Chronic pain often develops as a result of a mental health condition. It can both be a symptom of a mental health condition, and a cause. Chronic pain and depression are often closely linked. Depression can result in chronic pain, a physical manifestation of psychological symptoms, and the stress of living with chronic pain can easily cause someone to become depressed. 

Chronic pain may be a symptom of other common mental health problems, such as anxiety, bereavement, suppressed anger, and emotional overwhelm. Chronic musculoskeletal pain (CMP) and PTSD are highly co-morbid. 

According to the 'shared vulnerability model', psychological and biological vulnerabilities interact with a traumatic experience to produce an emotional response characterised by hypervigilance, cognitive biases, and avoidance. Attentional bias for threat therefore exists in both PTSD and CMP; specifically, individuals with PTSD and CMP attend quickly to diagnosis-congruent stimuli but subsequently avoid such stimuli, thus maintaining symptoms of anxiety and pain (2).

Dealing with chronic pain can be immensely stressful and tiring. If you are developing any symptoms of anxiety or depression, or any other mental health condition, you should address it by visiting your doctor and/or a therapist or counsellor. There is more information about counselling for chronic pain below, but there are also other things you can do to help yourself:

• Consider joining a support group where you can share your experience with other people in a similar position.
• Learn more about your condition; knowledge is empowering and will make you feel more in control.
• Socialise with friends and family; they will want to spend time with you, despite what your negative self-talk might sometimes tell you. If it's easier than going out, invite them round for a movie.
• Practise relaxation techniques, such as mindfulness meditation.
• Taking physical limitations into consideration, maintain hobbies and outings enjoyed prior to the onset of chronic pain. This can be helpful as it can help keep feelings of hopelessness at bay. 
• Exercise is important. Some people actually find relief from vigorous exercise, with the release of endorphins acting like natural pain killers. If gentle exercise is more appropriate, swimming is a particularly good option as it puts less pressure on joints, stretches the muscles and helps with stress. 
• Eat well. Alcohol and junk food can cause inflammation in the body which can worsen chronic pain. 
• Assess your workplace environment. Where possible, avoid repetitive movements or prolonged sitting or standing.
• It is important to manage your stress and emotions, as they can worsen or even prolong your chronic pain symptoms.

Chronic pain can be mentally and emotionally, as well as physically, debilitating. A person with chronic pain may resist the idea that the root of their pain is emotional and mental, rather than purely physical, out of fear that they will be seen as 'making the pain up'. Whether rooted in a physical or mental/emotional problem, the pain of chronic pain is real. 

Counselling for chronic pain will help an individual challenge unhelpful thoughts about their pain, offer them a space to talk about the impact of their chronic pain and offer them the relief of talking to an objective listener about the problem, away from those who put, sometimes unintentional, pressure on you, such as children, partners and employers. 

Chronic pain can also prompt feelings of grief as you mourn the loss of activities that once came easily. A counsellor or therapist can help you work through these complicated feelings. 

Talking therapy is a good solution to the many issues that may accompany chronic pain, such as insomnia, anxiety and depression.

(1) Glombiewski, J. A., Holzapfel, S., Riecke, J., Vlaeyen, J. W. S., de Jong, J., Lemmer, G., & Rief, W. (2018). Exposure and CBT for chronic back pain: An RCT on differential efficacy and optimal length of treatment. Journal of Consulting and Clinical Psychology, 86(6), 533–545. https://doi-org.uoro.idm.oclc.org/10.1037/ccp0000298.supp 

(2) Carleton, R. N., Duranceau, S., McMillan, K. A., & Asmundson, G. J. G. (2018). Trauma, pain, and psychological distress: Attentional bias and autonomic arousal in PTSD and chronic pain. Journal of Psychophysiology, 32(2), 75–84. https://doi-org.uoro.idm.oclc.org/10.1027/0269-8803/a000184