The Health Psychologist

Society for Health Psychology

The Role of Health Psychologists in Treating Chronic Pain and Comorbid Depression

2024 Spring, Clinical highlight, The Health Psychologist

Madeline Foster, MSPH
Clinical Psychology Ph.D. Student
School of Psychology
Fielding Graduate University

Chronic pain is a complex and dynamic phenomenon that impacts the daily lives of over 50 million adults in the United States, making it the leading cause of disability in America (Rikard et al., 2023). While chronic pain in and of itself is a crippling condition that can greatly impact an individual’s daily functioning and quality of life, it is often comorbid or multimorbid with other serious health conditions, making it a complex issue to treat. In fact, individuals with chronic pain are four times more likely to have a severe or chronic health condition than those without chronic pain (Foley et al., 2021). Oftentimes individuals with chronic pain also have a psychiatric disorder, most commonly depression. It is estimated that between 40% and 80% of those with chronic pain meet the criteria for depression (Rikard et al., 2023; Sheng et al., 2017). Chronic pain and depression can interact as comorbidities, where there is a primary and secondary condition, or multimorbidities, where both conditions coexist with neither being more central than the other (Harrison et al., 2021). Psychologists play an important role in treating individuals with both chronic pain and depression, with key responsibilities including pain management, behavioral interventions, emotional support, and interdisciplinary collaboration with other healthcare providers. 

Medical Treatments

For those who are experiencing both chronic pain and depression, treatment is typically provided by an interdisciplinary team. This team may include physicians, physical therapists, occupational therapists, and psychologists, among other professionals (Danilov et al., 2020). Medical treatments commonly include medications that target both chronic pain and depression (Roughan et al., 2021). Pain medications, such as opioids, non-opioid pain relievers, or anticonvulsants (e.g., gabapentin and pregabalin), can be used to target chronic pain and antidepressant medications, such as Selective Serotonin Reuptake Inhibitors (SSRIs) or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), can be used to target depressive symptoms. 

In addition to pharmacological interventions, treatment often involves physical therapy to improve overall physical function. While physical therapy will often focus on reducing pain, increased physical activity has also been shown to reduce depressive symptoms (Kandola et al., 2019). In some cases, interventional procedures can be used in the treatment of chronic pain or depression. For depression, this may include Transcranial Magnetic Stimulation (TMS) which is often used to treat treatment-resistant depression. For chronic pain, procedures may include nerve blocks or spinal cord stimulations (Thomson et al., 2020). In addition to traditional medical interventions, many individuals living with chronic pain and depression may seek complementary treatments like acupuncture, massage therapy, or herbal remedies (Dale & Stacey, 2016). 

Key Issues Psychologists Can Address

Psychologists treating individuals with chronic pain and depression must consider both the psychological and physical issues patients may be facing. Physically, there are several key issues a psychologist can help with.  Psychological and behavioral interventions can be used to reduce the physical burden living with pain day in and day out can have on an individual. For example, treatments can help improve mobility, minimize loss of function, and increase motivation for engaging in daily activities (Keefe et al., 2004). Since medical treatment for chronic pain and depression often involves pharmacological interventions, psychologists can work with prescribers to help manage medication side effects and facilitate adherence to pharmacological intervention plans (Barley & Lawson, 2016). Fatigue and sleep disturbances are also common issues faced by individuals with chronic pain and depression (Keefe et al., 2004). Psychologists can work with patients to implement healthy sleep hygiene practices and relaxation techniques to aid sleep. 

Furthermore, psychologists are instrumental in managing depression symptoms for the large number of individuals living with chronic pain and depression (Turk & Okifuji, 2002). Psychologists also play an important role in helping individuals cope with their situation. Through Cognitive Behavioral Therapy (CBT) techniques, mindfulness, and psychoeducation, psychologists are in a unique position to facilitate greater coping by focusing on the psychological and emotional aspects of living with chronic pain and depression (Hilton et al., 2017). Psychologists are not only able to help individuals with chronic pain and depression manage their conditions in the short term, but they are also able to help develop long-term strategies to acknowledge the chronic nature of the conditions. 

Psychological and Behavioral Interventions

Treatment for chronic pain and depression is often approached from a biopsychosocial perspective, which conceptualizes each disorder as complex and multifaceted illnesses, rather than biological diseases (Roditi & Robinson, 2011). Psychologists play an integral role in the treatment process providing a number of psychological and behavioral interventions. CBT is widely considered the gold standard of psychotherapy interventions for both chronic pain and depression (Dale & Stacey, 2016). CBT is key in addressing the psychological aspects of chronic pain, including negative thoughts and maladaptive pain-related behaviors (Nash et al., 2013). CBT can address maladaptive coping strategies like catastrophizing and avoidance and strengthen adaptive coping mechanisms such as positive self-statements and the cultivation of social support. CBT can be delivered individually or in a group setting, with group settings providing a supportive and empathetic environment that can facilitate positive health outcomes through the opportunity to share experiences and learn from others (Andersson et al., 2012). 

Third-wave CBT interventions such as Mindfulness-Based Cognitive Therapy (MBCT) and Acceptance and Commitment Therapy (ACT) are commonly utilized by psychologists working with patients who have both chronic pain and depression. Both interventions have proven to be effective in improving coping mechanisms and promoting positive mood improvements (Nigol & Di Benedetto, 2020; Veehof et al., 2016). Relaxation techniques such as deep breathing and progressive muscle relaxation can help patients cope with their symptoms and facilitate a greater sense of control over their body and mind. Acceptance-focused psychotherapy is also commonly used to foster a non-reactive and non-judgmental stance toward the experience of pain (Veehof et al., 2016). Given the ongoing nature of chronic pain, greater acceptance can reduce feelings of hopelessness as well as promote positive coping mechanisms (Hughes et al., 2017).

Psychologists who work with individuals with chronic pain and depression can provide psychoeducation to help patients understand the unique nature of chronic pain and its link to depression (Vanhaudenhuyse et al., 2018). Psychoeducation can assist patients in understanding the biological, psychological, and social factors that may influence their experiences with pain and depression. Studies have shown that psychoeducational interventions are associated with the development of adaptive (?) coping strategies and a reduction in perception of pain (Vanhaudenhuyse et al., 2018). Moreover, for individuals with chronic pain and depression, psychoeducation on chronic pain has been shown to result in a significant reduction in depression symptoms (Salvetti et al., 2012). 

Psychologists can also utilize behavioral activation to facilitate health-promoting activities that can reduce the severity of chronic pain and depression symptoms (Kim et al., 2017). This may involve collaborative goal setting to work towards realistic step-by-step plans that will help increase an individual’s quality of life or ability to partake in activities of daily living. Psychologists can also help individuals build confidence in certain behaviors that may be challenging because of pain symptoms and potentially made worse by the negative thoughts associated with depression (Andersson et al., 2012). By helping individuals manage their pain during activities and reducing the fear around behaviors that may cause pain, psychologists can greatly increase the functionality of patients (Dale et al., 2016). 


Ultimately, while chronic pain and depression are two distinct diagnoses, oftentimes health psychologists treat patients living with both conditions simultaneously. Chronic pain and depression and inextricably linked, and it is imperative that both are considered relevant to the management of the other condition. For psychologists, treating multimorbid or comorbid chronic pain and depression involves addressing several key physical and psychological issues. Several psychological and behavioral interventions can be utilized by psychologists to address these key issues and improve the functioning and quality of life for patients living with both chronic pain and depression.


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