Chronic Pain & The Brain: A Story of Mental Health

Yesterday was World Mental Health Day. The aim of this initiative is to get everyone to reflect on their own mental health. It’s about more than promoting awareness, it’s about providing strategies for prevention and options for treatment. As a Chiropractor, I often see instances where a patient’s pain and mental health interact. So to mark Mental Health Day we are discussing the link between mental health and chronic pain.

Depression affects one million Australians each year. Sufferers experience long term sadness or disinterest, affecting they think, feel and participate in daily activities. Pain is an important contributor to depression that is often forgotten in public discussions. Chronic pain such as musculoskeletal pain and headaches relate to depression in a negative way. The pain itself can contribute to depression. It can also be a result of social isolation due the chronic pain sufferer’s reduced ability to work, play sport and attend social gatherings.

Unfortunately, depression can also have a negative effect on a sufferer’s pain levels. The body possesses natural chemicals (such as endogenous opioids) which are released by the brain and pituitary gland to moderate pain throughout the body. Descending nervous system pathways carry signals from the brain to the rest of the body to lower pain levels. However, in a depressed or distressed individual, the nervous system’s helpful responses to pain are less active. As a result, the body’s natural painkillers are not released which leads to higher levels of pain. I should clarify these facts by stating that in these individuals the pain is not “in their head”. The pain is, of course, too real. The mental illness component is only that the nervous system has a reduced ability to lower pain levels.  

You can see the cycle that can develop in these instances: chronic pain leads to a mood disorder which causes greater and longer lasting pain. The same interplay also exists between chronic pain and anxiety (which is most common mental illness in Australia).

So what can be done?

While this cycle is a complication for people who do not seek care, it can be an opportunity because it gives health practitioners another avenue for treatment. Treatment for the mental health aspect is crucial. General Practitioners deal with mental health issues daily and are the best people to go to. A GP will refer to the most appropriate practitioners to properly address any mental health issue. Medications can also be prescribed to patients if appropriate.

Of course, the cause of chronic pain must also be treated by an appropriate healthcare professional e.g. a chiropractor if the pain is musculoskeletal in origin.  

Reflect on your own mental health and check out the Mental Health Month Website for more information: https://mentalhealthmonth.wayahead.org.au/.

If you are feeling symptoms of mental illness, make an appointment with your GP or call one of the help lines below.

National Helplines

Beyond Blue Support Service: 1300 22 4636

MensLine Australia: 1300 78 99 78

Kids Helpline:1800 55 1800

Further Reading

Ossipov et al. Descending pain modulation and chronification of pain. Curr Opin Support Palliat Care. 2014 Jun; 8(2): 143–151. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301419/

Scott Leabeater

Scott Leabeater is The Backstory Chiropractic’s Principal Chiropractor. Scott uses up to date research literature to guide an evidence based approach to diagnosis and treatment. His unique professionalism and knowledge has made Scott highly sought after. Throughout his career he has treated everyone from local office workers to Olympic athletes. Scott is an AHPRA registered Chiropractor and member of Chiropractic Australia.