In honor of World Mental Health Day, we at Clearing want to acknowledge the immense mental strength it takes to go through chronic pain. If you or someone you love is dealing with chronic pain, know that our hearts are with you.

Pain and mental health regulation happens in some of same parts of the brain

The connections between mental health and chronic pain are complex. Chronic pain doesn’t tend to “stay in its lane,” so to speak — over time, chronic pain can change the fundamental way the brain interprets pain, sometimes heightening the body’s perceived sensitivity and making pain feel just plain worse. 

This is because many important neural pathways in the brain are shared between systems that interpret sensations and ones that help regulate mood. So the pathways that interpret pain are often the same ones that process anxiety, grief and other emotions.

Neural pathways can sometimes enter feedback loops that blur the lines between physical and mental health. When pain sensations worsen, for example, depression can sink in more deeply as well. Or as pain continues, anxiety can ramp up, since the body and mind don’t want to have to handle any more hurt. 

The body and brain: not always as separate as they seem

When talking about the mind and body, it may not help, in fact, to keep making a strict division between the two. When it comes to pain interpretation and mental health, it may be more useful to understand that the mind and body intertwine in nuanced ways that influence each other. An upset gut, for example, is correlated with depression, just as spinal injuries tend to accompany mood disorders. Chronic pain isn’t a happy state to be living in, with or without a formal diagnosis of a mental disorder, so it’s not surprising to feel mentally and emotionally impacted by pain. 

Scientists can’t yet untangle all the intricacies of exactly how pain influences your mental wellbeing, but initial data shows a strong connection between chronic pain and an increased struggle with mental challenges. Stress, which is often spurred on by pain, spikes brain chemicals like cortisol, which correlate with higher inflammation (and, in turn, higher levels of pain.)

Pain can also keep people away from friends and family. With isolation comes a higher risk of depression. And even when chronic pain doesn’t drive people into mental health diseases like depression and anxiety, it still often causes brain fog and short-term memory trouble. 

The bottom line: pain isn’t just physical. That may seem obvious, but people with chronic pain say that even health professionals can underestimate how many of the challenges they face have a mental component. 

That’s why Clearing approaches pain management using the biopsychosocial model, which is a treatment approach that takes into account not only the biological aspects of what patients are experiencing (their symptoms, clinical data, etc.), but also the level of support they get from friends and family, their psychological health, and the overall “big picture” of what’s going on in their lives.

Trying to put a more positive spin on pain

Now here’s a question: if pain can kick negative feedback loops into motion, is there anything that can spark positive feedback loops? 

It turns out there are! One of the top things people in pain can do to stay in close contact with friends and loved ones (we’re biased, but we think pets probably count, too). Relationships matter deeply. In the long-running Harvard Study of Adult Development, the quality of one’s personal relationships turned out to be more crucial for a life filled with a sense of happiness and purpose (even in the midst of challenges and pain) than money or huge achievements. Strong relationships make us feel more secure and more capable of weathering mental and physical challenges. 

Tips for helping the mind and body work together:

When it comes to chronic pain and mental health, a few things that can be challenging include: 

• Other people’s expectations: Chronic pain can make it tough to explain what you’re going through, and other people may not always understand. People in pain may feel under pressure to show improvement or “just get through it” for the sake of others. What can help is clear, open communication. You are doing your best and should be met where you’re at. Conversation techniques can help you guide others toward better understanding where you’re at and what expectations you can and cannot meet. 
• Your own expectations: Sometimes we’re our own harshest critics. We have big goals, big dreams and the drive to make those things happen. When chronic pain or mental health challenges are holding us back, it can feel heartbreaking. It’s easier said than done, but sometimes we owe ourselves some understanding and a little slack, too. We can acknowledge and celebrate even “small” successes, remembering that not everyone is facing the same thing and not every day is the same. Things will change. We will have days when we can better meet our own expectations. 
• Not feeling listened to: People with chronic pain don’t always expect others to give them the perfect answers. Sometimes it would be ideal simply to be heard. If you’d like to be listened to, here’s a guide to try out with friends. The American Chronic Pain Information Line is at 1-800-533-3231 and here is a list of crisis line numbers from the American Psychological Association. 
• A healthcare system that isn’t always set up to help you both mentally and physically: Our healthcare system often leaves a lot to be desired, despite the fact that healthcare professionals are doing their best. Not all healthcare professionals are trained in mental health care, or are aware of how deeply mental and physical health are intertwined. You might get shuttled to one doctor for a throbbing knee, for example, and another for anxiety. Too much of that, and you start to feel as though you’re falling through the cracks. One approach is to seek out pain specialists who take the mental components of pain into account. 

A few things that can help keep your mental health strong include: 

• Keeping friends close: Friends and loved ones help our body release chemicals that make us feel more stable, more cared for and more able to face hard challenges. So it’s important to schedule time for these relationships in a way that works for you. That could be online, over the phone, in person, via text or a combination. You could take a short walk together, share a tea or coffee, or pick a good movie to watch, for a start. The important thing is simply to spend quality time together. 
• Mastering mind techniques: Recent research recommends a wide range of techniques and approaches to support mental health. Cognitive behavioral therapy (CBT) is a great start, because it focuses on how to frame experiences. Meditation and mind exercises can help as well. 
• Using the mind-body connections in your favor: What helps the mind often helps the body. Exercise, for example, can help release pain-fighting chemicals. While it doesn’t sound enjoyable, or sometimes even doable, to move when in pain, many people are able to find a type of exercise that matches where they’re at. Swimming, yoga, and biking might help. And remember, doing even 10 minutes’ worth of exercise is still worth doing! Eating for pain helps, too. The Mediterranean diet or an anti-inflammatory eating plan can support your brain as well as your body. Finally, try breathing exercises to keep muscles relaxed, which can lower pain and keep tight muscles from releasing stress hormones.
• Starting a noticing practice: Some people call it mindfulness. Some call it being curious. The practice of staying in touch with your body, your breathing, and what’s going on around you helps you stay in the moment. Noticing small, bright moments throughout the day doesn’t necessarily banish pain, but does help you get more joy out of what’s worth celebrating. Keeping a journal of things that raise your spirits can also help you make the most of these small moments.

Most of all, it’s important to be aware of how you’re feeling and take it seriously. You matter, and your feelings do, too. At Clearing, we wish the very best for you and are ready to listen if there’s anything you’d like to tell us about your pain experience.