The Pain-mood Connection, Part 1: Pain, Pain, Go Away

February 19, 2019
written by:Claire Brandon, M.D.

Lady Gaga presented us with a wonderful statement at the 2019 Grammy Awards, “If you see somebody that’s hurting, don’t look away, and if you’re hurting, even though it might be hard, try to find that bravery within yourself to dive deep and go tell somebody…”

Her quote speaks to what we often seen used in colloquial language, depression and other mood symptoms can be painful. But then why do we so often associate pain with only the physical? Realizing the profound and reciprocal mental and emotional impact on pain can be freeing and help to decrease the stigma to get treatment for mental health conditions associated with physical illness. 

What happens when the body interprets emotional signals as pain?

Mental health diagnoses such as depression, anxiety, somatic symptoms, and PTSD can significantly overlap with pain signaling in the brain and research looking at brain scans have found that in certain diagnoses, areas in the brain associated with pain light up more in patients that also suffer from mood disorders. Thankfully, even without great assessment tools to quantify pain, gone are the days of chalking it up to being “all in your head.” Physical conditions can stand alone without an interference from mental health, but, it doesn’t mean that having an untreated or under-treated mood disorder can’t worsen your physical conditions.

In fact, as a consult liaison psychiatrist, my specialty training is focused on this exact intersection of the physical and mental and how our bodies respond to various stressors, including pain. Although many conditions can be included, some of the most prominent and debilitating include headache disorders, neuropathy, inflammatory bowel disease, fibromyalgia, and chronic fatigue. In working with these patients, under medical care for their diagnosis, we can tackle many aspects of how to decrease pain by utilizing psychotherapy and medications.

The Pain-Mood Connection

Another interesting aspect of the intersection of pain and mental health is the idea of inflammation in the body. Many chronic illnesses, including chronic pain (whether it is isolated or due to another illness) can result in signs of physical inflammation, including elevated cortisol levels, elevated white blood cell counts, and decreased immune functioning. Depression and anxiety can do the same, and make other chronic physical illnesses worse! It is so important to treat these conditions for overall health and wellbeing and to decrease stress on your body. Often patients with mood disorders express feeling shame that they cannot just “deal with it.”

Let’s think of a different example. No one suggests that a patient diagnosed with cancer simply “walk it off”. Mental health conditions that result in inflammation are just as important to treat, to prevent long term damage to our bodies. They deserve to be thought of as chronic illness and as disorders that can get better, with the right treatment. The first step to stopping the hurt is reaching out and better understanding your condition and treatment options, ideally with a psychiatrist that is trained in consult liaison psychiatry to help you understand how your mental and physical conditions are intersecting and what to do next. 

Check out the blog on Thursday for tips to intervene on both mood and pain in your everyday life. 

**This blog is not to be treated as medical advice, please discuss with your physician if you have any concerns.**

Claire Brandon, M.D.

Dr. Brandon is a dual board-certified psychiatrist in both adult psychiatry and consultation-liaison psychiatry (treatment of psychiatric illness in medically ill adults). She completed her residency and fellowship training at Mount Sinai Hospital in New York City and did a second fellowship in public psychiatry at New York University in New York City

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