Depression Can Worsen Joint Pain

Treating mental as well as physical health may alleviate symptoms.

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When your joints are aching and painful, here’s an aggravating factor you may not have considered: your mood. Understandably, being in pain can cause you to feel depressed, but research suggests the opposite is also true: being depressed can make pain worse.

In fact, a 2011 study published in The Journal of Bone and Joint Surgery showed that for people with osteoarthritis (OA), depression can have just as strong an effect on knee pain as physical damage.  

“The finding was particularly true in patients with radiographic findings of less severe – mild to moderate – knee osteoarthritis,” says lead author Tae Kyun Kim, MD, PhD, director of the division of knee surgery and sports medicine at the Joint Reconstruction Center at Seoul National University Bundang Hospital in South Korea.

Dr. Kim’s research team studied data from 660 Korean men and women older than age of 65. They measured the severity of participant’s OA damage with X-rays, questioned patients about their pain and interviewed them to diagnose depressive disorders. As expected, those with the most joint damage reported feeling the most pain. Surprisingly, participants with mild-to-moderate knee OA who were experiencing depression also reported severe pain, even if X-rays didn’t show the significant damage that typically indicates pain.

The reason for increased pain severity with depression is not clear, researchers say. However, some hypotheses have been proposed, says Marina B. Pinheiro, a researcher at the University of Sydney, Australia, who found a significant connection between depression and nonspecific back pain in a study of 2,148 twins from a Spanish twin registry. Nonspecific means that other serious pathologies and nerve root compromise have been ruled out, she says. “It is very likely OA is a cause, although we did not assess this directly.” The study was published in 2015 in the journal Pain.

The Pain-Depression Connection

One hypothesis for the pain/depression connection is depression leads to lifestyle changes that can worsen pain, says Pinheiro. “For instance, individuals with depression usually engage less in physical activity, become less socially participative, and have worse sleep quality.These factors have been shown to influence back pain.”

Another theory proposes that high levels of depression weaken a person’s ability to deal and cope with the current pain problem, Pinheiro says. “So based on this theory, the individuals’ perception about their condition, for example back pain, might become more negative when compared with individuals that are not depressed.

“In addition, there is a plausible biological link as both conditions – pain and depression – share common biological pathways and neurotransmitters, such as serotonin and norepinephrine.”

Jon T. Giles, MD, an assistant professor of medicine at Columbia University and rheumatologist at New York Presbyterian Hospital in New York City, says “Painful sensations are relayed through the brain in a very complex way, and can be modulated up or down,” he says. With stress, poor sleep, anxiety and depression, which are known to influence pain levels, “stimuli feel more painful than they would in someone without the adverse psychosocial factors.”

Treating Depression and Pain

Because depression might amplify pain responses in OA and other musculoskeletal conditions, Dr. Giles says clinicians should use antidepressants and other treatments if necessary to alter mood, rather than just prescribing medications designed to block pain.

“Antidepressant medications have been found to have analgesic as well as antidepressant effects,” agrees Dr. Kim.

Dr. Giles says it’s also important for caregivers who treat musculoskeletal conditions to screen patients for potential psychological aggravators of pain and refer them for treatment when needed. Likewise, people with painful musculoskeletal conditions who are experiencing emotional stress, an ongoing blue mood or other signs of depression – including fatigue, irritation and loss of interest in favorite activities – should mention it to their doctor who can prescribe or refer them for treatment that could potentially improve both their depression and their pain.

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