The Connection with Mental Health and Chronic Pain

Even though I do clinical art therapy, the number of people I see with chronic pain and other chronic issues is quite common and is also inextricably linked with psychological health. Working on my doctorate in mind-body medicine has helped me to see this even more clearly and find integrative ways of helping people improve both psychologically and physically.

Chronic pain and mental health

Reviewed by Robert Bogenberger, PhD

Written by therapist.com team

Last updated: 08/14/2024

Living in pain creates a number of challenges, including the potential for mental health issues. Chronic pain and mental health disorders like depression, anxiety, and stress have a great deal of overlap.  As many as 85% of chronic pain sufferers will experience significant depression. Treatment options and management of symptoms can improve the quality of life for those experiencing overlapping chronic pain and mental health issues.

What Is Chronic Pain?

Chronic pain is any pain that lasts for six months or longer. The pain can range from mild to severe. For some people, chronic pain is an everyday occurrence. Others may experience pain that comes and goes. 

Chronic pain symptoms can include throbbing, stinging, dull aches, stiffness, soreness, and other feelings of pain. Individuals with chronic pain often experience other symptoms like trouble sleeping, weakness, and feeling fatigued in addition to the feelings of pain.

Chronic pain may last after the injury or illness that initiated the pain has healed. This is because pain signals in the central nervous system can remain active.

Pain vs. Chronic Pain

Pain is often a sign that something is going wrong in the body. This can be simple and acute, such as when you step on a hard object or your finger accidentally touches a hot surface. In other cases, medical issues can cause pain that lasts longer, but it resolves when the medical condition itself is resolved. A broken leg, for example, may cause pain for a while, but that pain generally goes away once the leg is healed.

Acute pain typically lasts less than six months and is caused by something specific. Acute pain also tends to go away once the cause of the pain is resolved. Chronic pain, in contrast, typically lasts for more than six months, and it may not go away even if the underlying condition is resolved. In other cases, chronic pain occurs from conditions where no cure or resolution is possible.

Is Chronic Pain a Disability?

Chronic pain can be considered a disability. Individuals may qualify for accommodations or assistance if their chronic pain is a symptom of an illness or condition and it interferes with their ability to work or perform required tasks. In addition, individuals who experience mental health challenges as a result of chronic pain may also qualify for assistance or accommodation. 

Causes of Chronic Pain

The exact causes of chronic pain are unknown. Causes will differ depending on the type of pain and other factors. Some common risk factors for chronic pain include: 

• Genetics: Not only will some individuals have a predisposition for conditions that cause chronic pain, but researchers have also found that genetics may play a role in how we experience and perceive pain¹. 

• Age: Some chronic pain results because of the aging process. Older individuals may experience chronic pain due to changes to joints, bones, and other parts of the body.

• Illness or injury: Experiencing an illness or an injury can increase a person’s risk of developing chronic pain.

• Obesity: Chronic pain and obesity often coexist². Obesity can worsen conditions like arthritis or other joint issues, for example. Chronic pain can also lead to weight gain.

• Mental illness: Those with mental illness issues also have an increased risk for chronic pain.

Does Psychological Pain Physically Hurt?

A broken heart may not be caused by an illness or physical injury, but it can still cause pain. Emotional and mental distress, including grief, loneliness, depression, sadness, and rage, can all cause biological pain reactions³ that are similar to physical pain. Many of the neural pathways for pain perception also regulate mood and anxiety.

While physical and emotional pain are different, they both cause neurological changes that affect the body. Some of the common physical effects of psychological pain include:

• Headaches

• Nausea

• Muscle pain

• Dizziness

• Stomachache 

Common Types of Chronic Pain

While chronic pain can happen for a variety of reasons, there are some conditions commonly associated with chronic pain, including:

• Fibromyalgia

• Complex regional pain syndrome

• Migraines

• Gastrointestinal diseases (IBD, IBS)

• Menstrual pain (including endometriosis)

• Arthritis

• Back and neck pain

• Cancer-related pain

Mental Health and Chronic Pain

Chronic pain impacts many aspects of daily life. This includes not only physical health, but also mental health. This means that for many people, chronic pain overlaps with stress, anxiety, and depression.

Chronic Pain and Depression

The relationship between chronic pain and depression is a complex one. Living with chronic pain can be stressful, both physically and mentally. Heightened long-term stress can affect brain chemistry, which can increase the risk of mental health issues like depression. 

In addition, many of the neural pathways that the brain uses to signal depression are similar to those used to signal chronic pain. Because of this, chronic pain is also a symptom of depression. 

Some of the symptoms associated with depression include:

• Feelings of sadness or hopelessness

• Sleep disturbances

• Loss of interest in normal activities

• Anxiety and restlessness

• Lack of energy

• Physical issues, like headaches and back pain

• Thoughts of death or suicide

 Anxiety and Pain

For individuals with an anxiety disorder, chronic pain like muscle aches, headaches, and soreness is a common symptom. While doctors and researchers are still trying to understand the connections between anxiety and pain, many people with anxiety disorders experience chronic pain and vice versa. Some individuals with chronic pain may worry about what they feel or are experiencing, which may increase their risk of developing an anxiety disorder. 

Some of the symptoms associated with anxiety include:

• Feeling nervous or tense

• An increased heart rate

• Feeling a sense of impending doom or danger

• Sweating

• Breathing rapidly

• Trembling

• Having trouble controlling worry

• Feeling tired or weak

Stress and Chronic Pain

Chronic pain and stress also influence each other. Chronic pain can create chronic stress about not being able to do normal activities, financial stress if an individual is unable to work, and even stress and fear about movements that might heighten pain. Chronic stress, in turn, can also affect chronic pain. Stress can tense muscles and raise cortisol levels, which increase inflammation in the body.

Some of the symptoms of chronic stress include:

• A lack of energy

• Heachaches

• Aches, tense muscles, and other pains

• Frequent colds or infections

• Insomnia

• Chest pain or elevated heart rate

• Upset stomach and nausea

Chronic Pain and Addiction

Chronic pain can cause or exacerbate addiction and substance abuse. Some medications used to treat chronic pain, like opioids, are highly addictive. Sadly, many addictions begin with opioid treatment after an illness or injury. In some cases, individuals with chronic pain develop a tolerance for a particular medication and need higher doses to achieve the same results. This increases the risk of addiction.

In addition, medications like opioids increase dopamine, a neurotransmitter in the brain. Known as the “feel-good” neurotransmitter, dopamine is related to pleasure and influences mood. Certain painkillers can result in an addiction even if used to treat acute pain, but especially if used long-term for chronic pain.

Those suffering from chronic pain who cannot access prescription painkillers may self-medicate with other substances, such as alcohol or heroin. 

The Opioid Epidemic

In the 1990s, there was an increase in the number of opioids prescribed to treat issues like moderate-to-severe pain following surgeries and injuries. Pharmaceutical companies told doctors that patients were unlikely to become addicted to the prescribed drugs. 

However, this wasn’t the case. Not only did patients become increasingly addicted to opioid prescriptions, but there was also an increase in addictions to non-prescription opioids, including heroin. 

Once patients became addicted, it was hard to stop using opioids. In addition, people using opioids on a long-term basis can experience a rising tolerance, which means they have to use a larger dose for the same effect. This increased misuse and abuse of these substances. 

In 2019, more than 49,000⁴ individuals died from an opioid-related overdose in the United States. It’s estimated that over 10 million people misused an opioid prescription the same year. 

Is It Safe to Use Medication to Treat Chronic Pain?

Some medications may help alleviate symptoms of chronic pain, but they should only be taken if prescribed by a doctor. When possible, doctors today often prescribe painkillers that are less addictive than opioids, such as medicinal cannabis. Increased monitoring  procedures and processes are in place today to help ensure that high-intensity painkillers do not result in addiction. Speak with your doctor about whether medication of any sort is right for you.

Chronic Pain Treatment

Although chronic pain can have many negative effects for those experiencing it, it can often be managed with treatment and self-care activities. For those experiencing mental health issues associated with chronic pain, seeking out a qualified therapist is important.

Can Chronic Pain Be Cured?

While chronic pain is often something that cannot be cured or reversed, it can be managed. Chronic pain treatments and other management strategies can reduce the amount of pain and create a better quality of life for those experiencing chronic pain. 

Ongoing research and effects to find better treatments for chronic pain will continue to lead to better treatments and outcomes. 

Chronic Pain Management

Currently, there are a number of effective treatments for those experiencing both mental health issues and chronic pain. These include:

• Cognitive behavioral therapy (CBT)

• Mindfulness-based stress reduction (MBSR)

• Hypnotherapy

• Somatic therapy

• Biofeedback therapy

• Emotional freedom technique (tapping)

• Medication 

In addition to therapy, medications, and other professional treatments, there are self-care activities that can also help chronic pain management. These include:

• Meditation

• Yoga

• Massage

• Exercise

• Nutrition

If you are experiencing any mental health issues, like stress, depression, or anxiety, due to chronic pain, reach out to a therapist today to find help.

 

What is Art Therapy?

Some of you may wonder what I do as an art therapist.  Here is an article that succinctly summarizes our field.  

https://therapist.com/types-of-therapy/art-therapy/

Art therapy: Benefits and treatment options

Reviewed by Stephanie Steinman, PhD, CSAC

Written by therapist.com team

Last updated: 05/24/2024

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What is art therapy?

Art therapy is a form of expressive therapy. It uses the creative process of making art to improve a person’s physical, mental, and emotional wellbeing. It’s practiced in various settings including hospitals, clinics, and schools, helping people of all ages.

You don’t need to be an artist or have artistic talent to benefit from this type of therapy. Its primary goal isn’t for you to learn more about art (though it’s a nice side benefit). The goal is for you to learn more about yourself.

Why is art therapeutic?        

Art allows you to approach your thoughts and feelings indirectly. Making art requires you to be present and engages your body in a physical craft.

Art also allows you to express yourself in ways other than language. While language can give you great insight into your psychological wellbeing, it has its limits. Art therapy helps bridge the gap between what you feel comfortable saying and what goes unsaid.

How does art therapy work?

A mental health professional will begin by assessing your needs, therapeutic goals, and personal strengths. They’ll then suggest art activities that suit you best and work with you to develop your personalized treatment plan.

Art therapy sessions look different depending on the setting, type of art involved, and other variables. For instance, some art therapy is hosted in group settings. The number and length of group art therapy sessions will likely change based on the size of the group and other variables.1 In a session you might learn how to draw with help from an artist, paint with watercolors on your own, or create your own book to share your feelings.

Reflection is a critical part of art therapy. You, your therapist, and potentially your group members will discuss your artwork to uncover emotions or thoughts. This is what separates art therapy from an art class.

Group vs. individual therapy

In group art therapy, you’ll work in a supportive, collaborative environment alongside your peers. Individual therapy, on the other hand, provides a private space just for you and the art therapist. This one-on-one atmosphere allows for personalized attention and a tailored approach to your needs.

What does art therapy treat?

Art therapy has been used as part of a treatment plan for a variety of mental health conditions, including:

• Anxiety
• Depression
• Stress
• ADHD
• Eating disorders2 
• Addiction
• Issues with self-esteem

Art therapy activities

This therapeutic approach uses many different artistic forms and mediums. Common examples of art therapy activities include:

Drawing, coloring, painting, or doodling: In art therapy, colors can hold significant emotional value. Warm colors like red and orange are stimulating and energizing, while cool colors like blue and green tend to be calming and soothing. You can choose colors and images that reflect your current emotions or desired emotional state.

Making collages: Collage-making allows you to piece together images and items that resonate with your experiences. It’s a way to create a visual narrative of your thoughts. You might cut out pictures from magazines, use fabric, or even natural materials. This can help in expressing complex emotions that might be difficult to articulate with words.

Sculpting or carving: The tactile experience of molding or carving materials like clay can be grounding. It offers a three-dimensional way to represent your feelings or experiences. When you sculpt or carve, you’ll be encouraged to focus on the process as much as the end product. Part of the process is to feel each movement and observe how you’re shaping your thoughts into something tangible.

Visual journaling (or art journaling): Combining visual art with written words, art journaling is a powerful expressive arts therapy technique. You could draw, paint, or doodle, and then write about what you’ve created. This process can help in connecting you with your inner self and also helps you track your progress over time.

Do adult coloring books count as therapy?

Adult coloring books do not count as a form of therapy, although it may feel therapeutic. Coloring is a great artistic activity that people of all ages may find comforting. However, art therapy requires the skills and direction of a trained art therapist. If you enjoy adult coloring books, consider incorporating them into your self-care routine. While they’re not a form of therapy, they may help you relax or manage your stress.

Benefits of art therapy 

Art therapy can be beneficial for mental health by providing an outlet for expression and reflection. There is growing research on multiple ways art therapy helps clients, including:

Self-exploration and discovery. Art therapy provides a safe space for you to express feelings that might be hard to put into words. Often used to address emotional challenges, it can lead to improved self-esteem and self-awareness. 3,4

Stress reduction. Art therapy is a natural stress-reducer. Engaging in the creative process allows your mind to focus on the task at hand, taking a break from your worries. Research indicates that mindfulness-based art therapy interventions can reduce anxiety and stress, improving overall mental health.5

Emotional healing. Thoughts and feelings can be difficult to put into words, especially when you’ve experienced trauma or pain. Pursuing art therapy may help reduce symptoms of anxiety and depression in certain groups, especially when used alongside other treatments.6

How every age can benefit

Each stage of life can benefit uniquely from art therapy’s adaptable methods.

Art therapy for kids: Children’s art therapy fosters emotional growth. Through activities like drawing or sculpting, children can learn to communicate complex feelings they might not yet have the words for.

Art therapy for teens: Teens might use collage or graffiti art to explore identity and navigate the often turbulent teenage years. This form of expression may help in reducing anxiety and boosting self-esteem.

Art therapy for adults: Art therapy can help adults cope with stress, emotions, and trauma in a concrete, hands-on way. By creating art, they might uncover new coping strategies and ways to deal with anxiety or depression. Painting or pottery, for example, can bring a sense of calm and focus.

Art therapy for seniors: Older adults may find comfort and mental stimulation in art therapy. Reminiscence art projects can help seniors preserve memories and maintain a connection to their personal history and identity.7

Treatment options

If you decide to seek treatment, it’s important to find a qualified therapist. Anyone can create art as a form of self-expression, but not all artistic creation is a form of art therapy. Working with a trained art therapist helps ensure you gain the psychological benefits of artistic expression.

When looking for a provider, keep the following things in mind: 

• Certifications and accreditations: Art therapists must have a master’s degree in art therapy, counseling, or a related field. Additionally, most art therapists are registered, certified, or licensed by the Art Therapy Credentials Board (ATCB).
• Additional therapies: Many providers use art therapy alongside other forms of traditional talk therapy, such as cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) art therapy. Check to see if your chosen specialist offers other forms of treatment in addition to art therapy.
• Preferred experience: When choosing a therapist, your preferences matter. You may find it helpful to choose a provider with experience treating people with similar experiences to you or your child. For example, if you’ve experienced a trauma, you’ll probably want to seek out a trauma-informed provider.

Find an art therapist near you

Art therapy can help you express your experiences when words alone aren’t enough. Whether you or someone you love is struggling, you can find a provider in your area using our therapist directory.

If you’re in crisis, help is available now. Free, confidential help is available at the 988 Suicide & Crisis Lifeline when you call 988. You can also text the word HOME to the Crisis Text Line at 741741 to chat with a crisis counselor.