Researchers say many people with chronic pain also deal with mental health issues. Ekaterina Lesnik/EyeEm/Getty Images

• Researchers say chronic pain can produce mental health issues for people who live with the condition.
• They note that chronic pain can cause people to miss work as well as fracture relationships between friends and family.
• Experts say chronic pain is often unsuccessfully treated with surgery and opioids.
• They say it’s better to “treat the whole person” with health and lifestyle coaching.

Gene Stewart, 48, from Lees Summit, Missouri, has dealt with severe pain since a 6-foot fall from a ladder in 2014 fractured his sacrum and both sides of his pelvis.

Stewart, who also injured the discs in his back, said there was little doctors could do for him.

“I had to naturally heal and work through physical therapy for a while,” he said.

Stewart noted that he developed depression from the physical pain and that, in turn, blinded him to what was the most important thing in his life: his family.

“Chronic pain has removed me from society and family life and driven me to a kind of depression that I never knew existed,” he told Healthline. “The pain is intrusive and crippling on the psyche and the effect it has on others is equally as damaging.”

Stewart is working to begin the healing with his family.

“I see now just how much chronic pain is responsible for countless suicides worldwide,” he said.

“The pain will never go away, but at least I have insight to do better and try and stay positive. With a good support group, it is possible to be happy. I will try. I don’t want to go back to the deepest part of my life,” Stewart added.

Chronic pain affects millions

Stewart is one of the millions of people in the United States whose chronic physical pain has affected their mental health.

Chronic musculoskeletal (MSK) pain, which includes pain in the muscles, bones, ligaments, tendons, and nerves, has been linked in multiple studies to psychological issues, which can sometimes be just as debilitating as the physical ones.

A new report from Hinge Health, a digital health company focused on improving the lives of people with chronic conditions, takes an in-depth look at the toll that pain can have.

Each year, Hinge Health analyzes the Centers for U.S. Disease Control and Prevention’s most recent National Health Interview Survey data.

Hinge identifies gaps and challenges that individuals, employers, and health plans face related to the management of MSK conditions.

The costs of physical and emotional pain

Dr. Jeffrey Krauss, chief medical officer at Hinge Health, said that two in five people with chronic MSK pain also experience depression and anxiety.

“Pain can intensify mental health challenges and, conversely, anxiety and depression can worsen chronic pain,” Krauss told Healthline

“MSK annual care costs in this country are roughly $600 billion,” he noted. “They’re right up there with heart disease and diabetes, and are driven largely by the procedures that are done.”

Krauss said that for the most part, surgery is not the solution.

“There is a great misunderstanding of what causes pain. In the majority of people, there is no underlying structural issue to address the pain,” he explained.

Krauss said the same regions of the brain that process pain also process many stressors, and they’re tied in with depression and anxiety.

“Generally, what is going on is that your nervous system is overactive. It is over-sensitized. Stressors cause this, physical or emotional or financial, whatever they may be,” he said.

Labor-intensive industries see the highest incidence of MSK pain, followed by work that requires repetitive action or jobs where workers are sitting all day.

MSK issues are a big burden on productivity at work, accounting for an average of 8 days out of work, and with the mental health component, it is 13 days, according to the study.

Education services, retail stores, distribution centers, and manufacturing recorded the highest incidences of MSK pain, the study reports.

Proper care and lifestyle changes

Krauss said it often becomes a vicious circle in which chronic pain can intensify mental health challenges and the anxiety and depression can worsen the chronic pain.

About 40 percent of people with chronic pain coupled with mental health needs are not getting the necessary support to make lifestyle changes that are key for recovery, Krauss said.

And 30 percent of them are more likely to be prescribed opioids than those with chronic MSK pain alone.

People of color and lower-income populations with chronic MSK pain are more likely to experience higher pain levels, disruptions to daily life, and poor health, Krauss said.

The lack of access to physical therapy, especially in rural areas, leads to higher rates of invasive surgery, accompanied by long recovery times, the study reported.

Treating the whole person

Krauss said that the best way to make things better for people who are dealing with chronic pain is to “treat the whole person.”

For example, Krauss said, Hinge Health goes beyond physical therapy and provides an integrated clinical care team that includes doctors of physical therapy, health coaches, physicians, and orthopedists.

Members receive personalized exercise therapy plans, lifestyle support, and expert second opinions in a comprehensive care environment.

The key is to get people moving.

“It’s critical. It calms down the nervous system,” Krauss said. “Education, too, is extremely important. We need to explain to people that you are not damaged, your body is strong, and you should be moving”

Krauss also encourages the use of behavioral health support by utilizing health coaches.

“They’re the ones supporting people with addressing barriers. It is critical to motivate people. Get sleep, eat well, people just don’t do it, they need someone there to be accountable,” he said.

While MSK challenges are complicated, the path forward for employers and health plans is becoming clearer.

As the study concludes, “Leading organizations are adopting MSK solutions like Hinge Health that address disparities in care by providing a complete clinical care team, advanced technologies to personalize care at home, and connected care systems that bridge the gap between digital and in-person care.”

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