Pain that never really goes away wears you down: it disturbs sleep, limits work and chips away at your mood. Low mood, in turn, makes pain harder to bear. Here’s how to break the cycle.
Chronic pain and depression often go together. About four in ten adults with chronic pain have significant depressive symptoms, and each makes the other worse. Your pain is real, and treating sleep, activity and mood alongside it can improve daily life.
What counts as chronic pain
Pain is chronic when it lasts, or keeps coming back, for more than three months. Sometimes it comes from a condition such as arthritis or sickle cell. Sometimes, as with much long-term back pain, there’s no single clear cause, and doctors now treat the pain as a condition in its own right.
Normal scans don’t mean the pain isn’t real. International pain experts say a person’s report of pain should always be respected.
Chronic pain in Nigeria
Back pain is especially common. Nigerian studies make up almost half of all African research on low back pain, and a household survey across 21 states found chronic back or neck pain in about one in six adults and one in three people aged 60 or over. It went hand in hand with mood problems.
Nigeria’s own national pain guideline says pain is “grossly under-treated” in the country. Specialist pain clinics are few, and the ones described in research are in teaching hospitals.
The pain and depression cycle
- Pain and mood feed each other. In a year-long study, changes in pain predicted later changes in depression, and changes in depression predicted later changes in pain.
- Poor sleep makes pain worse. Sleep problems are one of the strongest predictors of new or worsening pain.
- Fear of movement. Avoiding activity because it might hurt leads to weaker muscles and more disability over time.
- Losing work, income and social life adds to low mood.
Getting help for both
- Talking therapy. Cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) help people cope and function better with pain. Their effect on pain itself is small to moderate. Therapy doesn’t mean the pain is imagined: it works on the stress, fear and low mood that make pain harder.
- Movement. Supervised or group exercise and physiotherapy bring modest gains in function, with few harms. Start small and build up.
- Pacing. Spreading activity through the day, instead of overdoing it on good days and crashing after, helps with tiredness and stiffness, though not with the pain itself.
- Sleep. Treat sleep as part of pain care. Our guide to sleeping better for your mental health can help.
- Medicines. Some antidepressants are used for chronic pain, even without depression. A doctor can talk you through the options for your kind of pain.
You can find a therapist who works with sleep and body symptoms, by video, voice or chat. Read our overview of chronic illness and depression, or more about depression.
Be careful with painkillers
When pain goes on and care is hard to reach, some people turn to painkillers bought without a prescription. In one Benin City study, most people with sickle cell who were misusing a strong painkiller injection had bought it from pharmacies or patent medicine stores without a prescription, and some developed serious complications. Across Africa, pain relief is one of several reasons people use tramadol without a prescription.
Strong painkillers need a doctor’s prescription and regular review. Our explainer on whether tramadol and codeine are banned in Nigeria covers the law, and our piece on sickle cell and mental health covers pain crises.
If you’re having thoughts of ending your life, call Safe Place Nigeria on 0800 800 2000, free and open 24 hours. If you’re in immediate danger, call 112, or 767 in Lagos.
Suggested read: Binge Eating Disorder: Signs and Help
Frequently asked questions
Can chronic pain cause depression?
Chronic pain and depression are closely linked, and each can make the other worse. About four in ten adults with chronic pain have significant depressive symptoms.
Is my pain all in my head?
No. Pain is real even when scans are normal. Stress, sleep and mood can make it worse, which is why treating them helps, but that doesn’t mean you’re imagining it.
Does therapy help chronic pain?
Yes, mostly by helping you cope and function better. CBT and ACT reduce distress and disability, and they have a smaller effect on pain itself.
Can antidepressants help with pain?
Some antidepressants are used for chronic pain, even when a person isn’t depressed. A doctor can advise whether one might suit you.
Is it safe to use tramadol for chronic pain?
Only as prescribed by a doctor who reviews it regularly. Tramadol is prescription-only in Nigeria, and using it without a prescription carries serious risks.
This article is awaiting clinical review. It’s based on published research and health guidelines, and we’ll update it once a clinician has reviewed it.
