It may not be obvious on the surface, but the way we feel mentally impacts how we feel physically. Stress and depression can lead to several physical ailments. A sick body is something you can, by-and-large, observe and identify confidently. We’ve all felt ill at some point in our lives, and we know when things look and feel unwell – even if we can’t always put a name to what is ailing our bodies. We approach doctors with our aches and pains, infections, faintness, disturbing sensations and other forms of physical turmoil and trust them to know what to do with our bodies. Their business is the body: physicians guide us in how to heal and maintain these very concrete parts of ourselves.
A study conducted by Johnson & Johnson Health and Wellness Solutions (JJHWS) demonstrates, however, that the body and its physical sensations never stand alone. As psychologists and neurologists have shown, there is a deep, complex connection between our mental world and physical form. JJHWS’s research explores how patients’ experiences of stress and depression influence how they experience their medical conditions and perceive their well-being.
Published in the June 2016 issue of Quality of Life Research, their findings suggest that “psychological distress impacts a person’s quality of life as much, or more, than having a chronic condition.” Despite how previous studies have shown that addressing psychological stress improves patients’ chronic medical conditions, the psychological well-being of patients is often still neglected by physicians. Recognizing this, the researchers emphasize the necessity of caregivers and doctors of all kinds to address the mental health needs of their patients, even if ostensibly they are only treating them for a medical condition.
Stress and Depression Impact Well-Being As Much As Chronic Pain
Conducted between May 2005 and January 2012, the JJHWS study focused on the data from 1,424,430 participants. Some had no chronic health conditions, while others had chronic illnesses such as diabetes conditions, cardiovascular diseases, chronic pain and cancer. In their analysis, the researchers measured psychological distress by patients’ perceived levels of stress (i.e. how overwhelmed or frustrated they felt) and rated symptoms of depression (such as how sad, worthless or fatigued they felt, and if they contemplated suicide).
Out of all the chronic health conditions observed, those with chronic pain across all ages were the most affected by experiences of stress and depression. That is, their psychological distress was just as harmful to their sense of well-being as the physical pain itself and was associated to an increased difficulty in attending to regular daily activities. In this sense, how we feel and interpret our life situations (such as chronic pain) can significantly influence our experiences of pain and disease.
The Psychological Distress of Chronic Pain Overwhelms Many
That those with chronic pain were the most impacted by stress and depressive feelings is, although significant, not entirely surprising. In this day and age, pain is an all-too common reality among many Americans
- It’s the most common reason that people visit doctors, writes the National Pharmaceutical Council.
- According to a 2015 report by the National Center for Complementary and Integrative Health (NCCIH), approximately 25.3 million adults (11.2 percent) experience chronic pain – “that is, they had pain every day for the preceding 3 months,” or longer.
- The NCCIH adds that nearly 40 million adults (17.6 percent) experience severe levels of pain, and that those struggling with severe pain tend to have worse health.
What the JJHWS study helps to highlight, therefore, is how many of these millions suffering from severe and chronic and pain are particularly vulnerable to the psychological distress that accompanies their conditions. When unable to manage their stress, this can negatively color their outlook on life and even make them neglect taking care of themselves.
“This is problematic because failing to follow screening recommendations or medication regimes, as well as not seeking treatment when necessary, may contribute to worsening health,” said Len Greer, president of JJHWS, in a press release.
Taking it Personally
All this information underscores how having a physical illness is more than being able to point to ‘where it hurts.’ Being sick in any way comes with its share of emotional distress. Especially when dealing with an illness for the first time, contracting a particularly severe case of a disease or developing a continual condition like chronic pain, a palpable sense of fear is almost inextricable to the physical symptoms experienced. What’s wrong with me? What’s happening? Is this serious? Will I get better? These questions flood our minds and shake us to the core as we attempt to cope with our altered bodies – and changing realities.
That is to say that when a disease or injury hits us, it is a very personal experience. This is because the body is a fundamental part of who we are, just as is our psychological selves. How we think and feel (so-called activities of the mind) and how we perceive the world (sensory experiences of the body and brain) are largely inseparable from one another, try as we might to cleanly organize them as wholly distinct.
When something in our biological nuts and bolts isn’t functioning the way it should, it’s not just a mechanical malfunction: it’s also a blow very intimate to our sense of who we are. This is especially the case for those suffering from chronic pain. Often, you can’t do the things you used to, which makes it’s hard not to feel helpless to your pain and frustrated at the situation at hand – in other words, your life. Over an extended period, the impact of a chronic medical condition can be so deep that it has even been associated with personality changes.
Chronic Pain, Prescription Medication and the Opioid Epidemic
Clearly, psychological distress is a powerful force that can alter your orientation toward the world, the way you relate to people and the type of action you take in maintaining your well-being. As the JJHWS study suggests, this mental and emotional stress is particularly severe among the many Americans with chronic pain conditions.
Yet pervasive as this problem is throughout much of the country, chronic pain has also become nearly synonymous to the controversy surrounding prescription pain medications. After all, with few therapeutic alternatives to treat chronic pain, opioid analgesics are what doctors have tended to prescribe for this increasingly prevalent condition. With an astounding quarter of a billion of opioid painkillers prescribed in 2013, the Centers for Disease Control and Prevention (CDC) noted that “this is enough for every American adult to have their own bottle of pills.”
Simultaneously, addiction to opioids has been on the rise. Approximately 2.5 million adults were reported to have been addicted in 2014, and there has also been an alarming increase in cases of overdoses from opioids.
According to Dr. Nora Volkow, director of the National Institute on Drug Abuse, and Thomas McLellan, co-founder of the Treatment Research Institute, a significant portion of these cases has been linked to medical opioids prescribed to patients and later diverted (i.e. obtained and used illegally by others). They write that “more than a third (37%) of the 44,000 drug-overdose deaths that were reported in 2013 […] were attributable to pharmaceutical opioids; heroin accounted for an additional 19%.”
Among Risk Factors, Stress and Depression Factor in Significantly
While the scope of the opioid problem is massive and continues to grow, what often gets lost in this controversy is how stress and depression – especially prolonged experiences of them – tend to underlie abuse of and addiction to pharmaceutical opioids.
Granted, some of the primary risk factors for prescription opioid abuse and addiction listed by the CDC clearly relate to the how freely these medications have been prescribed by physicians. By “obtaining overlapping prescriptions from multiple providers and pharmacies” and “taking high daily dosages of prescription opioid pain relievers,”8 this unregulated and high intake of the drug no doubt raises the risk of becoming tolerant to the painkiller’s effects and physically dependent on it. When you need an increasing amount of the opioid to reduce the pain you’re experiencing over an extended period of time, the possibility of overdosing also increases. 
Though these risk factors provide insight into the methods of obtaining and administering drugs that may spell out danger for patients, they leave out important contextual information – namely, what experiences might influence individuals to abuse pharmaceutical opioids in the first place. This, again, brings us back to stress. Significantly, the CDC includes “having a mental illness or a history of alcohol or other substance abuse” and “living in rural areas and having low income” as factors that raise the risk for prescription opioid abuse and overdose.8
Much can be said about both mental illness and economic insecurity, but what ties them together is the prolonged psychological distress that often accompanies both experiences. As many researchers, including the Founding Director of the Yale Stress Center Rajita Sinha, have pointed out, chronic and intense states of distress are often at the center of substance abuse and addiction.
The Stress of Chronic Pain May Shed Light on Prescription Opioid Addiction
Although the JJHWS study didn’t directly tackle the dilemma of opioid abuse and addiction, the mental and emotional distress chronic pain patients reported further helps affirm this important connection between severe stress and substance issues. In other words, it might not be the pain alone that encourages opioid misuse among chronic pain patients, but the stress associated to it that isn’t as often addressed by physicians.
Again, developing a condition like chronic pain is a trying experience that can shake the foundations of who you are. This tumultuous medley of emotions – feelings of confusion, fear, disbelief, melancholia, anger and helplessness – that coincides with chronic pain and disability is difficult to cope with at the best of times. Add this to any preexisting life stressors, such as living with a mental illness or economic instability, and the psychological distress could be overwhelming.
Altogether, it seems likely that patients who excessively rely on prescription opioids are at once trying to treat their physical and emotional pain. Opioids’ analgesic properties may reduce patients’ perception of pain – but it’s worth asking: to what extent is this pain psychological? Given how intimately psychological health is intertwined with physical wellbeing, it’s hard to say and is perhaps impossible to measure. However, it’s critical to remember that it’s there: emotional and mental distress feeds into the experience of bodily pain and how one copes with it. The sense of euphoria often experienced when taking prescribed opioids is also a likely incentive for patients attempting to dampen the negative thoughts and emotions associated to their physical illness.
“If there is a cause of addiction for patients with chronic pain,” Sonya Huber, Associate Professor of English at Fairfield University and chronic pain patient herself, writes, “it is the desperation induced by searing pain itself, combined with isolation, lack of support, and the resulting deep depression and anger that come with seeing one’s life slip away.”
Compassionate Addiction and Mental Health Treatment
All this information underscores how important addressing the mental health of any patient is to helping them cope with their conditions. Regardless of how one develops an addiction to drugs like prescription opioids – whether they’re obtained from a physician or off the streets – severe stress and depression typically factor into the substance use problem.
At Unity Behavioral Health, we treat you as an individual – not merely as a body to cure. Our addiction experts understand how psychological distress can impact patients’ perceptions of their lives and fuel a dangerous relationship to drugs. We work tirelessly to improve both your psychological and physical well-being through our programs.