Anxiety and Depression Associated with Physical Pain

“Thats the thing about pain.  It demands to be felt.”- John Green

Early on in college, I decided in addition to majoring in physical therapy, I would also major in psychology.  Why?  I felt that if I was going to treat and understand the physical aspect of a person, I better understand a little bit about the brain, thoughts and emotion of an individual.  After all, each of us is not just a body or a brain.  We have both.  Why is it that it’s readily accepted as the “norm” if you mention you have knee arthritis or back pain, however, it becomes taboo to discuss the psychology or emotion that may be involved with that pain?  I firmly believe that the psychology of what one is experiencing is extremely important to discuss and address.

Here are some common phrases I hear from my own patients:

• I feel depressed because I can’t do what I want and need to do for my job/family.
• I don’t want to burden my friends/family with my pain.
• I am worried that I will never feel better.
• I’m so sad I am missing my senior season in my favorite sport.

These thoughts and feelings are very common. According to the National Center for Biotechnology Information, 44.9% of patients reporting no pre-injury mental health issues, felt depressed within 6 weeks of suffering whiplash.¹ This is why you may see these questions on intake forms when you see your physical therapist or physician:

• Have you had little interest or pleasure in doing things?
• Have you felt down, depressed or hopeless?

Patients reply yes to the above-mentioned questions more than one might anticipate.  Recognizing feelings of anxiety and depression are commonly associated with physical pain is important to know and talk about openly.  So what if you do feel this way?  What do you do?  Here are a few recommendations:

• Tell your physical therapist or physician. They may have some answers for you that help make you feel better.  Also, sometimes just discussing how you feel and having your physical therapist listen may help you feel better. Understand that how you feel is common, and that things will most likely improve.
• Sometimes we need a specialist in psychology to help us with our emotion. Just as if you would see an orthopedic specialist for your knee surgery, you may benefit from seeing a mental health specialist for your anxiety or depression.  Talk with your physical therapist or physician for a recommendation on who might be a good doctor in your area to see in this field.

We are not just bodies or brains.  We have both.  Many emotions occur with an injury or pain.  Honesty with yourself and your healthcare provider can help in getting you the care you need to treat the whole you.  Take comfort in knowing that these emotions are common.  Anxiety and depression associated with physical pain may require additional resources, but we are here to listen and help!

1. Carroll, L. J., Cassidy, J. D., Côté, P., & Phillips, L. A. (2010, February 2). Whiplash-associated disorders: who gets depressed? Who stays depressed? Eur Spine J, 19(6), 945-956.