People suffering from depression and anxiety experience more pain

Everyone experiences pain at some point, but in people with depression or anxiety, pain can become particularly intense and hard to treat. People suffering from depression, for example, tend to experience more severe and long-lasting pain than other people.

The overlap of anxiety, depression, and pain is particularly evident in chronic and sometimes disabling pain syndromes such as fibromyalgia, irritable bowel syndrome, low back pain, headaches, and nerve pain.

For example, about two-thirds of patients with irritable bowel syndrome who are referred for follow-up care have symptoms of psychological distress, most often anxiety. About 65% of patients seeking help for depression also report at least one type of pain symptom. Psychiatric disorders not only contribute to pain intensity but also to increased risk of disability.

Researchers once thought the reciprocal relationship between pain, anxiety, and depression resulted mainly from psychological rather than biological factors. Chronic pain is depressing, and likewise major depression may feel physically painful. But as researchers have learned more about how the brain works, and how the nervous system interacts with other parts of the body, they have discovered that pain shares some biological mechanisms with anxiety and depression.

Shared anatomy contributes to some of this interplay. The somatosensory cortex (the part of the brain that interprets sensations such as touch) interacts with the amygdala, the hypothalamus, and the anterior cingulate gyrus (areas that regulate emotions and the stress response) to generate the mental and physical experience of pain. These same regions also contribute to anxiety and depression.

In addition, two neurotransmitters — serotonin and norepinephrine — contribute to pain signaling in the brain and nervous system. They also are implicated in both anxiety and depression.

Treatment is challenging when pain overlaps with anxiety or depression. Focus on pain can mask both the clinician's and patient's awareness that a psychiatric disorder is also present. Even when both types of problems are correctly diagnosed, they can be difficult to treat. A review identified a number of treatment options available when pain occurs in conjunction with anxiety or depression.

Harvard Health Publishing

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