Breaking the Cycle of Pain and Depression

If you or a loved one are living with chronic pain, you know it can be very different from occasional aches and pains that come and go, like an aching lower back or nagging leg or neck pain. Truly chronic pain — pain that lasts more than three months — can interfere with sleep, daily activities, and overall mental well-being. 

In older adults, chronic pain and depression can be a two-way street: pain can affect your mood and trigger depression, and depression can decrease your ability to tolerate pain. About 13% of older adults experience this cycle of chronic pain and depression.

But treating the emotional, behavioral, and physical aspects of the chronic pain and depression cycle can improve both daily functioning and quality of life, even when the pain doesn’t go away completely. 

Why chronic pain and depression can feed each other

Chronic pain and depression are “bidirectional,” meaning the relationship runs both ways. Pain that doesn’t go away can lead to depression, and depression can make pain feel more intense and harder to cope with.

Pain is your body’s way of protecting itself from harm. If you touch a hot stove, it hurts. That pain is your body sounding an alarm that something isn’t right. But sometimes, that alarm system continues for months or years, and it can affect your mental health. 

This doesn’t mean the pain is all in your head. Chronic pain is still very real and can directly affect your mental and emotional health. And addressing one of these can help manage the other.

Later-life challenges like managing several health conditions at once, keeping track of multiple medications, losing a spouse, and adjusting to changing levels of independence can add to the mental weight of pain and low mood. Each of these factors can make pain or mood seem more intense.

What the pain-depression cycle can look like in later life

Let’s say you have arthritis in your knees. Walking makes the pain worse, so eventually you stop going out to see family or friends. Now, you sit more, and your knees get stiffer and your low mood increases. You become more tired, sleep poorly, and have less energy. With fewer things to distract you, pain occupies more of your attention and daily life.

It’s understandable to have emotional responses to chronic pain, like frustration, grief, and even anger. It’s a normal human response to grieve the loss of your long neighborhood walks. Some older adults also feel discouraged or demoralized over chronic pain, which often eases when life circumstances get better or you experience small wins along the way. 

Depression, on the other hand, affects more of your life. Some symptoms of depression can be mistaken for pain or aging, such as:

• Feeling anxious
• Flat mood
• Loss of interest in things you used to enjoy
• Low energy or fatigue
• Moving or talking slowly
• Trouble concentrating
• Memory problems
• Difficulty sleeping
• Poor appetite

If you’re an adult child who’s noticed your parent who lives with pain has gradually stopped going out, abandoned their usual routines, become more withdrawn, or seems to have given up, don’t assume the change is simply a result of pain or aging. This could all point to depression, and depression can be treated at any age. 

Ways to interrupt the cycle

Instead of the goal being a pain-free life (because unfortunately, that may not be realistic), consider aiming to restore daily function and gain back a sense of control, so that the pain doesn’t take over your life. 

Don’t wait for pain or mood to get better before returning to your activities — whether that’s more exercise or a hobby you enjoy, like puzzles, or a social activity. It’s okay to start before you feel ready. 

Choose a way you can help yourself, then find a version you can manage today. Some ideas include:

• Ask your doctor about safe movements, such as walking for a few minutes around the house or chair exercises, if a 30-minute walk isn’t possible. 
• Meet a friend for coffee or make a phone call if going out to dinner is too exhausting. 
• Join by livestream or ask a friend to fill you in over the phone afterward if attending church or a social meeting is too much.
• Ask someone to video call you from the sidelines if attending a grandchild’s game is too hard on your knees and back. 

Can therapy help with chronic pain and depression?

Therapy doesn’t replace medical evaluation or treatment for a physical cause of your pain. But it can be a valuable addition to your overall care. 

Success looks different for everyone. For some, the pain can decrease, and for others, the pain can stay similar, but it stops ruining the whole day. You might return to the hobby you gave up, sleep better, reconnect with friends, or just feel more like your old self.  

Types of therapy that can help with chronic pain and depression

There are some specific types of therapy that can be helpful to older adults experiencing chronic pain and depression. 

Cognitive behavioral therapy for chronic pain (CBT-CP) can help identify thoughts, beliefs, and emotions that contribute to how you view pain. CBT-CP teaches you skills to decrease how much pain controls your thoughts and mood. This helps break the cycle and makes chronic pain easier to live with.

Emotional awareness and expression therapy (EAET) is a type of therapy based on the idea that unresolved emotions and trauma can make pain worse. It helps older adults recognize and work through feelings of grief, fear, or anger to decrease the distress on their bodies. Research on veterans found EAET can be more helpful than CBT sometimes. 

Acceptance and commitment therapy (ACT) teaches that pain, fear, grief, and disappointment are part of life, and helps you make room for these difficult experiences while focusing on what gives your life meaning. This flexibility allows you to continue doing the things you care about, even on days when pain is present.  

Why chronic pain and depression both deserve treatment

You don’t necessarily need to choose between “seeing someone for the pain” or “seeing someone for depression.” Instead, you may work with a care team that might include your primary healthcare provider, a pain specialist, a physical therapist, and a mental health therapist. With your permission, they can share information with each other in order to coordinate your care.  

Mental health support can be helpful when:

• Symptoms of depression stick around
• Your pain dictates your daily life
• You withdraw from important relationships or activities
• The fear of pain is causing avoidance
• Coping alone no longer feels doable 

Medicare Part B covers outpatient psychotherapy with eligible providers, including telehealth sessions. For older adults with pain or mobility issues, support can come from the comfort of home. 

How Sailor Health can help when chronic pain starts affecting your mood

Living with chronic pain can wear on more than your body. When pain starts affecting your sleep, independence, relationships, or ability to do the things that make life feel like yours, therapy can help you work through the emotional side of that experience and find ways to cope without letting pain take over your entire day.

Sailor Health makes that support easier to access from home. Therapy sessions are available by video or phone call (including landlines) so pain, fatigue, or mobility issues don’t have to become another barrier to getting help.

Our therapists understand the mental health challenges that often come with later life, including chronic health conditions, loss of independence, grief, and changes in daily routine. All Sailor Health providers accept Medicare, and most of our Medicare patients have a $0 copay. Getting started is simple, and you may be able to meet with a therapist in as little as 24 hours.

You may not be able to eliminate chronic pain completely, but you can get support for the depression, frustration, and isolation that sometimes grow around it. If pain has started changing how you feel or how you live, reaching out for support is one way to begin taking some of that ground back. Get started today, and we’ll help you take the first step.

Chronic pain and depression FAQ

Can chronic pain actually cause depression?

Chronic pain can cause depression, especially when pain makes it difficult to sleep, remain independent, or have a social life or activities that once brought you joy. On the other hand, depression can make chronic pain feel more difficult to live with. 

How can you tell depression from an emotional reaction to living with chronic pain?

Frustration, sadness, and grief over how pain has affected your life are all normal human responses. Small wins or having “good days” can make this pain easier to live with. Depression affects a larger part of your life. Some signs of depression can include loss of interest, low mood, and feelings of hopelessness. 

What symptoms can chronic pain and depression have in common?

Both chronic pain and depression can cause trouble sleeping, fatigue, memory issues, difficulty concentrating, or poor appetite. 

Why does inactivity make both chronic pain and depression harder to manage?

When you have chronic pain, you might start moving less, which can cause muscles and joints to become stiff. Over time, the pain can get worse. When you withdraw from activities, there are fewer opportunities for socializing, which can worsen your mood. Focus on gentle and gradual activity that your doctor says is safe to help you move more and connect with others. 

References

1. Cleveland Clinic. (2024). Chronic Pain. https://my.clevelandclinic.org/health/diseases/4798-chronic-pain
2. Zis, P., Daskalaki, A., Bountouni, I., Sykioti, P., Varrassi, G., & Paladini, A. (2017). Depression and chronic pain in the elderly: Links and management challenges. Clinical Interventions in Aging, 12, 709. doi:10.2147/CIA.S113576. https://pmc.ncbi.nlm.nih.gov/articles/PMC5407450/
3. Wang G, Huang S, Sun N, Gui W and Wang Y. (2025). Depression and its influencing factors among older adults with chronic pain in China: an empirical analysis based on CHARLS data. Front. Public Health 13:1547860. doi: 10.3389/fpubh.2025.1547860. https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1547860/
4. National Institute on Aging. Depression and Older Adults. https://www.nia.nih.gov/health/mental-and-emotional-health/depression-and-older-adults
5. University of California San Francisco. Cognitive Behavioral Therapy (CBT). https://pain.ucsf.edu/nonpharmacological-pain-management/cognitive-behavioral-therapy-cbt
6. Yarns BC, Jackson NJ, Alas A, Melrose RJ, Lumley MA, Sultzer DL. Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(6):e2415842. doi:10.1001/jamanetworkopen.2024.15842. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2819961
7. Martinez-Calderon, J., García-Muñoz, C., Rufo-Barbero, C., Matias-Soto, J., & Cano-García, F. J. (2024). Acceptance and Commitment Therapy for Chronic Pain: An Overview of Systematic Reviews with Meta-Analysis of Randomized Clinical Trials. The Journal of Pain, 25(3), 595-617. doi:10.1016/j.jpain.2023.09.013. https://www.sciencedirect.com/science/article/pii/S1526590023005394