The 1-2 Punch: Physical Pain and Depression

I work a part time job on a receiving crew for a retail store. Three days a week I get up at 4 a.m. and get to work by six. I spend the next six to nine hours lifting heavy merchandise and empty pallets, pushing loaded carts of products, and shoving hundreds of pounds of boxes into a compactor. When I get off work, I limp into my house, pop half a dozen ibuprofen to ease the aching, and collapse onto my bed to have a fitful nap.

Being in my late thirties, some chronic physical pain is expected. It also doesn’t help that I’m not in shape. But to be consistently so sore after work seemed odd to me. It was even more troubling when I developed tendinitis in my elbow and a spot in the middle of my back that burned whenever I lifted anything, but the skin over it was numb. Why was I experiencing so much physical pain when, for all intents and purposes, I was doing work I’ve been doing most of my life?

The answer lied not with my physical condition, but my mental one. Physical pain has links to depression, and vice versa. According to Dr. Daniel K. Hall-Flavin, a board certified psychiatrist in general and addiction psychiatry, in an article written for the Mayo Clinic, depression can manifest physically by way of chronic back pain and headaches, for example. Dr. Hall-Flavin also pointed out that chronic physical pain can exacerbate depression symptoms.

“Pain and the problems it causes can wear you down over time and affect your mood,” Dr. Hall Flavin explains. “Chronic pain causes a number of problems that can lead to depression, such as trouble sleeping and stress. Disabling pain can cause low self-esteem due to work, legal or financial issues.”

Aches and pain can also be the first signs of depression. In a paper published by Dr. Madhukar H. Trivedi, Dr. Trivedi explains that “chronic joint pain, limb pain, back pain, gastrointestinal problems, tiredness, sleep disturbances, psychomotor activity changes, and appetite changes” can be depression manifesting, making it harder to diagnose.

“A high percentage of patients with depression who seek treatment in a primary care setting report only physical symptoms, which can make depression very difficult to diagnose,” Dr. Trivedi said in the paper’s abstract. “Physical pain and depression have a deeper biological connection than simple cause and effect; the neurotransmitters that influence both pain and mood are serotonin and norepinephrine. Dysregulation of these transmitters is linked to both depression and pain.”

In my particular case, depression coupled with poor physical fitness and rigorous work activity could very well be the cause of my daily collapse after work. The resulting injuries also make me feel like I’m broken, a feeling that only corroborates the thoughts of uselessness and hopelessness that accompany my depression. 

The best solution for me would be to improve my physical fitness. I’ve recently made a few life changes to my diet and sleep habits to help with this, but I have not made much progress in the physically active part of my life. Walking more often, engaging in light stretching and cardio workouts, and not being sedentary would benefit me greatly and hopefully reduce or stave off such horrible pain after work. This is a huge hurdle for me, as I have a deep aversion to exercise. It is something I’ve struggled with for years.

If you or someone you know is having issues with the combination of chronic physical pain and depression, you may need to be like me and take some steps in improving your physical health along with your mental health. A combination of regular exercise, counselling, and possibly medication will help alleviate both problems at once. Dismissing the physical symptoms of depression could lead to treating the wrong problem. Make sure your doctor and therapist know that you’re having both sets of symptoms so they can work together to get you relief.

As for me, walking more regularly and losing a little weight might just save me some money on ibuprofen.

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