The link between chronic pain and mental health

Most of us have experienced acute pain in some form or another, a toothache, a headache, a laceration, or a broken bone. Generally, acute pain comes on quickly; for instance, an accident or infection; and it can be resolved with stitches, a temporary cast, some antibiotics, and over the counter pain relief.

It is estimated that globally 1.5 billion (one in five) people suffer from chronic pain, which can last for months or even years. In some cases, it is hard to identify the root cause; and frequently it is difficult to treat. Meaning the individual is left suffering, some in constant agony, for long periods of time. This can have a debilitating effect on every aspect of their life. Affecting job prospects, social interactions, relationships, and their mental well-being.

Individuals struggling with chronic pain are at increased risk for mental health problems such as anxiety and depression; substance use disorders including alcoholism, drug addiction and prescription medicine dependency. 

Chronic pain, depression, and anxiety.

It is estimated that upwards of 35% of those struggling with persistent pain will also suffer with depression. Two separate clinical studies, von Knorring et al in 1983 and Aguera-Ortiz et al in 2011, both indicate that up to 85% of patients with chronic pain are affected by severe depression. Anxiety, particularly generalised anxiety disorder, is also commonly associated with those affected by this debilitating condition.

In 2019 Australian researchers (led by Associate Professor Sylvia Gustin from Neuroscience Research Australia and the University of New South Wales) found “that people with chronic pain experience physical alterations in their brain that likely leads to negative changes in their personality.” It was discovered that chronic pain sufferers had less of the brain messenger chemical, glutamate, making it harder for them to process feelings.  Over time this would lead to them being more negative, fearful, pessimistic, or worried.

Even without the potential chemical changes in the brain, people struggling with on-going pain; as well as any chronic illness such as obesity, heart problems and diabetes, frequently struggle with mobility, which can then lead to isolation and loneliness.

People with little social contact, or a support network, are again more at risk of developing mental health problems. Fear of illness, the struggle with persistent pain symptoms, feelings of loneliness and the onset of any psychological conditions, can all lead to them using alcohol and drugs to combat negative emotions.

Chronic pain, substance abuse, and addiction.

Opioids, opiates, and benzodiazepines are frequently given as pain relief after surgery, an injury, an accident, or to manage a chronic illness or pain. Opiates are “natural” as they are derived from the opium poppy plant, such as opium, morphine, and codeine. Opioids are synthetically made in a laboratory and include drugs such as OxyContin and fentanyl. Nowadays the term opioid is often used to describe both. In addition to anxiety and pain, benzodiazepines are used to treat sleep problems, such as insomnia, which can accompany long-term health conditions.

These drugs are highly addictive. With continued regular use they change the chemistry in the brain leaving the user requiring higher or more frequent doses to get the desired effects. Long-term use leads to addiction and dependency and will cause physical and psychological withdrawal symptoms once the use of the drug is halted. Not all people who are dependent are addicted, however the physical dependency alone can create problems when trying to stop. Drugs which were initially prescribed with the best of intentions are leaving some users physically dependent, and psychologically hooked.

In addition to medications obtained by prescription, the use of drugs and alcohol to self-medicate is common. Self-medicating is the term used when referring to a patient trying to cure (or fix) an issue, without being under the care of a licensed medical professional. Individuals will use alcohol to give themselves confidence and alleviate anxiety, to stave off boredom and loneliness and to block out difficult feelings. Some use alcohol and sleeping tablets to overcome insomnia; slimming pills to reverse the weight gain; opioid painkillers to numb the aches and pains; or benzodiazepine to relieve anxiety.

Whether it is illegal street drugs, alcohol, or the use of illicitly obtained prescription medication (i.e., using more than initially prescribed, someone else’s prescription, or to obtain feelings of euphoria), using substances to manage uncomfortable emotions or physical discomfort is common, but incredibly dangerous.

Most substances have the capacity to be highly addictive, both physically and psychologically. Using them to alleviate symptoms of stress, trauma, and mental health conditions, or to deal with chronic pain, increases the chance of dependency and substance abuse problems and frequently aggravates the underlying issues and causes further health problems.

Signs of substance abuse.

For those individuals struggling with chronic pain, it can feel like they are in a no-win situation. They either suffer in agonising pain or take potentially addictive drugs, and for some sadly this may be the only option. However, it is always worth talking with your health care provider to see if there are any alternative solutions.

For others it may be the case that they have been using substances for so long that they are addicted or dependent, and the drugs (or alcohol) is causing them more harm than good.

Here are some common signs that may suggest an individual could have a problem:

• An increase in the amount or frequency of use.
• Continued use of the drug, even after the pain it was prescribed for has ceased.
• Complaining about vague symptoms to get more medication.
• Lack of interest in treatment options other than medications.
• Taking prescriptions not meant for them.
• Personality changes.
• Unable to meet responsibilities, within the home, or at work, or school.
• Changes in behaviour, sleeping or eating patterns.
• An increase in secrecy, or dishonesty.
• A further decline in physical health.

If you, or someone you love, is showing any of the above signs, it is worth speaking to a professional as soon as possible and enquiring about the proper way to reduce or stop the use of any substances. This is important as certain drugs may require a medical detox for safety reasons.

Rehab clinic in Spain.

Has your mental health been affected by chronic pain? Do you find yourself reaching for a drink or drug to try and relieve symptoms? Could you be self-medicating?

Here in Ibiza at our luxury residential rehab centre, we offer a range of therapies suitable for the treatment of substance abuse, compulsive or addictive behaviours, and other mental health disorders.

Our highly qualified team of doctors, therapists and counsellors use a carefully designed program, which includes individual and group therapy, transcranial magnetic stimulation, EMDR and equine- assisted therapy.

For further details and information on admissions to our Rehab in Spain, contact [email protected]