Pain Anxiety Depression Everyone has experienced pain, however, there are those with depression, anxiety, or both. Combine this with pain and it can become pretty intense and difficult to treat. People that are suffering from depression, anxiety or both tend to experience severe and long term pain more so than other people.

The way anxiety, depression, and pain overlap each other is seen in chronic and in some disabling pain syndromes, i.e. low back pain, headaches, nerve pain and fibromyalgia. Psychiatric disorders contribute to the pain intensity and also increase the risk of disability.

Depression: A (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how an individual feels, thinks, and how the handle daily activities, i.e. sleeping, eating and working. To be diagnosed with depression, the symptoms must be present for at least two weeks.

• Persistent sad, anxious, or “empty” mood.
• Feelings of hopelessness, pessimistic.
• Irritability.
• Feelings of guilt, worthlessness, or helplessness.
• Loss of interest or pleasure in activities.
• Decreased energy or fatigue.
• Moving or talking slowly.
• Feeling restless & having trouble sitting still.
• Difficulty concentrating, remembering, or making decisions.
• Difficulty sleeping, early-morning awakening & oversleeping.
• Appetite & weight changes.
• Thoughts of death or suicide & or suicide attempts.
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease with treatment.

Not everyone who is depressed experiences every symptom. Some experience only a few symptoms while others may experience several. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression. The severity and frequency of symptoms along with the duration will vary depending on the individual and their particular illness. Symptoms can also vary depending on the stage of the illness.

PAIN ANXIETY DEPRESSION

Objectives:

• What is the relationship?
• What is the neurophysiology behind it?
• What are the central consequences?

Brain Changes In Pain

Figure 1 Brain pathways, regions and networks involved in acute and chronic pain

Davis, K. D. et al. (2017) Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations Nat. Rev. Neurol. doi:10.1038/nrneurol.2017.122

PAIN, ANXIETY AND DEPRESSION

Conclusion:

• Pain, especially chronic is associated with depression and anxiety
• The physiological mechanisms leading to anxiety and depression can be multifactorial in nature
• Pain causes changes in brain structure and function
• This change in structure and function can alter the ability for the brain to modulate pain as well as control mood.