Information provided in the “Ask the Doctors” column is not meant to take the place of individual consultation with a qualified health care provider. See your health care provider to discuss specific questions about your health, medication and treatment plan.

Question: What is the relationship between depression and physical pain?

Answer: Pain may be a symptom of depression. It may also be a separate condition that can worsen depression. Many people report unexplained aches and pains to doctors before they notice other symptoms of depression.

A World Health Organization survey found that 69% of those with major depression had sought help for physical symptoms only. Individuals with physical pain may go to their doctors and be told that nothing is wrong.

In other cases, pain and depression are two separate co-existing conditions. Illnesses such as fibromyalgia, chronic fatigue and irritable bowel syndrome often co-exist with depression. Chronic pain from injuries also can trigger depressive episodes.

Both pain and depression can interfere with life. It’s important to find a doctor who recognizes that your pain and depression are real. They may not be visible but you deserve to have them treated.

Traditional treatments for depression can help with pain. A Journal of the American Medical Association article described a study of 1001 patients with depression and arthritis. Half of them were given additional treatment with psychotherapy and/or antidepressants. The therapy/ medication group was more likely to report a 50% reduction in symptoms and improved day-to-day life.

Some researchers believe that there is a change in the way the brain reacts to pain signals in people who have chronic pain. It is also possible that the perception of pain is greater in people with depression.

Pain affects the serotonergic and noradrenergic pathways in the brain. If you take medication, talk to your doctor about which medication or combination of medications can help. The antidepressants most likely to be effective for depression and pain affect the activity of serotonin and norepinephrine. Trycylic antidepressants, and some newer antidepressants called SNRIs, have this effect.

If you do not take medication, there are non-medical solutions. Treatment such as cognitive behavioral therapy can be effective in helping you manage symptoms, even if it doesn’t completely relieve the pain. Treatments such as psychotherapy, massage therapy, chiropractic treatment, clinical hypnosis and acupuncture may also provide some relief and help you cope. Be sure to choose a health care provider who has a good, solid reputation and is certified and licensed.

As with other illnesses, learn all you can about depression and pain. Choose health care providers and treatments you feel comfortable with. Discuss goals at the beginning of your treatment. Be patient when waiting for treatment to take effect. Find support groups that help you. Know that there is hope and you are not alone.