Strong connection between chronic pain and mental health issues

By Tony Poland, LegalMatters Staff • The link between chronic pain and mental health issues is often marginalized or ignored, especially when it comes to long-term disability (LTD) claims, says Toronto and Markham-area disability lawyer Rupa Karyampudi. 

Karyampudi, a partner at MK Disability Lawyers, points to a Harvard Medical School study that reports the “overlap of anxiety, depression, and pain is particularly evident in chronic and sometimes disabling pain syndromes such as fibromyalgia, irritable bowel syndrome, low back pain, headaches, and nerve pain.” 

“Research shows pain shares the same biological mechanisms associated with anxiety and depression,” she tells LegalMattersCanada.ca. “Basically, the same neural pathways or the same type of neural mechanisms are involved for both pain and depression and anxiety. And it can be bi-directional because mental health and chronic pain really do feed off each other.

Headaches prominent in people suffering from depression

“An LTD claimant can start off with a mental health issue that can turn into chronic pain,” Karyampudi adds. “There can be physical manifestations associated with mental health issues, such as muscle aches. For instance, chronic headaches are quite prominent in people suffering from depression and anxiety. And studies have shown that in some of these cases, depression can go unrecognized, undiagnosed and, unfortunately untreated.” 

Nov. 6 to 12 was National Pain Awareness Week, she noted. According to Pain Canada, one in five Canadians live with chronic pain.

Mental Health America (MHA) reports that acute pain typically lasts three to six months. Pain lasting beyond that is considered chronic. Sufferers are four times more likely to have depression or anxiety than those who are pain-free. MHA reports chronic pain:

• is one of the most common reasons that adults seek medical care; 
• is linked to activity limitations, dependence on opioids and reduced quality of life; 
• causes chronic stress that is known to change the levels of stress hormones and neurochemicals found within the brain and nervous system; and
• can cause sleep disturbances, fatigue, concentration difficulties, decreased appetite and mood changes.

Chronic stress can be the result, according to MHA, and is known “to change the levels of stress hormones and neurochemicals found within the brain and nervous system; these can affect your mood, thinking and behaviour. Disrupting your body’s balance of these chemicals can bring on depression in some people.”

A psychiatric disorder could be overlooked

Karyampudi says the Harvard study shows treatment can be challenging when pain is accompanied by anxiety or depression because a psychiatric disorder could be overlooked since the focus is on pain relief.

Those with chronic pain already start off at a disadvantage because they suffer from what is considered an invisible condition that can be difficult to diagnose, she says.

“They can feel extremely isolated. These people often struggle to be believed not just by insurance companies, but by friends and family. They tend to feel stigmatized,” Karyampudi says. “They can feel shame in not being able to work or contribute which adds to the mental health aspect.”

• Research shows the benefit of psychedelic drug therapy
• Gender bias in the medical profession adding to women’s pain
• The challenge of representing clients who have PTSD

If people are unable to find relief from the pain, they may experience anxiety and depression, she says, adding that their issues can become more deep-rooted if they are dealing with a denial or termination of their LTD benefits.

Karyampudi says when it comes to chronic pain claims, insurance companies have standard guidelines setting out recovery times for different illnesses. Denials often cite how chronic pain is based on self-reports by claimants, but this may not necessarily tell the entire story, she says.

“Credibility is a big component of proving these claims. Insurance companies often believe a claimant is exaggerating the pain,” says Karyampudi. “They say there is no objective medical evidence based on the self-reports. 

‘They need to correct their analysis’

“That is a very outdated way of looking at these conditions. They need to correct their analysis when it comes to these types of claims and carefully assess the credibility of the claimant along with the medical records and the treating doctor’s assessment.”

There should also be more of an understanding of post-traumatic stress disorder (PTSD) and the link to chronic pain, she says. 

The “mind-body connect is so often mysterious,” Karyampudi explains, and diagnosing PTSD can be difficult, which can make claiming long-term disability benefits a challenge.

She says one of the misconceptions about PTSD is that someone has to suffer something catastrophic to trigger it, but that’s always the case. 

For example, Karyampudi says she represented a client who was sexually assaulted at a young age. She was able to put the traumatic event behind her and was a functional, active person. Years later she was involved in a minor traffic accident. Although her injuries were incidental, she eventually suffered from chronic pain, anxiety, and PTSD she says.

Sought help from a holistic health practitioner

“She sought help from a holistic health practitioner and learned the human body doesn’t always know the difference between physical and emotional trauma,” says Karyampudi. “She was traumatized when she was younger and again with the car accident and her body responded. Insurance companies don’t often understand that. An incident may appear minor but when you understand a person’s history of trauma, it makes a lot of sense that they could suffer from chronic pain.”

When it comes to LTD claims for chronic pain, she says more emphasis should be placed on the claimant’s treatment history and not just their functionality. 

Karyampudi says in her experience, if someone is in constant pain “they will do what needs to be done.”

“The clients I represent have been willing to try everything because they just want some relief,” she says. “That includes traditional treatment. But there are also alternative treatments to treat more difficult conditions. It could be yoga or mindfulness meditation, which has been scientifically proven to help. Insurers need to be more accepting of those types of different treatments because chronic pain is such a complicated issue that the traditional medical community has not really solved. 

Expand the assessment for determining functionality

When assessing functionality, LTD claimants should not only be judged on what they can do but also on “what prevents them from working,” she says.

“This evaluation can be easier where there is a physical aspect of the job,” Karyampudi says. “But when it comes to a desk job, the claimant should ensure their medical reports address how the pain prevents them from focusing cognitively. This assessment should be comprehensive.”

She says claimants must consider the mental health fallout of chronic pain and seek the appropriate care. 

“They should be getting treatment concurrently for both the physical and psychological conditions and ensure they are highlighting the mental health issues and physical pain when applying for benefits,” says Karyampudi. “It is essential they get their doctor’s support and ask for referrals to a specialist who can treat them.

“The claimant should seek pain clinics that take a multidisciplinary approach to address the physical pain and resolve the mental health issues.” 

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