Chronic pain disorder is often associated with anxiety, and depression. Several studies have shown a clear link between depression and chronic pain — chronic pain is more prevalent in patients with depression and depressed individuals complain of pain more. Because the relationship between pain and depression is complex, antidepressants work only on some patients with chronic pain, and not everyone. Chronic pain can also lead to personality changes, by generating negative emotions. On the other hand, our own “personality fabric” (the way we cope with adversities or how preoccupied we can be with physical symptoms) may also intensify pain or prolong the pain after injuries. Epidemiological studies have shown that in many cases, chronicity in regards to pain tends to be linked to poorer socioeconomic status, female gender and poorer health status.
Only rarely will there be situations where pain is the clear result of distorted thoughts and emotions. In the vast majority of cases, pain starts from a physical event (at times quite small and at times serious) and then intensifies and persists as a host of psychoemotional, social and physical factors come into play (such as one worrying about their job or their finances, becoming depressed, been scared to drive after a car accident that could be minor, becoming conditioned to fear or expect more pain etc). Untreated or poorly treated acute pain is a serious cause of chronicity, as research has shown. It is interesting to note that the American military treats acute pain promptly at the battlefield, as they have observed that untreated acute pain is associated with a high incidence of Post Traumatic Stress Disorder, a disabling psychiatric condition that is responsible for high levels of disability in the American troops.
In my next paper, I will discuss how early and late experiences in life and other factors such as the meaning of pain or paying attention to it shape our perception of pain.
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Angela Mailis Gagnon, MD, MSc, FRCPC(PhysMed)
Director, Comprehensive Pain Program,
Senior Investigator, Krembil Neuroscience Centre
Toronto Western Hospital,
Chair ACTION Ontario www.actionontario.ca
These topics are also covered in Dr. Mailis Gagnon’s book: Beyond Pain: Making the Mind-Body Connection