At first, you might say, “Well, of course.”
And when I’m done writing about this study, you’ll probably also say, “Well, I would have guessed that.”
But you’ll also see some interesting things about these findings and what research trail they might lead us, too.
More importantly, if you’re struggling on these fronts, it might help to know you’re not alone and whenever you feel you’re not alone, well, we intuitively know there’s comfort in that and there is, empirically, too.
To the study!
A new systematic review and meta-analysis, published in JAMA Network Open, from researchers at Johns Hopkins University found that chronic pain was associated with a higher prevalence of symptoms of anxiety and depression.
That research question isn’t new, but the meta-analysis is important because it looked at 376 studies published over a ten year period and across 50 countries. In other words, it was an exhaustive analysis of previous studies to try to clear through the brush.
And, indeed, the researchers found that among those with chronic pain, there was a pooled prevalence of 40.2% for symptoms of depression and 39.3% for symptoms of anxiety. That compared with a prevalence of 16.7% and 3.5%, respectively) in the control groups.
In other words, those 376 studies seem to support the idea, empirically, that victims of chronic pain are more likely to show symptoms of depression and anxiety than those without chronic pain.
That makes sense.
If you’ve got chronic pain, it can be difficult to do the things you want to do, and I don’t mean as in, “Live as your own God” kind of way, but something as simple and human as the need to be with others can sometimes be taken away from us for periods of time.
Then there’s the fact that if you have chronic pain, you might wonder, “Where’s this coming from?” (more on that later) or “How bad is it going to get?” or “Can I make it to my son’s flag football game tomorrow” as you lie awake in the middle of the night.
Of course, it would be nice if we could just subdue the anxiety with and depression with an “Ah, it’s okay, that’s just the suffering of life and I’ll be of good cheer because the Lord has overcome it,” but God himself understands and empathizes with our pain, suffering, depression, and anxiety, deeply.
In fact, the Bible is consistent on this thread. He shows up when those are crying, he numbers our tears in a bottle, and when he was on earth, he wasn’t just about healing our spiritual scars (of course, which is the better thing), but he was constantly going around healing people from diseases and expressing great compassion.
In fact, sometimes, he was so overcome with compassion when he saw illness that he either grew angry at the broken world that would produce so much pain, or he’d just be filled with unadulterated, overwhelming compassion like the kind that we’re filled with when we see our kids in pain. He even fed the 5,000 because he felt such compassion over hunger!
And note: when confronted with physical suffering, he never grew angry at those in pain or told them to just get over it.
I can’t look into Christ’s exact mind as I write this, but based on his life and the revelation of Scripture, I’d guess he’d be awfully grieved at the “ah, it’s not big deal, just buck up and deal with it” crowd (that group is simply just kindly naive, projecting their own optimism onto others, or downright cruel in the way they treat others’ pain).
Now… back to the study, because there are a couple, other things to note.
First, the type of pain was sometimes associated with higher rates of depression and anxiety.
For example, those with fibromyalgia were more likely to show higher rates than those with osteoarthritis.
Of course, that speaks to one of the questions you might have had by now.
We know that, in many studies like this one, correlation does not necessitate causality. In other words, the study doesn’t answer the question of whether pain is more likely to cause depression or anxiety or even that depression or anxiety are more likely to cause pain.
That’s a question of directionality, and there are plenty of studies that look into those specifics, but this meta-analysis was just meant to address prevalence and association, which is worthwhile too. It’s a good starting point.
Now, as to the different rates in some different types of pain…. why might that be?
Well, one particular explanation comes from one of the study investigators Dr. Rachel Aaron.
Dr. Aaron, speaking to Medscape:
“Although we were unable to test directionality of the relationship between chronic pain, depression, and anxiety in the study, one thought is people with fibromyalgia and other nociplastic-related pain conditions are more vulnerable to developing depression and anxiety in the first place, and that could be a factor driving chronic pain.”
So what is nociplastic-related pain?
You can click on the link to get more on it, but basically, it’s pain from “continuous damage and inflammation of bodily tissues.”
It’s not a diagnosis, but a description of pain. There are all different kinds, including fibromyalgia, IBS (irritable bowel syndrome), chronic lower back pain, complex regional pain syndrome, migraines, and others.
There’s no test to definitively say you have fibromyalgia. Likewise, there’s not really a pathological test to diagnose irritable bowel syndrome. Indeed, in the case of the latter, it’s a diagnosis of exclusion.
You can’t see IBS on a colonoscopy, it doesn’t show up in common blood markers, it doesn’t raise a red flag on a CT scan.
But the symptoms sure can be there, and the route of their origins can be many. No one denies it exists, it’s just hard to see (unless you’re in the bathroom). You’re either in the bathroom 10x/day or maybe dealing with constant pain from constipation or whatever, but it’s definitely there.
Now…. why are those types of pain associated with higher depression and anxiety?
We don’t know. The study can’t say that. We probably all have our own guesses.
My own hunch is that one factor might run along the lines of something like this: When you have clinical proof of a pain, when you have a clear diagnosis — even if it’s a bad one — you often hear yourself or others say, “Well, at least we know.”
There’s a kind of relief in the clarity. Theoretically, wouldn’t that help our anxiety? Anecdotally and personally, it’s helped others and me. When you don’t know, you can’t help but wonder. And sometimes you think (and plenty of others will pipe in with their damaging comments): “It’s all in your head.” As if it’s not real and you’re nuts.
That can make you both more anxious or depressed. You feel less understood, you feel implicitly judged, mocked, or made to feel your pain isn’t real.
I’ve come across so many people who suffered for years with something no doctor could explain and, man, they suffered mentally over it, too, because it really sucks to be told by others, “you’re making this up” or to just not know what’s going on.
Once those victims finally get a diagnosis — even if it’s a scary one — it at least offers some relief.
To be crass: It’s the same as if you’re on a cross country road trip, and your car is making horrible noises every 15 miles and so you pull over in every town, ask the local mechanic and he says, “Runs fine for me, I can’t see any problem,” and then you drive for 30 minutes and feel better for a moment, and then the car starts sounding like a volcano again just as you’re about to ascend the Rockies.
And that road trip is 2 years and just goes on and on with that pattern.
Except this is your pain, and it has major effects on your life. Not just the road trip example.
So that’s one of my guesses for this disparity on pain type and depression/anxiety.
Of course, perhaps ongoing inflammation plays a huge role too. Sometimes it’s hard to measure inflammation in the body, because on any given day, your blood markers might show some or not, and there are some types of inflammation that you either can’t test for, or are bloody hard to test for by conventional, insurance-covered methods.
Also, many of these types of pain can be involved in a vicious “mind-body feedback loop” with anxiety and depression, making it further difficult to figure out.
So there are loads of reasons why this might be the case.
Of course, further research should look into these more precise questions and undoubtedly will, and praise the Lord for researchers who are genuinely into the business of caring for people. They are doing the Lord’s work, genuinely, and that’s why it’s important for a good society to grant funding for projects such as these. I don’t think North Korea is looking into questions like this, so praise the Lord that we actively give grants and funding money to people involved in this work.
Also, a final note that I addressed earlier.
I hope you never feel shame about the fact your physical pain leads you to either feelings of depression or anxiety.
The Psalms are full of mourners who speak of the sadness of suffering and “Lord, where are you?” He never rebukes any of them. He never treats them with “Buck up” or “How dare you.”
The Great Physician cares about our spiritual health more than anything (his death on the cross to save us and his ministry of teaching us), but he also spent a great deal of time focused on the physical suffering of those around us and was moved with compassion, showed gentle mercy, never doubted the pain.
In fact, if anything, he looked at those in physical pain with a special gaze because he understands our frame and when he renews all things, the body is notably right up there with renewal in resurrection. And remember, we are buried in brokenness and we are raised in glory.
May the Lord bless you as you fight any of your diseases. He gets it.
It’s hard.
If you struggle with depression, anxiety, or any other such disorders — for readers in the United States…
Find a psychiatrist here.
Find a therapist here.
For readers, internationally, seek help from a local resource.
For salvation, Christ and Christ alone.
[Photo: Pexels, free, by Andrea Piacquadio]
