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  • Brittany Montes, Psy. D.

Mental Health and Chronic Pain

The topic of chronic pain has been widely discussed in nearly all aspects of the medical and psychological communities.  In an attempt to address the ongoing opioid epidemic and reduce patient dependence on narcotic pain management, pain management clinics are becoming increasingly reliant on mental health providers to assist their patients in managing their chronic, physical pain.


Mental Health and Chronic Pain

However, patients who are referred to therapy to assist in pain management are often left feeling as though their medical providers believe that the patient is “making up” or “imagining” their pain for some sort of personal gain.  Unfortunately, this gap in communication between patients, medical providers, and mental health providers often leaves patients hesitant and/or unwilling to pursue mental health treatment.


The relationship between physical pain and mental health functioning is complex and, oftentimes, difficult to fully define.  Additionally, the complexity and stigma of chronic pain has made it difficult for providers and patients to more fully explore the relationship between mental health and chronic physical pain.  With my own patients, I often refer to the relationship between chronic pain and mental health as a “vicious cycle.”  Specifically, as physical pain increases, so does emotional distress.  Conversely, increased emotional distress often contributes to an exacerbation of chronic physical pain.


Generally, chronic pain is defined as pain lasting longer than 6 months (Molitor et al., 2011).  Further chronic pain is defined as a public health crisis that affects approximately 25.3 million Americans (Crouch, et al., 2020).  Furthermore, the American Psychiatric Association (2020) notes that “people living with chronic pain are at heightened risk for mental health problems, including depression, anxiety, and substance use disorders.”  In fact, it is estimated that approximately 35% to 45% of chronic pain patients endorse experiencing depression.


Unfortunately, the public health crisis that is chronic pain is often paired with the ongoing opioid epidemic.  While opioid-based treatment has been found to be effective in treating short-term pain, there is very little research regarding the effectiveness of opioid treatment over the long-term (Crouch et al., 2020).  Additionally, researchers have found that opioids often contribute to depressive symptoms while also failing to adequately control chronic pain (Vadivelu et al., 2017).  The risks of opioid-based treatment paired with the lack of supporting research has contributed to a significant decline in prescribing practices and further limited available treatment options for individuals suffering with chronic pain.


In the absence of opioid-based treatment, medical providers are relying on the therapist community more and more to provide treatment for chronic pain patients.  The American Psychiatric Association (2020) recommends that primary care providers initiate conversations surrounding mental health with their chronic pain patients rather than waiting for these patients to begin reporting symptoms.  Similarly, Molitor et al. (2011) notes that emotional wellness is as important as physical wellness and traditional medical treatment for chronic pain.  Additionally, authors note that “chronic pain is physically and psychologically stressful and its constant discomfort can lead to anger and frustration with yourself and your loved ones” (Molitor, 2011).


With regard to psychological treatment for chronic pain, typically providers will work with patients to change their relationship with their chronic pain (i.e. how they think and feel about their chronic pain) so that they can build meaningful and purpose-filled lives while also respecting their physical limitations.  These goals can be achieved through a variety of evidence-based treatment modalities including CBT, DBT, and ACT.  Additionally, Vadivelu et al. (2017) state characteristics such as hope, pain acceptance, and optimism contribute to substantially lower levels of pain, pain-associated disability, and distress.


In sum, while your mental health may not be causing your chronic pain, it is likely that your chronic pain is damaging your mental health.  Additionally, it is also likely that your mental health may be intensifying the severity of your pain.  Regardless of the root cause of your chronic pain,  seeking mental health treatment will likely increase your ability to cope with and manage your pain over the long-term.


About the Author

Dr. Montes is a licensed clinical psychologist and co-owner of Cognitive Behavior Therapy Center in Chesapeake, VA.



References

American Psychiatric Association. (2020, November 13). Chronic pain and mental health often interconnected. Psychiatry.org - Chronic Pain and Mental Health Often Interconnected. https://www.psychiatry.org/news-room/apa-blogs/chronic-pain-and-mental-health-interconnected#:~:text=People%20living%20with%20chronic%20pain,levels%20and%20contribute%20to%20depression

 

Crouch, T. B., Wedin, S., Kilpatrick, R. L., Christon, L., Balliet, W., Borckardt, J., & Barth, K. (2020). Pain rehabilitation’s dual power: Treatment for chronic pain and prevention of opioid-related risks. American Psychologist, 75(6), 825–839. https://doi.org/10.1037/amp0000663 


Molitor, N., Keck, A., & Nordal, K. (2011). Coping with chronic pain. American Psychological Association. https://www.apa.org/topics/pain/chronic 


Vadivelu, N., Kai, A. M., Kodumudi, G., Babayan, K., Fontes, M., & Burg, M. M. (2017). Pain and psychology-a reciprocal relationship. Ochsner journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472077/ 


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