What causes pain in the body? When is that pain considered chronic? And how do you know when chronic pain becomes too much?
Many things cause pain in the body – injuries, infections, even non-physical events like traumas. Often that pain can be treated or managed effectively so that the issue resolves well (specifically with physical pain). But other times that pain can linger and worsen, impacting our lives in new ways; some ways you might not even recognize at first.
This long lasting pain is what we call chronic pain. But chronic pain isn’t just about physical discomfort, it is a complex and multifaceted issue. Chronic pain impacts cognitive function and mental health in profound ways for millions of people worldwide. These are the unseen affects of chronic pain.
Many conventional interventions seek simply to reduce or relieve the physical pain. And while that can be helpful, this approach leaves a significant amount of residual damage unattended.
Functional psychiatry seeks to uncover and address the root causes of mental and physical health conditions offering a unique lens for understanding how chronic pain influences the brain, mood, and cognition. In this article, we will explore how chronic pain affects cognitive abilities and mood disorders, while also discussing holistic, functional approaches to treatment.
Understanding Chronic Pain: More Than Just Physical Discomfort
Chronic pain is defined as pain that lasts longer than three months, often persisting after the injury or condition causing it has healed. According to the CDC, approximately 20% of the global population lives with chronic pain, making it one of the leading causes of disability worldwide. In the United States, 50 million adults report living with chronic pain, with 19.6 million of those experiencing high-impact pain that interferes with daily activities. But chronic pain doesn’t just disrupt physical function; it takes a toll on cognitive performance and mental health.
How Chronic Pain Impacts Cognitive Function
Brain Fog: The Cognitive Burden of Chronic Pain
Chronic pain significantly affects cognitive abilities, often causing what many describe as “brain fog.” People with chronic pain commonly report difficulties with memory, attention, and executive function, which can make everyday tasks seem overwhelming.
1. Attention and Concentration: Studies indicate that chronic pain patients experience a decline in attentional capacity. A meta-analysis by Berryman et al. (2014) revealed that individuals with chronic pain struggle with tasks requiring sustained focus.
2. Memory Impairment: The hippocampus, the brain’s memory center, is adversely affected in chronic pain conditions. Research by Rodriguez-Raecke et al. (2011) showed significant hippocampal atrophy in chronic pain patients, correlating with worsened memory performance.
3. Executive Function Deficits: Chronic pain hampers the ability to make decisions, plan, and adapt to new information. Reduced cognitive flexibility is often observed, making it harder to manage complex situations and stress.
Chronic Pain and Mood Disorders: The Emotional Toll
Chronic pain not only impacts cognition but also poses a significant risk for mood disorders like depression and anxiety. According to the American Psychological Association (APA), between 30-50% of individuals with chronic pain also suffer from depression. Moreover, chronic pain can amplify anxiety symptoms, creating a vicious cycle where mental health issues worsen pain perception, and vice versa.
Depression: A Common Companion to Chronic Pain
Chronic pain leads to a persistent activation of the brain’s stress response, elevating cortisol levels and increasing vulnerability to depression. The Global Burden of Disease (GBD) study found that individuals with chronic pain are three times more likely to develop depression. Neuroimaging studies highlight changes in the default mode network (DMN), a brain region implicated in both chronic pain and depression, suggesting a shared neurological pathway.
Anxiety and Hyperalgesia
Chronic pain and anxiety often go hand in hand. In fact, chronic pain sufferers are at higher risk of experiencing generalized anxiety disorder (GAD). The heightened anxiety amplifies pain perception through a phenomenon known as hyperalgesia, or increased sensitivity to pain, exacerbating the overall experience of discomfort.
Inflammation: The Link Between Pain, Cognition, and Mood
Functional psychiatry emphasizes the role of inflammation in linking chronic pain to cognitive and mood disturbances. Chronic pain conditions, such as fibromyalgia, arthritis, and neuropathy, are frequently associated with low-grade chronic inflammation.
- Cytokine Imbalance: Elevated levels of inflammatory markers like IL-6 and TNF-alpha have been shown to disrupt neuroplasticity, leading to both cognitive decline and depressive symptoms. A key study in Biological Psychiatry (2015) demonstrated that higher inflammatory markers predicted cognitive decline in chronic pain sufferers.
- HPA Axis Activation: Chronic stress and pain activate the hypothalamic-pituitary-adrenal (HPA) axis, resulting in sustained cortisol release. This not only exacerbates pain but also leads to cognitive impairments and mood dysregulation, perpetuating the cycle of chronic pain.
Functional Psychiatry’s Holistic Approach to Mental Health and Underlying Chronic Pain
Rather than treating chronic pain, cognitive impairment, and mood disorders as separate entities, functional psychiatry adopts a holistic, root-cause approach. Below, we outline key strategies employed within functional psychiatry to address the interconnected issues of chronic pain, cognitive function, and mood disorders.
1. Anti-Inflammatory Nutrition
An anti-inflammatory diet is foundational to reducing chronic pain and supporting brain health. Nutrient-dense diets, rich in omega-3 fatty acids, antioxidants, and phytonutrients, have been shown to lower inflammation and improve cognitive clarity.
A 2019 study in Pain Medicine found that individuals following a Mediterranean diet—rich in anti-inflammatory foods—reported reductions in both pain and cognitive “fog.”
Incorporate anti-inflammatory foods like fatty fish, leafy greens, berries, and turmeric into your daily diet.
2. Mind-Body Therapies
Techniques like mindfulness-based stress reduction (MBSR) and cognitive-behavioral therapy (CBT) are effective at alleviating both the physical and emotional burden of chronic pain.
Consider enrolling in an MBSR program or working with a therapist trained in CBT for chronic pain management.
A meta-analysis published in JAMA Internal Medicine (2016) found that MBSR not only reduces the severity of pain but also mitigates depression and anxiety.
3. Nutritional Supplementation
Functional psychiatrists frequently recommend supplements to target inflammation and improve brain function. Key supplements include:
- Magnesium: Known for its role in reducing pain and depression symptoms.
- Curcumin: A powerful anti-inflammatory compound that combats neuroinflammation.
- N-Acetylcysteine (NAC): An antioxidant that supports brain health and cognitive function.
Consult with a functional medicine practitioner to determine the most appropriate supplements for your individual needs.
4. Exercise and Movement Therapy
Physical activity is a cornerstone of functional treatment for chronic pain. Exercise has been shown to lower pain perception, improve mood, and support cognitive health by boosting brain-derived neurotrophic factor (BDNF).
A 2015 study in The Journal of Pain found that chronic pain patients who engaged in regular physical activity experienced improved cognitive function and reduced depression.
Start with low-impact exercises like walking, swimming, or gentle yoga, and gradually increase intensity as tolerated.
Breaking the Cycle of Pain
Chronic pain is not just a physical ailment—it is a condition that deeply affects cognitive function and mood. By adopting a functional psychiatry approach that addresses underlying inflammation, stress responses, and lifestyle factors, individuals can experience not only pain relief but also enhanced cognitive and emotional well-being.
If you’re struggling with chronic pain and its effects on your mood and cognitive function, consider consulting a functional psychiatry practitioner. They can help you develop a personalized, holistic plan that addresses the root causes of your symptoms and supports overall brain health and emotional resilience.