Does chronic pain lead to depression or does depression lead to chronic pain?


Author: Brooke Carmen, PT, DPT: Doctor of Physical Therapy and Blog Contributor.  Loves fun informational gems.  Fitness addict and wannabe foodie. Emphasizes patient-specific treatment style and promotes goal-oriented care. Learn more about Brooke on here. gems.  Fitness addict and wannabe foodie. Emphasizes patient-specific treatment style and promotes goal-oriented care. Learn more about Brooke on here.

Many people that have chronic pain also experience depression. For those that have both depression and chronic pain, which comes first? If you have depression are you doomed to have chronic pain or vice versa?

Let’s start by fully understanding what depression is. Depression is a mental health disorder that is characterized by a depressed or “low” mood as well as a loss of interest in activities. Fatigue is a common symptom of depression. There are many different types of depression all of which are made of genetic, environmental, and psychological influences.

Chronic pain, on the other hand, is pain that has a long duration, from weeks to years. Three and six months are common timeframe markers in healthcare to define chronic pain. Acute pain, especially for the low back, generally falls within 6 weeks duration or less. Time frames can vary between healthcare practices and individual providers.

It’s very important to understand that chronic pain and depression are not single diseases in themselves. They are both made of pathophysiological and psychological etiologies. [1] Pathology is a medical term to describe what is observed during a disease. For example, a person has the flu and they are sneezing and coughing. Physiology is a biological term to describe processes in an organism. The person with the flu has pathogen markers in their respiratory system. Psychology is the study of the behavior and mind. That sick person is crying.

So what comes first? Depression or chronic pain? There is no solid answer and there may never be. There are five known hypothesis to try and answer this question. One that likely has the most evidence is that chronic pain can formulate depression. [1]

It has been show that those first diagnosed with depression who experience pain usually have a lower pain threshold, or lower overall tolerance to pain. This does not necessarily mean that because they have depression and a low pain tolerance, they will formulate long-term, chronic pain.

A healthcare provider should not ignore the complaints of chronic pain. This can reduce the likelihood of a person developing depression. If chronic pain remains separate diagnosis than depression, the overall prevalence of depression will reduce. [1] It can be somewhat looming to wonder if our healthcare system always documents and defines the two separately. Is that possible with chronic pain?

One can see why diagnosing and separating depression from chronic pain is hard alone and it's even more complicated when the two are treated with medication. There can be large interactions with medicines used to treat pain and depression. Many medicines used to treat chronic pain effect moods and behaviors. Gabapentin, to name one, is used to treat nerve pain; however, if one has depressive-symptoms, it can worsen the depression significantly to the point of suicide.

What physical therapists can do is listen. Chronic pain that does not respond normally to interventions may be undiagnosed depression. A client that is depressed needs different care and education than acute pain.

If you have symptoms of depression or chronic pain, and you haven’t yet, please reach out to your doctor. If you'd like to learn more about chronic pain and depression, a physical therapist can be an informative healthcare provider. Physical therapists cannot treat depression alone, but they can help lessen depression.


1. Blackburn‐Munro, G., and R. E. Blackburn‐Munro. “Chronic Pain, Chronic Stress and Depression: Coincidence or Consequence?” Journal of Neuroendocrinology, Blackwell Science, Ltd, 21 Dec. 2001,