Chronic Pain and Depression

It shouldn't always be like this.

This issue is topical and it has been my main research topic since I graduated from university. This topic is why I furthered my studies into Psychology.

It is such a complicated matter and I have been postponing writing it for a while. I do not want to give advice, but merely inform of its significance.

The co existence of these two conditions is underestimated and often poorly understood. It is important to understand that since these two conditions are common causes of morbidity, a multidisciplinary approach for their management, is vital.

Most research on the management of chronic pain in the community has been condition-specific rather than considering chronic pain as a distinct entity or stand alone syndrome. 2

"Professional and public interest in the role of complementary therapies is growing. For chronic pain management the main complementary therapies are acupuncture, reflexology, osteopathy, chiropracty, homeopathy and hypnotherapy". 2

One of the most common emotions associated with chronic pain is depression. It is thought to be three to four times more common in people with chronic pain than in the general population. Furthermore, 30% to 80% of people with chronic pain will have some type of depression. The combination of the two can often be associated with greater disability than either depression or chronic pain alone. 3

It is well established that there is an association between chronic pain and depression. What is unclear is the strength and mechanism of this association. Undiagnosed and untreated chronic pain and depression can exacerbate the other condition, leading to a cycle of worsening pain and depression". 4

To date, neither the corresponding pathophysiological mechanisms of chronic pain and depression nor their mutual correlation has been identified, which poses a huge challenge for the treatment of pain accompanied by depression. However, in recent years, studies have revealed considerable overlaps between pain and depression-induced neuroplasticity changes and neurobiological mechanism changes. Such overlaps are vital to facilitating the occurrence and development of chronic pain-induced depression. 5

Collaboration with other treating clinicians and specialist advice are often useful, especially in complex cases. Despite these challenges, successful treatment of major depression will reduce pain and improve function and quality of life for patients with chronic pain. 6


It is imperative that you consult your clinician and seek proper advice when it comes to the combination of these two presentations. Osteopaths are trained to identify psychological concerns, but if the case history indicates signs of depression, I urge my patients to seek advise from a professional in counselling.

People often feel lost, some days are good and other days are really bad. When this is coupled with pain, life can become insufferable. Please communicate your concerns to your practitioner, friend or family member.



1. (Chronic Disease Prevention and Health Promotion Harald Schmidt, MA, PhD).

2. Chronic pain in primary care Blair H Smith Jane L Hopton W Alastair ChambersFamily Practice, Volume 16, Issue 5, October 1999, Pages 475–482.

3. American Chriropractor association

4. Chronic pain and depression. A Surah, G Baranidharan, S Morley. "Continuing Education in Anaesthesia Critical Care & Pain", Volume 14, Issue 2, April 2014, Pages 85–89.

5. The Link between Depression and Chronic Pain: Neural Mechanisms in the BrainJiyao Sheng, Shui Liu, Yicun Wang, et. al

6. Depression and chronic painAlex Holmes, Nicholas Christelis and Carolyn ArnoldMed J Aust 2013; 199 (6): S17-S20.

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