Chronic pain is generally understood to be any persistent or intermittent pain that has been ongoing for more than 3 months, and can involve both pain from an injury, or from an unknown cause. It is quite common in Australia, with studies showing that 1 in 5 adults are living with a chronic pain condition, making it difficult for them to work, study, or spend time doing the things that they enjoy.
Additionally, depression will affect 1 in 7 Australians through their lifetime. And it is now recognised to be the third leading contributor to the global disease burden. Looking at these two conditions together, it’s been found that ongoing pain can often cause a depressive episode, and up to 85% of chronic pain patients are also affected by depression. With such a prominent link, it’s important to look at treatment options for them together to ensure more successful outcomes for pain patients.
There are a number of reasons that depression and chronic pain are thought to occur together so commonly. Firstly, the effects of having to deal with ongoing pain, and how it affects your social, work and family life, can lead to situations that make you more vulnerable to depression. For example, losing your job from an inability to work and the concurrent financial stress, not being able to participate in your usual activities like sport or family life, or being cut off from your regular social outlets due to pain being too high, can all contribute to clinical depression.
Secondly, depression itself may contribute further to the pain you’re experiencing. Pain tolerance is often reduced in people experiencing depression, therefore exacerbating the pain sensations you are feeling. This can then become a vicious cycle, with the more pain you feel increasing the depression, and the more depressed you are feeling leading to an increase in pain.
How to break the cycle between pain and depression
Current treatments tend to focus on the two separate parts of the condition individually – using antidepressants for the depression, and then analgesics and anti-inflammatories for the pain. There has been some benefit found from the older antidepressants (called Tricyclic Antidepressants, TCA’s for short) that can have a beneficial effect on both the pain and depression, but they tend to have quite strong side effects in the higher doses required, such as sedation, blurred vision, and increased risk of delirium.
Psychological interventions like Cognitive Behavioural Therapy (CBT) have also been shown to help both pain and depressive symptoms, and can be used alongside other therapies quite safely.
The role for Chinese Medicine
As acupuncture and Chinese medicine treat the person as a whole, we see that both chronic pain and depression can arise together, and so can be treated together. The main aim initially is to reduce your pain levels, as that can have an immediate effect on your mood. But we are also treating the depression and everything that can go along with it – lifting the mood, improving sleep, increasing energy, and clearing up foggy thinking. Acupuncture is the main therapy used, but I also often combine it with Chinese herbal medicine or nutritional supplements to help get you back on your feet sooner.
Australian Institute of Health and Welfare (2020). Chronic Pain in Australia – Insight. [Online] Available at: https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx
Beyond Blue (2021). Statistics [Online]. Available at: https://www.beyondblue.org.au/media/statistics
Holmes, A., Christelis, N. & Arnold, C. (2013). Depression and Chronic Pain. Medical Journal of Australia, 199(6), 17-20.
Sheng, J., Liu, S., Wang, Y., Cui, R. & Zhang, X. (2017). The link between depression and chronic pain: neural mechanisms in the brain. Neural Plasticity, June 2017, doi: 10.1155/2017/9724371