronic pain, there are many things you can

do--antidepressant medications, therapy, pain-rehabilitation programs, or stress-reduction

training, such as physical activity or meditation. Treatment is most effective when combining

those therapies ( Mental Health America ). Treatment options for when pain and anxiety or

depression intersect also include Cognitive Behavioral Therapy, Hypnosis, or mood stabilizers (

Harvard Health Publishing ).

After dealing with chronic pain for several years, psychologically driven pain could

potentially develop. To clarify, all pain is real. “A person’s experience of pain is unique to the

individual, and it can’t be measured from the outside, with the exception of sophisticated brain

mapping available with a functional MRI, which is only in a few laboratories across the country”

( Psychology Today, 2013 ). The experience of chronic pain is simply subjective, therefore it is

typically labeled “psychosomatic,” implying that the pain is psychologically driven. This,
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however, does not make the pain any less real or important because physical and psychologically

driven pain cannot be separated. Pain is pain and no matter what, the psychological impact of

pain is intense. ​In response to pain, the brain changes physically and chemically as the brain

signals to prepare for fight or flight acting as a survival mechanism. ​“Chronic pain goes beyond

the pain itself. The mental stress and biologic psychological effects of pain can be just as severe

as the pain itself. In fact, people with chronic pain are three times more likely to develop

depression” ( Augusta Pain Center, 2019 ). Therefore, it does not matter if the chronic pain an

individual is experiencing is occurring physically, or is being psychologically driven. It all has an

impact on your mental health.

All pain is real because “all pain is regulated by the brain—whether there is an actual nail

in your thumb or an old injury that should have healed by now but inexplicably keeps

hurting—in both cases it is nerve fibers that are sending messages to your brain that cause you to

feel pain ( Psychology Today, 2013 ). Everything in the human body is connected. It doesn’t

matter if it is something associated with a mental or physical situation. The way that chronic pain

interacts with the brain and how it later becomes psychosomatic is very complex. “Often, for

unknown reasons, the injury or tissue damage doesn’t heal as expected, and because of this, the

nerve fibers continue to fire as if there is damage that needs attention. With this unrelenting

signal traveling up the spinal column to the brain, eventually, the transmission circuits become

more efficient at transmitting these signals—like a one-lane road becoming a four-lane highway.

The continuous input into these circuits causes more transmission, with the net result being more

pain. At the same time, the number and array of pain-causing neurotransmitters in the nervous

system increase. Over time, the threshold for the pain receptors to fire is lowered, and a less
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intense stimulus is needed to cause the nerve to discharge and send its signal. What started out as

a message from the site of an injury to the brain has become a self-contained feedback loop

within the nervous system—a disease of the brain” ( Psychology Today, 2013 ). This can have a

very big impact on an individual's life if it is experienced.

Oftentimes, pain is associated with emotions. Pain is the universally integrated way that

the brain processes sensory and emotional experiences. Emotions and pain are both created by

the brain. “​Neurotransmitters are involved with the experience of pain as well as with emotions.

They are responsible for sending information between nerves about the pain and/or emotions

being sensed ( Psychology Today, 2013 ). Pain is the brain’s way of being protective. When we

feel pain, it is human nature for us to “experience a set of aversive emotions so that we will

attempt to move away from whatever is causing it” because that is how humans are circuited (

Psychology Today, 2013 ). It is logical for humans to have emotional responses to pain. All of

this information justifies why psychosomatic pain is just as real as physical pain and why it all

has an impact on an individual’s mental health. Emotions are as real as the pain that causes them,

so by accepting and investigating the emotions humans experience with chronic pain, individuals

can achieve substantial improvements in their well-being, which will essentially help them get

better and improve.

There is no denying that a person who struggles with chronic pain has had mental health

challenges because of it. Chronic pain will affect a person’s daily life no matter what. There is an

immense amount of evidence supporting that people with chronic pain struggle with mental

health issues due to the impact that their pain has on their daily life. “In a 2006 study, 77% of

people who suffered from chronic pain reported feeling depressed. Over 85% of chronic pain
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patients said that they had difficulty sleeping” ( Florida Medical Center, 2020 ). Therefore, for

some, to help with their chronic pain and to hopefully improve their quality of life, which will

hopefully improve their mental health, some use opioids as a way of coping or to get rid of their

chronic pain.

The sales for prescription opioids have nearly quadrupled in the U.S. from 1999 to 2014,

with more than half being prescribed to adults with mental disorders. Statistically, adults living

with depression, anxiety, and mood disorders receive 51 percent of all opioid prescriptions. For

over a decade, chronic pain has been largely responsible for the spike in opioid prescriptions (

Mental Health First Aid, 2017 ). To target the root of this physician prescribing problem, more

tools and training must be available. Across the nation, many states, like Tennessee, are

launching anxiety recovery program​s, which educate patients with chronic anxiety about how

their condition interacts with physical pain. The Tennessee Department of Mental Health and

Substance Abuse Services has also begun creating a protocol for emergency rooms to identify

people with anxiety and depression and to treat them ​using other methods besides opioids if

possible. “Trainings and initiatives like these help patients manage their mental health

challenges, as well as their pain, with alternative treatment models. To divert people from

prescribing and using opioids, we must first understand the connection between mental health

and substance use disorders” ( Mental Health First Aid, 2017 ). Everyone reacts differently

towards things, but understanding the connection between mental health and substance abuse

when dealing with chronic pain, could make a difference in someone’s life, therefore, improving

their mental health, and with that, their quality of life too.
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When getting treated for your chronic pain, opioids may be prescribed. “Opioids have

been regarded for millennia as among the most effective drugs for the treatment of pain. Their

use in the management of acute severe pain and chronic pain related to advanced medical illness

is considered the standard of care in most of the world” ( NCBI, 2008 ). ​However, concerns

related to effectiveness, safety, and abuse liability have evolved over the past several decades in

the United States, which sometimes drives a more restrictive perspective on this form of

treatment. The interference between the legitimate use of opioids to help with chronic pain and

the phenomena associated with abuse and addiction challenges the medical community, leading

to the uncertainty of the proper use of these drugs in the treatment of pain. ​“Opioids play a

unique role in society. They are widely feared compounds, which are associated with abuse,

addiction and the dire consequences of diversion; they are also essential medications, the most

effective drugs for the relief of pain and suffering” ( NCBI, 2008 ). However, since they are one

of the most powerful drugs, they will impact your mental health, especially when experiencing

withdrawals.

Withdrawals can have a severe impact on the human body. There are many layers to it

when dealing with chronic pain patients. On top of dealing with normal withdrawal symptoms, it

is very tricky to distinguish between chronic pain and withdrawal pain, due to addiction being

associated with psychological distress and physical discomfort because of opioid withdrawal

symptoms, therefore making it harder to treat chronic pain patients ( NCBI, 2009 ). However,

there is evidence that experienced drug abusers can distinguish between the two types of pain.

“For example in studies of methadone maintenance patients, both the phenomenology and

correlates of chronic pain were different than for withdrawal pain. Chronic pain is typically
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localized (e.g., back pain, headache) and persists (although with varying degrees of severity) for

long periods of time. Although certain subjective experiences of withdrawal (e.g., muscle ache)

are similar to some distinct pain syndromes, other withdrawal experiences such as yawning,

sweating and hot and cold flashes are likely to be more commonly associated with subjective

drug withdrawal than with primary pain conditions” ( NCBI, 2009 ). To distinguish between the

two, the constellation of words used to describe withdrawal pain includes the reference to “being

sick” compared to the reference of a distinct pain. This is important to remember becaus​e the

prevalence of addictive disorders among chronic pain patients is hard to determine.

Overall, the use of opioids remains controversial due to the concerns about side effects,

long-term efficacy, functional outcomes, and potential drug abuse and addiction. “​These

concerns have propelled extensive work to develop predictors of problematic behaviors or frank

substance abuse or addiction during opioid therapy. Questionnaires to assist in this prediction

and monitoring have been developed and used in research and field trials” ( NCBI, 2009 ).

However, these are not being used in practice settings currently, but it is a step toward the future

of prescribing opioids safely and efficiently. There is a lot of evidence going against the use of

opioid treatment, especially for chronic pain patients, but there is also evidence supporting it.

Despite all of the evidence going against the use of opioid treatment, saying that they might be

harmful or have little effect, some opioid treatment practices continue. “Outcome studies of long

term use of opioids are compromised by methodological limitations which make it difficult to

acquire evidence of efficacy” ( NCBI, 2009 ). Therefore, many question whether or not to use

opioids as a treatment for chronic pain patients due to its many terrible consequences. If needed,
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chronic pain patients may need treatment for not only their chronic pain but for their mental

health and addiction to opioids as well, which once again, makes treatment more tricky.

Higher rates of drug and alcohol abuse have been linked to chronic pain patients. Many

studies show evidence of high rates of drug and alcohol abuse linked to chronic pain patients.

For example, “the Mayo Clinic reported that 24 percent of a consecutive series of patients

referred for the treatment of chronic pain were addicted to prescription drugs and another 41

percent were misusing medication to such an extent that they were classified as drug abusers” (

NCBI ). Patients with substance abuse disorders have often been associated with experiencing

depression. In a study of 533 opiate addicts, the prevalence of major depression was 24 percent.

All of this data indicates that these problems are all interconnected--depression and anxiety

states, depression and drug dependency, substance abuse and depression, and all of these with

chronic pain ( NCBI ). Regardless of whether substance abuse is a cause or effect of chronic

pain, “recognition and treatment of substance abuse disorders is likely to be an essential

component of successful rehabilitation of the chronic pain patient” ( NCBI ). As previously

stated, there are plenty of treatment options out there, but to help treat chronic pain patients that

struggle with substance abuse, there are mutual help groups, such as ​family or group therapy that

may be helpful.

Opioids are known to be very strong pain relievers that include drugs like OxyContin

(oxycodone), morphine, and Vicodin (hydrocodone and acetaminophen). To relieve pain from

after surgery or for an injury, doctors will typically prescribe opioids. Although these drugs can

be very effective pain relievers, they are also highly addictive. However, “in 2017, doctors in the

United States wrote more than 191 million prescriptions for these drugs” ( Healthline, 2019 ).
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Statistically, those who struggle with a mental illness, such as depression or anxiety, are more

likely to get prescribed opioids, which is a problem because they are also at greater risk for

developing a dependence on these drugs. “About 16 percent of Americans have mental health

disorders, yet they receive more than half of all opioid prescriptions. People with mood and

anxiety disorders are twice as likely to use these drugs than people without mental health

problems. They’re also more than three times as likely to misuse opioids” ( Healthline, 2019 ).

Not only does the evidence show that individuals with mental health conditions are more likely

to be prescribed opioids and use them​, but a reverse relationship also exists. Evidence also

suggests that opioid use can contribute to mental health problems. “​A 2016 study in the Annals

of Family Medicine found that about 10 percent of people prescribed opioids developed

depression after a month of taking the drugs. The longer they used opioids, the greater their risk

of developing depression became” ( Healthline, 2019 ). To explain the link between mental

health and opioid dependence, there are a few possible reasons. Firstly, pain is a common

symptom in people with mental health disorders, so to cope, ​people with depression and other

mental health issues may use opioids to self-medicate and escape from their problems. Ho​wever,

opioids may not work as well in people using them to treat mental illness, therefore, leading to

doses needing to be increased over time. Lastly, people with mental illnesses could have genes

that increase their risk of addiction. These are very important for doctors to take into

consideration before prescribing opioids to treat those with mental illnesses, or to treat chronic

pain patients. Opioids can be helpful for treating short-term pain, such as after surgery or for an

injury, however, they can also lead to dependence or addiction when used long-term.
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Due to the frustration of dealing with chronic pain, which can result in anxiety and

depression, after dealing with chronic pain for several years, psychological pain could potentially

develop, and when getting treated for chronic pain, opioids may be prescribed, which could lead

to potential mental health issues. Many individuals struggle with chronic pain, and for various

reasons, an individual’s mental health may suffer. Whether it’s due to the chronic stress of living

with chronic pain, which is emotionally and physically stressful, or because an individual's

chronic pain is psychologically driven, which despite the type of pain, has an impact, or due to

the type of treatment a person may get to help with their mental health or chronic pain, such as

an opioid prescription, which could lead to drug dependence or abuse, it all has an impact on

your mental health. Everything in the human body connects one way or another, so there is no

doubt that chronic pain affects an individual’s mental health. Chronic pain is a lot for someone to

live with every single day, so after a while, it takes a big toll on your mental health, for it can

affect your ability to do basic human activities, and more, which can result in other health

problems. There are many effects that chronic pain has not only on your mental health but your

whole body as well, so once again, it all links up.

It only takes common sense to understand why someone’s mental health may suffer

because of their chronic pain. All of the evidence collected over time further explains it as well.

Also, all of the evidence supporting why a chronic pain patient's mental health would be affected

is essential for an individual to improve and get better. No matter what, all chronic pain patients

need to recognize what they are going through, understand, and acknowledge every detail, which

the evidence for why a chronic pain patient's mental health would be affected aids in this. Many

people forget about the individuals that struggle with both physical and emotional pain, so a
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change needs to be made in increasing the awareness of this issue. Also, a change needs to be

made to find other ways to treat patients with chronic pain to help with the chronic pain part,

besides opioids, for it is doing several negative things towards an individual's mental health.

Many factors contribute to the decline in the mental health of chronic pain patients, so with

further research, awareness, and change, chronic pain patients can have hope that things do get

better.
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Works Cited

“Chronic Pain and Mental Health.” ​Mental Health America​,

www.mhanational.org/chronic-pain-and-mental-health​.

“Chronic Pain: It Is All in Your Head, and It's Real.” ​Psychology Today,​ Sussex Publishers, 2

Jan.

2013,

www.psychologytoday.com/us/blog/day-without-pain/201301/chronic-pain-it-is-all-in-yo

ur-head-and-it-s-real​.

“Chronic Pain, Mental Health and Opioid Prescriptions: A Juggling Act.” ​Mental Health First

Aid,​

11 July 2017,

www.mentalhealthfirstaid.org/2017/07/chronic-pain-mental-health-opioid-prescriptions/​.

Harvard Health Publishing. “The Pain-Anxiety-Depression Connection.” ​Harvard Health,​

www.health.harvard.edu/healthbeat/the-pain-anxiety-depression-connection

Institute of Medicine (US) Committee on Pain, et al. “Psychiatric Aspects of Chronic Pain.” ​Pain

and Disability: Clinical, Behavioral, and Public Policy Perspectives.​, U.S. National

Library of Medicine, 1 Jan. 1987, ​www.ncbi.nlm.nih.gov/books/NBK219250/​.

Legg, Timothy J., and Stephanie Watson. “Mental Health and Opioid Dependence: How Are

They

Connected? .” ​Healthline ,​ 29 Mar. 2019,

www.healthline.com/health/opioid-withdrawal/mental-health-connection#1​.

“Pain Management Associates- KC Pain Centers.” ​AAKC,​

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www.aakc.com/services/pain-management/​.

Rosenblum, Andrew, et al. “Opioids and the Treatment of Chronic Pain: Controversies, Current

Status, and Future Directions.” ​Experimental and Clinical Psychopharmacology​, U.S.

National Library of Medicine, Oct. 2008,

www.ncbi.nlm.nih.gov/pmc/articles/PMC2711509/​.

“The Psychological Effects of Chronic Pain.” ​Augusta Pain Center,​ 10 June 2019,

augustapaincenter.com/mind-not-body-psychological-effects-chronic-pain/.

“The Psychological Impact of Chronic Pain.” ​Florida Medical Clinic​, 21 Feb. 2020,

www.floridamedicalclinic.com/blog/psychological-impact-chronic-pain/​.