The Depression-Pain Dyad
Addressing MSK Pain & Mental Health with Digital Care
MSK Pain and Mental Health
With chronic musculoskeletal (MSK) pain left untreated during COVID-19, your employees may be struggling with increased pain and related mental health issues. Understanding the connection between MSK pain and mental health is critical for employers to effectively tackle both issues.
Depression has been shown to increase the severity and intensity of pain, and chronic MSK pain increases the risk for depression. This feedback loop is known as the depression-pain dyad.1
Chronic pain and depression share neural pathways and affect the same regions of the brain. Of people who live with depression, 65% also have chronic pain, compared to only 25–30% in the non-depressed population.2 And of people who have chronic pain, an average of 27% will experience depression compared to 5–10% of people in the non-chronic pain primary care population.1
Healthcare costs for an average employee who seeks treatment for major depressive disorder exceed $2,000 per year,3 while treatment for chronic pain can add $2,300.4 Given the high co-morbidity of mental health and MSK pain, employers are increasingly looking to holistic interventions to break the cycle of member’s physical and emotional pain.
- Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and Pain Comorbidity; A Literature Review. Arch Intern Med. 2003; 163(20): 2433–2445. doi:10.1001/archinte.163.20.2433.
Pain and Depression Are Linked
Depression-Pain Dyad & The Brain
Fighting depression without addressing MSK pain is like fighting with one hand tied behind your back. When someone is depressed, both the perception of pain and the emotional ability to manage the pain is disrupted. Pain also blunts the effects of anti-depression medication. 95% of patients who have refractory depression (depression that does not improve after 12 months of treatment) have an underlying chronic pain condition. Essentially, difficult to treat depression is a chronic pain problem.
Depression lowers the amgydala’s ability to control emotional response to pain, leading to feeling helpless to overcome pain. Pain and depression decrease critical neurotransmitters. MSK pain depletes the levels of the neurotransmitter GABA, which leads to increased stress, hypersensitivity, and higher risk of depression.
Depression raises the intensity of both physical and emotional pain, causing the hippocampus to create a cycle of pain that becomes learned and chronic.