Pain, anxiety and depression

The experience of pain can be frightening, discouraging, and
demoralizing, especially when pain becomes chronic. Because
this experience inevitably happens in a social context, it also can be stigmatizing, and there can be shame or guilt, once again particularly for chronic pain. People with chronic pain often face disbelief and can feel that they need to prove their condition is real. They frequently navigate health care systems in a state of considerable uncertainty, even as they struggle in making sense of their own circumstances. People with chronic pain often feel that their very sense of who they are is under threat or in some cases lost completely. As chronic pain persists, these experiences naturally can give rise to significant anxiety and depression. The purpose of this chapter is to examine anxiety and depression in the context of chronic pain. It will briefly describe the extent of these problems and their impact on individuals who experience them. It will also explore evolving perspectives on anxiety, depression, and chronic pain, whether these are best conceived as separate conditions that people have or something else. Relevant treatments for these problems will be discussed, with a focus on forms of cognitive behavioral therapy (CBT), including recent developments in CBT.