Mood and Chronic Pain: Where Pain, Depression, and Anxiety Come Together In the Brain

Man holding head against sunset

By Dr. Peter Abaci

The experience of pain usually carries with it a strong emotional component. The more intense the pain or the longer the pain lasts, the more dramatic the emotional changes seem to be. Part of what makes more persistent or chronic pain so difficult to deal with is the burden or heaviness of dealing with these significant mood shifts. Such changes not only affect how we feel inside but heavily influence how we interact with others, including family members, loved ones, or co-workers. In fact, patients often confide to me that they don’t feel like the same person that they once were. Unfortunately, mood changes linked to pain can be so disruptive that it can lead to severe psychological problems, broken families, and job loss.

The most common mood changes associated with persistent pain include:

  • Depression- Depression is a feeling of deep sadness. Other feelings associated with depression can include low energy, insomnia, and a loss of interest in pleasurable activities.
  • Anxiety- Feelings of intense worry and distress are hallmarks of anxiety and can be overwhelming to the point of not being able to engage in routine daily activities.
  • Anger- Anytime a person feels threatened or overstressed by a situation, they can lash out with anger or aggressive behaviors. For many, being in pain shifts their threat response mechanisms so that they become uncharacteristically angered about things that may not have bothered them before.
  • Fear- While fear can be an innate protective mechanism to avoid harm, the experience of ongoing pain can lead to pervasive feelings of pain associated with high levels of distress and behavior changes leading to the harmful avoidance of many daily activities or social interactions.

One of the key drivers in the brain of these significant mood changes is an area known as the amygdala. Amygdala comes from the Latin word for almond because of its shape and contour inside the brain. The amygdala is a key center for emotional learning and behavior, and it turns out that it is heavily involved in the processing of pain that goes on in the brain. Pain has a big impact on what goes on in the amygdala, and the longer the pain continues, the bigger the effects will be. In fact, research suggests that there are differences in what happens in the amygdala during acute pain episodes as compared to more chronic pain experiences.

The amygdala interacts with many parts of the brain and is considered a key part of the processing that goes on with chronic pain states. Emotional shifts toward things like anxiety, depression, and bouts of anger are heavily related to the changes and reactions that take place within the amygdala. This makes strategies that can help remold what is going on in emotional brain centers vital to better pain management. Channeling different inputs to parts of the brain like the amygdala through modalities like exercise, relaxation training, meditation, cognitive-behavioral therapy, and improved socialization all have the potential of remodeling the amygdala, resulting in potentially positive mood changes. 

If your pain has got you down and you don’t feel like your old self anymore, talk to your doctor about getting help as an important step toward better pain management. 



Image courtesy of Stuart Miles at