When a person goes through depression, the impact of that weight can manifest in the form of physical pain and other bodily discomfort. On the other hand, chronic pain has a significant effect on behavioral health. Recurring physical pain can lead to mood swings, lack of appetite, lack of self-care, changes in behavior and attitudes, as well as isolation.
What Is Chronic Pain and Its Impact
Chronic pain, as defined by Johns Hopkins Medicine, “is long standing pain that persists beyond the usual recovery period or occurs along with a chronic health condition. It may affect people to the point where they can’t work, eat properly, participate in physical activity, or enjoy life.”
Chronic pain is recurring for at least 90 days, daily or frequently. It could be a repeated health condition due to seasonal triggers or issues like lack of mobility. Pain measurements range from mild to severe and require timely, accessible, and accurate management. The physical manifestation can have an emotional impact on the person experiencing the pain, which can easily transform into depressive symptoms.
Current Findings on Chronic Pain
A recent NIH study in 2023 demonstrated that chronic pain among adults in the USA is a frequently occurring new health condition when compared with diabetes or hypertension. The study claims that the impact is about “21% among adults” (Nahin RL, Feinberg T, Kapos FP, Terman GW, Estimated Rates of Incident and Persistent Chronic Pain Among US Adults, 2019-2020). Chronic pain, a continuous feeling of discomfort of various intensities, is a condition that limits the way we function and our ability to focus. It is notorious for turning people into substance abusers as they try to numb the pain.
Going by the NIH study, chronic pain is like a pandemic. Pain affects one individual but can potentially impact that individual’s caregivers. From identifying the pain triggers to effective treatment, pain engulfs the person who experiences the variety of pain intensity and the caregiver equally. Both keep trying ways to control the pain at their levels. Nearly all of us have experienced mild to severe pain in our lives. As mentioned before, pain that keeps recurring is chronic. Pain has both physical and psychological impacts on an individual, ranging from temporary mobility issues to substance abuse in the form of excess pain medication used to control the experience and intensity of pain. Often, uncontrolled pain refers to a stage when pain medication is in use as prescribed by the provider. Still, due to age, environmental triggers, or the chronic nature, there is no change in the severity of the pain. In such situations, often, a person uses trial and error methods to control pain, hence creating a very high chance of pain medication abuse or overdose. Referring to the same NIH study, chronic pain is one of the primary reasons for the opioid epidemic in the USA (Nahin RL, Feinberg T, Kapos FP, Terman GW, Estimated Rates of Incident and Persistent Chronic Pain Among US Adults, 2019-2020).
Common Pain Management Practices
Opioids create that much needed numbness to fade the experience of pain. Still, with continued use, individuals become vulnerable to the practice and may indulge in enjoying the numbness even when the pain is non-existent. Hence, chronic pain and the way pain management occurs do have a significant impact on an individual’s decision-making capacity and judgment.
To look at the progression from pain to chronic pain, it is important to understand the process regarding physical impact and corresponding pain management practices. Chronic pain does not occur overnight since the nature of such pain is recurring. It starts with certain levels of mildness and gradually leads to uncontrolled pain. Pain that is chronic now likely began as a mild and nagging pain that was likely considered to be a temporary phase or environmental factor.
Since over-the-counter (OTC) analgesics are readily accessible, a common pain management practice is to take this OTC medication as needed. Very often, one fails to realize that what seems like a one-time pain management step may often lead to an addiction with anticipated and repeated use. By nature, when pain occurs, we immediately want to address it with medication for quick relief. Unfortunately, due to the narcotics in pain medication, one can easily get addicted, and often, individuals take pain medication in anticipation, even when the pain is not occurring. Hence, chronic pain creates anxiety and fear. The mind is preoccupied with pain, and the only solution seems to be the pain medication that provides instant relief.
Socio-Emotional Impact of Chronic Pain
A common impact of pain affects mobility and strength. When pain occurs, our mobility gets restricted, thus affecting our functioning, skills, confidence, and self-esteem. While physically we are restricted in ambulating, the impact is psychological and emotional. The lack of independent functional ability triggers a sense of low self-esteem. We initiate harvesting negativity about ourselves and self-judge our capacity. We interpret and anticipate what others would think of us due to our lack of functional capacity triggered by chronic pain, such as those slow walks, the need for support to change positions, and the continued reminder of the ache. While at night, the world around us sleeps in peace, chronic pain wakes us up, and then it’s hard to fall back to sleep. These impacts of pain leave us with self-pity and frustration – emotions that make us unhappy. Such involuntary changes in lifestyle develop negative thoughts that clutter our minds and lead to irritability, intolerance, and frustration. Thus, chronic pain is directly linked to the manifestation of initial negative thoughts, finally leading to depression. Often, pain and depression occur together, one being the physical impact and the latter being the emotional/mental impact. People with chronic pain illustrate that, especially for joint pain support, when they use prolonged metal supportive frames, commonly called braces, they observe changes in that part of the body. Patients report bruises, permanent marks, and even thinning of that body part compared to the symmetrical look they had before the chronic pain management via braces. Thus leading to body image issues.
Young adults with chronic pain share being self-conscious to use a cane or other devices to support ambulance because they are embarrassed to step out in public with a mobility device at their age. Chronic pain directly attacks the social identity of many. Regardless of age, chronic pain leads to a clutter of emotions and negative feelings.
Chronic pain also creates an environment of helplessness among older adults. Patients compare their lives to when they had controlled pain, but when the pain returns, it creates a state of helplessness. They feel life is not worth living. The impact is worse for older adults since this population presents higher comorbidity and lower immune capacity.
It is important to consider environmental factors, as well. Social Determinants of Health (SDOH) such as socioeconomic conditions, food habits and lifestyles, adherence to treatments and medication, self-awareness, and sociocultural practices significantly impact chronic pain management and associated psychological outcomes. Pain management options depend on the individual’s economic conditions; several private providers may not accept Medicaid as primary coverage. Since pain impacts movement, job options are heavily limited for the individual, affecting socioeconomic conditions. Lifestyles and attitudes towards accessible and affordable pain management play a key role, too. Diet management and food habits play a major role in pain medication intake. People may choose self-treatment over provider suggestions at the initial stages of pain management and may seek help when the pain intensity gets out of control. Often, in such conditions, individuals need continued caregiving and regular pain management.
Chronic Pain among Older Adults Enrolled in Managed Long-Term Care (MLTC) Services
As a healthcare professional in Care Management, the author is experienced in working with older adults from diverse backgrounds dealing with chronic pain. Community members, especially older adults who are enrolled in Managed Long Term Care services, always have a chronic pain-related goal and intervention as a requirement in their annual Care Plan. The approaches to treating chronic pain vary based on culture and attitudes towards life. Often, older adults accept chronic pain as an associated change in the body about age, while others try to fight it out so that they may remain independent as long as possible. There have been many in the spectrum of chronic pain who experience a lot of self-esteem issues due to pain and find it extremely difficult to cope with the pain. Most of the older adults with chronic pain need Long Term Care services since they require assistance with their activities of daily living. Most of the seniors seeking help develop chronic pain due to various arthritis diagnoses, post-fall effects, age-related changes in the body, bone health, and variations in activities. Of course, seasonal triggers and pain as an associated health condition hold equal importance. While chronic pain triggers anxiety, it is also a leading cause of mood swings among this older population. Due to pain, people forego social gatherings and impose isolation, thus leading to self-imposed loneliness and depression. Often, people with uncontrolled chronic pain have expressed the lack of worth they feel about themselves and how they have given up on any pain management options.
Living with pain becomes acceptable to many seniors since they believe their age is to be blamed for persistent health issues and chronic pain. A significant number of seniors in various communities teach themselves to come to terms with chronic pain. Seniors think that due to their associated health issues, pain management is limited and ineffective. For instance, an older adult might not accept a knee replacement as a remedy for chronic knee joint pain and accept tolerating the pain intensity. Seniors may stop physical therapy at another level because they fail to experience the change that occurs slowly. In addition, many community members who forego recommended pain management treatments refer to a friend or a relative who reported a treatment ineffective. In such cases, patients even refuse to go for a second opinion, voluntarily confirming their recommended treatment to be ineffective.
As a seasoned care manager in an MLTC program, the author recalls adding pain management interventions to all patient-centered care plans to ensure pain management education for all enrollees. In MLTC, the goal is to help the MLTC program members embrace a better lifestyle with accessible and appropriate pain management options. To help older adults stay away from getting addicted to pain medication narcotics, they are provided monthly education on topical pain management options, and Physical Therapy (PT) is encouraged as a pain management technique. Daily short walks and simple exercises are encouraged to maintain a positive mood while managing pain, and proper diet and identifying pain triggers are taught. Yet a significant number of older adults enrolled in MLTC services live with moderate to severe pain intensities due to comorbidities and age. Self-care of these members and their caregivers is mandatory to address chronic pain and its impact on behavioral health.
Summary
Pain is a physical experience that leaves traumatic experiences. Chronic pain is living that trauma regularly. While being present physically, pain can control mood and one’s entire socio-emotional behavior. Chronic pain impacts our physical and mental health and ruins our self-care process. It makes people anxious, stressed, embarrassed, isolated, and lonely to the extent that people often fall prey to overdosage of pain medication, even leading to narcotics addiction.
Chronic pain can control people’s lives, social skills, and willingness to engage in activities. Often, people train themselves to be numb to their pain if it is tolerable to avoid judgment. People suffering from chronic pain actively avoid disclosing the condition for fear of losing their jobs, leading to financial crisis, anticipating that they may be judged incapable of their professional role. This constant fear often creates burnout, leading to significant depressive symptoms that need to be treated on time.
Conclusion
Chronic pain has a direct connection to depression. Chronic pain and depression supplement each other and easily get enhanced if left untreated. Consulting with professionals and relaying the symptoms to relevant providers on time may help in breaking the cycle of repetitive pain and hammering down the link between chronic pain and depression. People benefit from appropriate education and access to treatments and therapies to address both symptoms. Insurance coverage also plays a key role in the administration of effective treatment. Hence, adequate room should be provided to the person with chronic pain to explore experimental treatment options for pain management by insurance plans. On the other hand, private providers should consider contracting with insurance plans that provide coverage to significantly low-income group patients since chronic pain does not choose its prey based on economic status.
Older adults mostly report chronic pain, but in truth, it is not an age-related issue. Hence, one with chronic pain is not aging ahead of time and should not self-victimize by ageism. Believing that chronic pain occurs in a certain community or due to a particular health condition only is not true either. Chronic pain is not a topic of medical racism. A significant physical health concern creates equally strong mental health impacts. Chronic pain and depression can be seen as the two faces of the same coin. With proper information and education, timely identification and treatment, and affordable and accessible treatment, the condition can be effectively treated, and its associated depressive syndrome can be avoided.
Veera Mookerjee, PhD, LMSW, is Founder/Director of Resolveera.
