Chronic pain can limit your everyday activities and make it hard to work. It can also affect how involved you are with friends and family members. Co-workers, family, and friends may have to do more than their usual share when you cannot do the things you normally do. You may feel isolated from the people around you.

Unwanted feelings, such as frustration, resentment, despair, and stress, are often a result. These feelings and emotions can worsen your back pain.

The mind and body work together, they cannot be separated. The way your mind controls thoughts and attitudes affects the way your body experiences pain.

Pain itself, and the fear of pain, can cause you to avoid both physical and social activities. Over time this leads to less physical strength and weaker social relationships. It can also cause further lack of functioning and pain.

Stress has both physical and emotional effects on our bodies. It can raise our blood pressure, increase our breathing rate and heart rate, and cause muscle tension. These things are hard on the body. They can lead to fatigue, sleeping problems, and changes in appetite.

If you feel tired but have a hard time falling asleep, you may have stress-related fatigue. Or you may notice that you can fall asleep, but you have a hard time staying asleep. These are all reasons to talk with your health care provider about the physical effects stress is having on your body.

Stress can also lead to anxiety, depression, a dependence on others, or an unhealthy dependence on medicines.

Depression is very common among people who have chronic pain. Pain can cause depression or make existing depression worse. Depression can also make existing pain worse.

If you or your family members have or have had depression, there is a greater risk that you could develop depression from your chronic pain. Seek help at the first sign of depression. Even mild depression can affect how well you can manage your pain and stay active.

Signs of depression include:

• Frequent feelings of sadness, anger, worthlessness, or hopelessness
• Less energy
• Less interest in activities, or less pleasure from your activities
• Difficulty falling asleep or staying asleep
• Decreased or increased appetite that causes major weight loss or weight gain
• Difficulty concentrating
• Thoughts about death, suicide, or hurting yourself

A common type of therapy for people with chronic pain is cognitive behavioral therapy. Seeking help from a therapist can help you:

• Learn how to have positive thoughts instead of negative ones
• Reduce your fear of pain
• Allow you to accept and deal with the pain better
• Make important relationships stronger
• Develop a sense of freedom from your pain
• Engage in activities that you enjoy doing

If your pain is the result of an accident or emotional trauma, your provider can assess you for post-traumatic stress disorder (PTSD). Many people with PTSD are not able to deal with their back pain until they deal with the emotional stress that their accidents or traumas caused.

If you think you may be depressed, or if you are having a hard time controlling your emotions, talk with your provider. Get help sooner rather than later. Your provider may also suggest medicines to help with your feelings of stress or sadness.

If you or someone you know is thinking about suicide, call or text 988 or chat 988lifeline.org. You can also call 1-800-273-8255 (1-800-273-TALK). The 988 Suicide and Crisis Lifeline provides free and confidential support 24/7, anytime day or night.

You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.

If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.

Cohen SP. Pain. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 26.

Schubiner H. Emotional awareness for pain. In: Rakel D, Minichiello VJ, eds. Integrative Medicine. 5th ed. Philadelphia, PA: Elsevier; 2023:chap 99.

Soble JR, Schulze ET, Resch ZJ, Critchfield EA, O'Rourke JJF. Psychological assessment and intervention in rehabilitation. In: Cifu DX, ed. Braddom's Physical Medicine & Rehabilitation. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 4.