Chronic Pain & Mental Health.

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If you have been following the this blog for some time, you may already be familiar with the differences between acute pain and chronic pain. Acute pain results from a clearly defined cause, such as an injury, and usually disappears after the injury heals. Chronic pain, however, is pain that persists for a long period of time, even after the injury or illness that caused it has healed.

Living with chronic pain can be challenging, as its consequences are not merely physical but also psychological. Research has demonstrated a strong correlation between chronic pain and mental health issues such as depression and anxiety, with people suffering from chronic pain three times more likely to develop symptoms of depression and anxiety.

Let Sophia Goh, psychotherapist and counsellor take you through with this guest post.


How Does Chronic Pain Affect Our Mental Health?

From the biological perspective, many of the same mechanisms are associated in both pain and mental health disorders. For instance, low levels of the neurotransmitter, serotonin, have been associated with chronic pain conditions such as migraine and fibromyalgia and mental health issues such as depression. Similarly, abnormal functioning of the neuroendocrine system, our stress regulatory system, have been observed in both pain conditions and mental health disorders.

Living with chronic pain itself can have an impact on our psychological state. Many individuals experience changes in various aspects of daily living due to the discomfort of chronic pain. These changes can range from avoiding activities that increase pain, to being unable to fulfill social and occupational responsibilities. Negative cognitions about pain (‘My pain will never stop’) and about themselves (‘I can no longer do the things that I used to be able to do’) greatly influences mood, increasing the risks of mental health disorders such as depression and anxiety.

This, in turn, becomes a vicious feedback loop, in which psychosocial distress leads to decreased physical activity, and decreased physical activity leads to increased psychosocial distress.


What to Look Out For?

Chronic pain is a complex problem and can have an impact on our mental health. If you have the following symptoms on top of chronic pain, do not hesitate to let your primary care doctor or physiotherapist know.


Symptoms of Anxiety

Symptoms of Depression

  • Excessive worry that is hard to control
  • Sleep disturbances (e.g. difficulty falling asleep, restless sleep)
  • Constantly feeling on edge
  • Shortness of breath
  • Increased heart rate
  • Nausea
  • Muscle tension
  • Change in behavior and disruption in daily life


  • Feelings of sadness
  • Loss of interest or pleasure in most activities
  • Difficulty in thinking, concentrating, and making decisions
  • Fatigue, or loss of energy
  • Feelings of worthlessness and excessive guilt
  • Changes in sleeping patterns
  • Changes in activity levels
  • Significant weight change
  • Thoughts of death or suicide



CBT for Chronic Pain (CBT-CP)

Because chronic pain is often a complex problem, a comprehensive pain management treatment plan should address both physical and psychological factors. A treatment team for chronic pain can include experts such as your primary care doctor, physiotherapist and psychotherapist.

In psychotherapy, one of the most effective modalities for the treatment of chronic pain is CBT (Cognitive Behavioral Therapy). CBT is an empirically supported, time-limited treatment that emphasizes the importance of cognitions and how it influences our emotions and behaviors. CBT-CP addresses negative thought patterns and behaviors associated with chronic pain and equips individuals with a variety of adaptive pain coping skills.

If you are struggling with emotional symptoms on top of chronic pain, do not hesitate to let your primary care doctor or physiotherapist know. Because of the complexity of chronic pain, it is also critical to address psychological and social factors for the management of chronic pain.


  1. Fishbain, D. A., Goldberg, M., Meagher, B. R., Steele, R., &Rosomoff, H. (1986). Male and femalechronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain, 26(2), 181-197
  2. Bair MJ, Robinson RL, Katon W, Kroenke K: Depression and pain comorbidity: A literature review. Arch Intern Med 163:2433-2445, 2003
  3. Watson, D., & Pennebaker, J. (1989). Health complaints, stress, and distress: Exploring the central role of negative affectivity. Psychological Review, 96, 234–254.
  4. Morley, S., Eccleston, C., & Williams, A. (1999). Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain, 80(1-2), 1-13.


This is a guest post written by psychotherapist and counsellor, Sophia Goh. Sophia is part of a multi-disciplinary team at Physio and Sole Clinic running the Chronic Pain Management Programme. If you would like to connect with Sophia, check out her website here or send her an email here.

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