Pain serves an important function in our lives. Whenyou suffer an acute injury, pain warns you to stop theactivity that is causing the injury and tells you to takecare of the affected body part.

Chronic pain, on the other hand, persists for weeks,months, or even years. Some people, often olderadults, suffer from chronic pain without any definablepast injury or signs of body damage. Common chronicpain can be caused by headaches, the low back, andarthritis. Unfortunately, there is scant objective evi-dence or physical findings to explain such pain.

Until recently, some doctors who could not find aphysical cause for a person’s pain simply suggestedthat it was imaginary—“all in your head.” This is unfor-tunate because we know that all pain is real and notimagined, except in the most extreme cases of psy-chosis. Emerging scientific evidence is demonstratingthat the nerves in the spinal cord of patients withchronic pain undergo structural changes.

Psychological and social issues often amplify theeffects of chronic pain. For example, people withchronic pain frequently report a wide range of limita-tions in family and social roles, such as the inability toperform household or workplace chores, take care ofchildren, or engage in leisure activities. In turn, spous-es, children, and co-workers often have to take overthese responsibilities. Such changes often lead todepression, agitation, resentment, and anger for thepain patient and to stress and strain in family and othersocial relationships.

How is depression involved with chronicpain?Depression is the most common emotion associatedwith chronic pain. It is thought to be 3 to 4 times more

common in people with chronic pain than in the gener-al population. In addition, 30 to 80% of people withchronic pain will have some type of depression. The combination of chronic pain and depression isoften associated with greater disability than eitherdepression or chronic pain alone.

People with chronic pain and depression suffer dra-matic changes in their physical, mental, and socialwell-being—and in their quality of life. Such peopleoften find it difficult to sleep, are easily agitated, can-not perform their normal activities of daily living, can-not concentrate, and are often unable to perform theirduties at work. This constellation of disabilities startsa vicious cycle—pain leads to more depression, whichleads to more chronic pain. In some cases, the depres-sion occurs before the pain.

Until recently, we believed that bed rest after an injurywas important for recovery. This has likely resulted inmany chronic pain syndromes. Avoiding performingactivities that a person believes will cause pain onlymakes his or her condition worse in many cases.

Healthy LivingPatient Information from the American Chiropractic Association

Chronic Pain and Depression

Healthy LivingChronic Pain and Depression

Depression associated with pain is powerful enough tohave a substantial negative impact on the outcome oftreatment, including surgery. It is important for yourdoctor to take into consideration not only biological,but also psychological and social issues that painbrings.

What is the treatment for chronic painand depression?The first step in coping with chronic pain is to deter-mine its cause, if possible. Addressing the problemwill help the pain subside. In other cases, especiallywhen the pain is chronic, you should try to keep thechronic pain from being the entire focus of your life.

• Stay active and do not avoid activities thatcause pain simply because they cause pain.The amount and type of activity should bedirected by your doctor, so that activities thatmight actually cause more harm are avoided.

• Relaxation training, hypnosis, biofeedback, andguided imagery, can help you cope with chron-ic pain. Cognitive therapy can also helppatients recognize destructive patterns of emo-tion and behavior and help them modify orreplace such behaviors and thoughts with morereasonable or supportive ones.

• Distraction (redirecting your attention awayfrom chronic pain), imagery (going to your“happy place”), and dissociation (detachingyourself from the chronic pain) can be useful.

• Involving your family with your recovery may bequite helpful, according to recent scientific evi-dence.

Feel free to discuss these or other techniques withyour doctor of chiropractic. He or she may suggestsome simple techniques that may work for you or mayrefer you to another health care provider for more in-depth training in these techniques.

Signs and Symptoms

Some of the common signs and symptoms ofchronic pain include:

• Pain beyond 6 months after an injury• Allodynia—pain from stimuli which are not

normally painful and/or pain that occursother than in the stimulated area

• Hyperpathia—increased pain from stimulithat are normally painful

• Hypersensation—being overly sensitive topain

Signs of major clinical depression will occur dailyfor 2 weeks or more, and often include many ofthe following:

• A predominant feeling of sadness; feelingblue, hopeless, or irritable, often with cry-ing spells

• Changes in appetite or weight (loss or gain)and/or sleep (too much or too little)

• Poor concentration or memory• Feeling restless or fatigued• Loss of interest or pleasure in usual activi-

ties, including sex• Feeling of worthlessness and/or guilt

For more information on preventionand wellness, or to find a doctor ofchiropractic near you, visit ACA’s web-site at www.acatoday.org/patients.

Lawrence H. Wyatt, DC, DACBR, FICC, Professor, DivisionOf Clinical Sciences, Texas Chiropractic College, Writer

This patient information page is a public service of the Journal of the American Chiropractic Association. The infor-mation and recommendations appearing on this page are appropriate in most instances, but they are not a substi-tute for a diagnosis by a specialist. For specific information concerning your health condition, consult your doctorof chiropractic. This page may be reproduced noncommercially by doctors of chiropractic and other healthcareprofessionals to educate patients. Any other reproduction is subject to ACA approval.

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