Chronic Arthritis Pain and Depression

Chronic pain and depression are common health problems, and they are frequently intertwined. Researchers estimate that, depending on the population surveyed, 25% to 80% of people with chronic pain also experience depression. ¹ Cheatle, M. et al. The prevalence and mediators of suicidal ideation in patients with chronic con-cancer pain. The Journal of Pain, Volume 14 , Issue 4 , S24. . http://www.jpain.org/article/S1526-5900%2813%2900798-0/fulltext. Accessed January 5, 2015.

Depression among arthritis patients

Arthritis pain is one of the most common causes of chronic pain, ² Johannes CB, et al. The Prevalence of Chronic Pain in United States Adults: Results of an Internet-Based Survey. (Abstract only.) The Journal of Pain, Volume 11 , Issue 11 , 1230 – 1239. so it is not surprising that many people who have arthritis also have depression. In the general population, approximately 9% of Americans have depression or major depression, according to the CDC. ³ Center for Disease Control and Prevention. Morbidity and Mortality Weekly Report (MMWR): Current depression among adults, United States, 2006 and 2009. Last reviewed October 1, 2010. Accessed January 5, 2015. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5938a2.htm?s_cid=mm5938a2_e%0D%0A. In contrast:

• Approximately 33% of people who have rheumatoid arthritis also have depression, according to researchers who examined more than 70 academic articles.
• One study found that about 25% of people with hand, knee, or hip osteoarthritis also had depression and/or anxiety, compared to 15% of people in a control group. ⁴ Navarro N, Orellana C, Vázquez I, Galisteo C, Gratacós J, Larrosa M, Prevalence of anxiety and depression in patients with osteoarthritis in a primary care-based rheumatology consultation. Osteoarthritis and Cartilage, Volume 18, Supplement 2, October 2010, Page S139, ISSN 1063-4584, http://dx.doi.org/10.1016/S1063-4584(10)60340-8.
• Several studies have found an association between ankylosing spondylitis and depression. One study reported that approximately one-third (33%) of ankylosing spondylitis patients reported symptoms of depression, with more women reporting more depression than men. ⁵ Barlow JH, Macey SJ, Struthers GR. Gender, depression and ankylosing spondylitis. Arthritis Care Res. 1993;6:45-51. Accessed January 20, 2015 via http://www.readcube.com/articles/10.1002%2Fart.1790060109?r3_referer=wol&tracking_action=preview_click&show_checkout=1.

It is important to note that statistics can vary depending on many factors, including how depression is defined, how chronic pain is defined, the population of people who are surveyed, and the quality of the research methods. However, even taking these variations into account, current research supports a clear connection between chronic arthritis pain and depression.

See Diagnosing Depression in People with Chronic Pain

Why is depression associated with chronic pain?

Depression is more commonly seen in patients with chronic pain problems than in patients with pain that is of an acute, short-term nature. A person may experience both chronic pain and depression for several reasons, including:

• Chronic pain leads to depression
• Depression leads to pain
• The pain and depression are the result of the same disease or disorder ⁶ Holmes A, Christelis N, Arnold C. Depression and chronic pain. Med J Aust. 2013 Sep 16;199(6 Suppl):S17-20. PubMed PMID: 25370278.

Understanding whether the chronic pain arises from depression or the depression arises from chronic pain can help facilitate an effective treatment. For example, if depression is rooted primarily in pain, treating the pain alone can do a great deal to lessen or eliminate depression.

The cycle of chronic arthritis pain and depression

For some people, the stress and depression resulting from chronic pain can become consuming, and can worsen and prolong the pain. Increased pain can, in turn, lead to increased stress and depression, creating a vicious cycle. In some cases, this becomes so severe that the depression takes on a life of its own regardless of the pain.

Downward spiral of pain and depression

Unfortunately, this situation can lead to a downward physical and emotional spiral. Over time, a person may feel that pain is controlling his or her life, leading to major depression. Once in this depressed state, the person may feel incapable of changing the situation even if possible treatments or options for positive action exist.

See Treating Depression and Chronic Pain

For this reason, it is important for people experiencing chronic pain and depression to seek the help of appropriate healthcare professionals who have special training in chronic pain (e.g. a pain psychologist or a physician who is a pain management specialist).