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Pain and Depression: Your Thoughts Make a Difference

Your thoughts can make depression and pain worse

If you have chronic pain, you may be at risk for depression. In one study, 35% of the participants who reported chronic pain were also depressed. Risk of depression was not associated with any particular pain type or site. Pain and depression seem to have a “reciprocal relationship”: they tend to feed upon each other; more pain can increase risk for depression and increases in depression can make pain feel worse. If you think you may be depressed, you may wish to talk with your primary care physician, therapist, or other health care provider.

You can start to manage your depression right now.

Take a careful look at how you talk to yourself. What you are telling yourself everyday about your pain, about who you are now, or what the future may hold has an important impact on your emotional life. Negative beliefs, thoughts, and self-talk play an important role in predisposing people to depression and can play a role in prolonging or worsening depression. Depressing images about pain can also make pain worse.  When pain and depression co-occur, negative self-talk has been found to be associated with more depression and greater pain interference. Depression makes chronic pain management even more difficult. What is Negative Self-Talk? The term negative self-talk refers to thoughts, ideas, beliefs, or even images that are overly negative and leave you feeling hopeless. This kind of self-talk takes a bad situation and makes it worse. Below are some examples:

  • My life is over.
  • People don't care about me anymore.
  • I don't have anything to offer.
  • I'll never work again.
  • No one understands what I'm going through.
  • There's nothing I can do.
  • I'm useless.
  • I'm all alone.

You may have said some of these things to yourself. They may feel true, especially on a really bad day. However, extreme thoughts, ideas, and beliefs are rarely completely true. Generally, if we challenge an extreme thought, we find exceptions (“I may have fewer friends, but I do have my family and my good friend Kristen”), possibilities (“I think I could work part time”), and hope (“I do have good days and the really bad ones aren't too frequent”). I am not suggesting that you lie to yourself or become overly positive. Instead, pay attention to how you talk to yourself and watch for those times when you may be overly negative. When you hear your negative self-talk, challenge it. Why should you just accept it? If someone else said the same things to you, wouldn't you question their right to talk to you like that? When you notice a negative thought, ask yourself:

  • Is there a different way to look at this?
  • Could it be partly true and partly not true?
  • Is this thought helpful or just making me upset? If it isn't helpful, then I can just let it go.
  • Is there a less extreme way to think about this that will help me to be hopeful?
  • Would someone who loves me talk to me this way? If not, why am I treating myself this way?

Living with pain is a real challenge. Don't make it more difficult than it has to be. Pain doesn't have to cause depression. You can control your thoughts and reduce your risk of depression.

About the Author. Dr. Linda Ruehlman is a social/health psychologist and researcher, co-founder of Goalistics, and director of the Chronic Pain Management Program, an interactive site that helps people with chronic pain to manage their pain and live richer, more effective lives as well as Think Clearly about Depression, a self-management program for depression.

DISCLAIMER: This blog is provided as an educational and informational resource only. It is not intended nor implied to be a substitute for professional psychological or medical advice.

——- Photograph by Ted Alverson ——-



  1. Keanu says:

    While I agree with all you have written, what is not addressed and causes great anxiety, depression is Dr’s lack of knowledge about CRPS, timeline between changes in medication to assessment and re-prescribing. Failed procedures, blocks. The hopeless situation CRPS suffers face with disbelief of the medical profession. Agree isolated, alone and the feeling your Dr is your greatest enemy.These are some of the expressions I have observed with regard to CRPS Chronic pain. In addition to this dwindling funds or exclusions by suffers from medical schemes add financial worry and inhibit regular visits, obtaining professional Psychosocial assistance.

  2. Jen says:

    I totally agree with this article. I have had chronic pain for about 10 years. While my pain comes in different severity and different locations in the beginning I almost became ” hijacked by my pain!”. My internal dialogues, while not intentional, was very self doubting amd self loathing. I mourned for my old self and often beat myself up for not being able to be that wife, mother and happy easy going person I was. It did not help that I never and still do not have a true diagnosis except “chronic pain”. Which made me feel that NO ONE believed me. I often wished my legs and arm LOOKED as horrible as they FELT. I have been very depressed and anxious and it has been very hard to navigate a life when you can not plan when you are going to be in pain or when you are feeling good, it is hard to know how much activity your bady will handle before you cross that invisible line.

    Over the last 10 years I have tried EVERY conceiveable medical treatment, alternative treatment and medication and while I have had waxes and wanes in my pain and my depression and anxiety, it has not been until recently that I have been seeing a new therapist teaching me a form of mindfulness and listening to all the “voices” inside myself and being more kind to myself and acknowledging my negative self talk and giving me tools to ground myself and challenge those negative talks and change my internal dialogue. I have been in and out of therapy for 32 years and this is the first time it’s been successful and ” clicking”
    This article is really great!

  3. John says:

    Having been diagnosed with chronic pain conditions for the past three years physically active has gone almost to nil. Prior to injuries, there were no limits to my physical activities. I have not reached the place that I can say and believe…just do your best and continue from that point. I know the words to say and I am aware of both positive and negative self talk and can recognize when I am doing each and the effects it has on behavior and emotion. I am stuck in the place that knows I know how to do physical activity but can’t get to the acceptance place and making progress from that point. I hope this makes some sense and welcome your thoughts.

    • Hi John,

      What you are saying definitely makes sense to me. Acceptance is an emotional as well as cognitive process…and I think it just takes time. It is difficult to accept any type of loss and move forward even though your head tells you to do so. I think one good strategy is to simply take small behavioral steps that show you are accepting the new reality, even if emotionally you are not there yet. It can be useful to create a plan for yourself that has definite steps or actions that are manageable and that will move you in the direction you want to go. I am so sorry for what pain has taken from you…but you can find a new way to live that will be both rich and happy.


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