Depression Can Lead to Chronic Pain

There is strong evidence that people who have depression have a lower tolerance to pain and/or may be more susceptible to chronic pain. For example,

  • In a study of male veterans experiencing depression and chronic pain, researchers found that 42% of patients experienced the onset of depression prior to the onset of pain, whereas 58% experienced depression after the pain began.1
  • In another study, researchers reported that 39% of the chronic low back pain patients they evaluated displayed symptoms of pre-existing depression.2

Depression can also exacerbate existing pain. For example, in a study of people with ankylosing spondylitis, researchers found that psychological variables such as feelings of helplessness and depression had more of an effect on patient’s reported disease activity than other factors, such as age, inflammation and damage seen on X-rays.3

See Reducing the Risk of Pain and Depression


Inflammation and depression

It has long been known that inflammation leads to pain. More recently, researchers have come to suspect inflammation also plays a role in depression. In fact, at least one study has found that people with depression have more inflammation-triggering proteins called cytokines in their bodies than people without depression. In turn, people with depression may experience more pronounced or prolonged periods of painful inflammation than people without depression.4

See Treating Depression and Chronic Pain

In these cases, treating a person’s depression is essential to eliminating his or her pain. In fact, treatments that target only pain may not be effective; according to the National Institutes of Health, chronic pain that does not respond to treatment may be a sign of associated depression.


Pain and depression can result from the same disease or disorder

It some instances, depression is considered a symptom of a painful disease or disorder. These conditions are often not well understood, making it particularly difficult to determine the source of pain and depression. For example, depression is a common symptom of fibromyalgia.5,6

See Conditions Related to Inflammatory Arthritis


  • 1.Atkinson JH, Slater MA, Patterson TL, Grant I, Garfin SR. Prevalence, onset, and risk of psychiatric disorders in men with chronic low back pain: a controlled study. Pain. 1991 May;45(2):111-21. PubMed PMID: 1831555.
  • 2.Polatin PB, Kinney RK, Gatchel RJ, Lillo E, Mayer TG. Psychiatric illness and chronic low-back pain. The mind and the spine--which goes first? Spine (Phila Pa 1976). 1993 Jan;18(1):66-71. PubMed PMID: 8434327.
  • 3.Brionez TF, Assassi S, Reveille JD, Green C, Learch T, Diekman L, Ward MM, Davis JC Jr, Weisman MH, Nicassio P. Psychological correlates of self-reported disease activity in ankylosing spondylitis. J Rheumatol. 2010 Apr;37(4):829-34. doi: 10.3899/jrheum.090476. Epub 2010 Feb 15. PubMed PMID: 20156952; PubMed Central PMCID: PMC2875793.
  • 4.National Institute of Mental Health. Depression and Chronic Pain. Accessed January 12, 2015. National Institutes of Health.
  • 5.Mayo Clinic. Diseases and conditions: Fibromyalgia: Symptoms. February 20, 2014. Accessed January 20, 2015. Mayo Foundation for Medical Education and Research.
  • 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.