Many people who live with mental illnesses like depression, anxiety, and PTSD also report experiencing physical pain, according to multiple studies examining the link between chronic pain and mental health. While doctors might not be able to identify a physical reason for this kind of pain, mental health professionals agree that pain and mental health are deeply intertwined and need to be treated together.
"We know that physical pain, such as headaches and back pain, can be a symptom of anxiety, depression, and stress. It is also true that chronic pain can contribute to symptoms of depression, anxiety, and even PTSD," Dr. Lindsay Henderson, Psy.D., a psychologist who treats patients virtually via telehealth app LiveHealth Online, tells Bustle. "In fact, physical and mental symptoms often feed into one another in a cycle that is difficult to break, making it hard to know which came first. Therefore, someone who struggles with anxiety, depression, or PTSD may in fact be more likely to also experience pain because physical pain is a symptom of these disorders."
Dr. Michele Cascardi, associate professor of psychology at William Paterson University and director of the university’s doctoral program in clinical psychology, concurs, telling Bustle that each condition informs the other. "Pain may prevent usual engagement in enjoyable activities, impair work productivity, decrease energy, or interfere with sleep. Not surprisingly, these negative experiences can increase the duration and intensity of pain, creating a vicious cycle of pain increasing depression and anxiety which then increases pain."
While this issue is getting more attention recently, in part due to outspoken advocates, it's not new. The Medical Journal of Australia published a 2013 study reporting that up to 40 percent of people who present for treatment of back pain also have a major depressive disorder. Another study published in the journal PAIN found that up to 42 percent of people who live with mental health issues also experience back and neck pain. Despite these statistics, many people living with these co-occurring conditions often feel alone, which can exacerbate their illnesses.
Along this line, Lady Gaga, who has been an outspoken advocate for both mental-health and chronic-pain awareness since she revealed that she lives with PTSD and the chronic-pain condition fibromyalgia, recently told Vogue that it infuriates her when people claim that fibromyalgia and other chronic-pain conditions aren't real. She explained that, in her experience, mental illness hijacks the nervous system and leads to to physical pain. She told Vogue that when she re-experiences the trauma of being sexually assaulted at 19, she becomes overwhelmed with physical and emotional pain — both of which are very real.
"My diaphragm seizes up. Then I have a hard time breathing, and my whole body goes into a spasm. And I begin to cry," she told Jonathan Van Meter for Vogue. [...] "For me, and I think for many others, it’s really a cyclone of anxiety, depression, PTSD, trauma, and panic disorder, all of which sends the nervous system into overdrive, and then you have nerve pain as a result."
This is why Dr. Henderson says addressing all of a patient's symptoms is vital for recovery. "It’s important to treat both chronic pain and symptoms of depression or anxiety. While one may assume that treating one will automatically fix the other, reducing pain doesn’t necessarily reduce symptoms of depression or anxiety. Some studies suggest that a collaborative and integrative approach is best."
Additionally, a global study published in the Journal of Affective Disorders found a strong link between mental illness and chronic pain and concluded that these co-occurring conditions should remain a priority for researchers. "Despite great diversity in demographic, socioeconomic and health patterns among the 17 countries surveyed, the pooled cross-national results consistently showed that depressive and anxiety disorders were independently and comparably related to a wide range of chronic physical conditions."
For those who live with chronic pain and anxiety, depression, or PTSD, the experience of going from doctor to doctor and being told it's all in your head can be frustrating to say the least. And, while there are many treatment options for people who live with both mental illness and chronic pain, Dr. Henderson says practitioners have seen success with one in particular.
"We know that our thoughts and emotions can influence one’s experience of pain, making it more or less intense. Research has demonstrated that treatment such as cognitive behavioral therapy, which specifically targets thoughts and emotions, have been most effective in managing both pain and depression/anxiety."
Additionally paper published in The Journal of the American Medical Association noted that the first step toward recovery is simply acknowledgement, which can go a long way toward healing for patients who feel alone. The paper recommended a method for doctors called turning toward: "Turning toward means recognizing suffering, becoming curious about the patient's experience, and intentionally becoming more engaged and present." The paper outlined how a patient who had suffered for years began to improve rapidly once her physical and emotional pain was acknowledged by her doctors.
This method doesn't just apply to medical settings. If you have a friend, loved one, or colleague who lives with mental health issues, chronic pain, or both, the greatest gift you can give that person is to acknowledge their pain. Remember that just because someone looks OK on the outside, it doesn't mean they're not in pain. You don't have to fix it. Simply extending kindness when someone discloses a chronic condition is a positive step toward both acknowledgement and reducing the stigma. Because, the pain — both mental and physical — is real.
If you or someone you know is experiencing suicidal thoughts, call the National Suicide Prevention Hotline at 1-800-273-8255 or text HOME to the Crisis Text Line at 741741. You can also reach out to the Trans Lifeline at 877-565-8860 or the Trevor Lifeline at 1-866-488-7386, or to your local suicide crisis center.