Emotional effects of pain

Cancer often exacts an emotional toll, and pain can cause even greater emotional distress. Dealing with chronic pain can lead to anxiety, frustration and even depression, so individuals with cancer should be sure to find emotional support as they seek methods to relieve their pain.

Studies have shown that greater levels of pain are associated with higher levels of emotional distress. So taking steps to reduce your pain is the first step in coping with distress. But for some people with cancer-related pain, more steps may be needed. If distress becomes severe enough, depression may develop.

Recognizing depression

Studies have shown that, among people with cancer, depression is most likely to occur during times of unrelieved symptoms, including pain. In fact, more than one-third of people with cancer have both pain and depression. Therefore, it is important to know the signs of depression. Depression is more than just feeling sad or hopeless. A clinical diagnosis of major depression requires that at least five of the following symptoms occur every day for at least two weeks:

  • Persistent sad, anxious or “numb” feeling
  • Loss of interest or pleasure in once-enjoyed hobbies and activities
  • Feelings of hopelessness
  • Feelings of guilt, worthlessness or helplessness
  • Fatigue and loss of energy
  • Difficulty concentrating, remembering and making decisions
  • Sleep problems
  • Changes in appetite and/or weight
  • Thoughts of death or suicide, or suicide attempts
  • Restlessness, irritability
  • Social withdrawal
  • Repeated episodes of crying

Unfortunately, many of the recognized symptoms of depression are also problems associated with chronic pain, such as sleep problems, lack of energy and recurrent worried thoughts. Seeking treatment both for the pain and for your mood is important.

Treatment for depression

Certain medications, counseling or both can help those with all stages of depression. Some people find benefit in counseling alone (without medications), but moderate or severe depression is typically managed with a combination of psychological treatment and medication (antidepressants). Types of counseling include:

  • Individual psychotherapy – to explore the emotional issues that contribute to depression.
  • Cognitive-behavioral therapy – to help a person change his or her negative thought patterns and behaviors.

Many antidepressants are available; those used most often for people with cancer belong to a class known as selective serotonin reuptake inhibitors (SSRIs). These drugs include fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft), among others. There are also newer antidepressants, known as SNRIs, that have some effectiveness in treating pain, such as duloxetine (Cymbalta). Each antidepressant drug has different potential side effects, which can usually be managed by adjusting the dose or switching the medication. Your doctor will work with you to find the antidepressant that works best for you with minimal side effects. Antidepressants do not take effect right away; SSRIs take about two to four weeks to become effective, and others may take longer.

Boost your mental health

Emotional distress can make your pain seem more severe. Maintaining your physical health can help boost your mental health, making it easier to cope with pain as you seek options for better pain management. An adequate amount of sleep, regular exercise, healthy eating and effective stress management can help you feel better both physically and emotionally. Explore ways to boost your mental health to find the ones that best meet your needs.

Boost your mental health

Improve your mental health by incorporating any of the following activities into each day.

  • Exercise (walk, yoga, swim, dance)
  • Pace your activity and learn to say "no" to things that will severely aggravate your pain
  • Eat well and avoid high-calorie comfort food
  • Get plenty of rest
  • Socialize with friends and family
  • Spend time with pets
  • Enjoy a hobby
  • Meditate or perform deep-breathing exercises
  • Seek out humor (watch a comedy or pick up a funny book)
  • Write in a journal or keep a diary
  • Join a support group
  • Unclutter your life

Seek professional help

Many people with cancer avoid talking about the emotional effects of cancer and pain because of the stigma attached to depression and other mental health problems. But you must be emotionally healthy in order to better cope with all of your cancer-related issues, including finding appropriate pain management. Do not be afraid or embarrassed to talk to your doctor or another member of your cancer treatment team about a referral to a mental health specialist who has experience working with people with cancer.