While chronic pain and depression are conditions that may occur together, their relationship to one another is not always obvious and is often overlooked. Depression can be overlooked because the health care provider, the patient and the family may be focusing on the pain disorder. At times, the patient’s level of disability may be attributed solely to pain. Because there is such a close relationship between depression and chronic pain, they have been referred to as “mutually maintaining” conditions. This is because the presence of both depression and chronic pain can increase the symptom severity of either condition. Pain is depressing, and depression causes and intensifies pain. People with chronic pain have three times the average risk of developing psychiatric symptoms — usually mood or anxiety disorders — and depressed patients have three times the average risk of developing chronic pain.
One disorder that has been shown to occur with depression is fibromyalgia. Fibromyalgia causes chronic, widespread muscle pain, tiredness, and multiple tender points—places on the body that hurt in response to light pressure. People with fibromyalgia are more likely to have depression and other mental illnesses than the general population. Studies have shown that depression and fibromyalgia share risk factors and treatments.
Almost every drug used in psychiatry can also serve as a pain medication. Relieving anxiety, fatigue, depression, or insomnia with mood stabilizers, benzodiazepines, or anticonvulsants will also ease any related pain. The most versatile of all psychiatric drugs, the antidepressants have an analgesic effect that may be at least partly independent of their effect on depression since it seems to occur at a lower dose.