Chronic pain and depression often go together, and each can make the other worse. According to a 2025 systematic review and meta-analysis published in JAMA Network Open, approximately 4 in 10 adults with chronic pain experience clinically significant symptoms of depression. These figures include people with significant symptoms, not just those with a formal diagnosis.
Your pain is real, and treating mood, sleep, and pain together usually works better than treating any one alone.
Most people with chronic pain do not develop depression, so low mood is not an automatic part of living with pain. But when it does happen, it deserves its own care. Here is what to know:
- The link runs both ways: pain can lower mood, and low mood can make pain feel harder to bear.
- Poor sleep and stress can turn up pain sensitivity.
- Some treatments help pain, mood or both, but the evidence varies, and some effects are small.
- According to Services Australia, since July 2025, GPs use a new Medicare plan to organise allied health support.
- Joined-up care (GP, psychology, physiotherapy and psychiatry) gives the best chance of breaking the cycle.
How Common Are Chronic Pain and Depression Together?
A 2025 study published in ScienceDirect found that 36.7% to 40.7% of people with chronic pain meet the diagnostic criteria for major depressive disorder, compared with approximately 7% to 8% of adults in the general population.
Chronic pain persists or recurs for more than three months, sometimes longer than expected for normal tissue healing. It is also common in Australia. The Australian Institute of Health and Welfare (AIHW), based on its 2016 data, reported that about 1 in 5 Australians aged 45 and over live with chronic pain (an estimated 1.6 million people, based on 2016 data).
AIHW data also showed a 67% increase in GP encounters involving the management of chronic back pain and unspecified chronic pain between 2006–07 and 2015–16.
These figures describe how often the two occur together. They cannot show which came first for any one person.
Fibromyalgia and Depression
A groundbreaking 2025 global review by Johns Hopkins researchers found that fibromyalgia patients experience the highest rates of mental health struggles, with depression symptoms affecting roughly 54% and anxiety symptoms impacting 55% of those studied.
Fibromyalgia is commonly associated with nociplastic pain, which occurs when changes in how the nervous system processes pain contribute to ongoing symptoms. It can occur without clear evidence of ongoing tissue damage, although other pain mechanisms may also be involved. The pain is no less real.
Can Chronic Pain Cause Depression?
Yes, chronic pain can raise the risk of depression, although it does not cause it in everyone. Ongoing pain can wear down sleep, work, hobbies, and relationships, and it can leave you feeling disbelieved. Over time, these losses can build into persistent low mood.
Common contributors include:
- constant pain and exhaustion
- losing work, sport or hobbies
- poor or broken sleep
- isolation from friends and family
- uncertainty about the future
- feeling that others do not believe you
If low mood lasts most days for two weeks or more, it helps to understand the symptoms and treatment of depression.
Chronic Pain and Anxiety
Anxiety is just as common as depression in people with chronic pain. It can look like fear of pain or movement, worry about the future, or constant checking of symptoms. Anxiety can also make pain feel stronger because a tense, alert body is more sensitive to pain signals. Worry about pain is understandable, and there are proven ways of managing anxiety when it becomes persistent.
Why Does Depression Make Pain Worse?
Depression can affect how the brain processes pain, making some people more sensitive to painful sensations. It can also reduce energy, disrupt sleep, and make everyday activities feel harder. As activity decreases, stiffness and reduced physical conditioning may worsen the problem.
That is the cycle: pain lowers mood, low mood reduces activity, and reduced activity can add to pain. The good news is that changing anything in the cycle can help.
Sleep and Pain: The Third Part of the Cycle
Pain often disrupts sleep, and poor sleep can increase pain sensitivity and lower mood. Sleep therefore sits in the middle of the cycle. Some simple steps can help:
- keep a regular wake-up time, even after a bad night
- wind down without screens before bed
- avoid caffeine later in the day
- find positions and supports that ease pressure points
If you snore, stop breathing in your sleep, or feel very sleepy in the day, see your GP. If you snore or wake unrefreshed, it’s worth reading about how poor sleep and snoring affect mood.
What Is Pain Catastrophising?
Pain catastrophising is a common pattern of feeling helpless about pain, dwelling on it and expecting the worst. Research links it with more distress and disability. It is a learned response to long-term suffering, not a personal failing, and it can change with support.
Can Antidepressants Help Chronic Pain?
Some antidepressants can help manage certain types of chronic pain. Among the medicines reviewed, duloxetine had the most reliable evidence of benefit, with a small-to-moderate effect on pain. Evidence for most other antidepressants was less certain.
The 2023 Cochrane review looked at 176 trials of 25 antidepressants. It found reliable evidence for duloxetine, with a small-to-moderate effect on pain. Another SNRI showed promise, but with less certainty. For all other antidepressants, the evidence was low certainty.
There is an important gap. Most trials excluded people with low mood, so we do not know how well these medicines work for people who have both pain and depression. The review’s authors also cautioned against reading the results as a reason to prescribe antidepressants where non-drug options could work equally well.
Your GP will review your pain medicines as part of your care. Do not stop or change any medicine without speaking to your prescriber.
What Therapy Helps Chronic Pain and Depression?
Psychological therapies can help people live better with chronic pain and depression, although the average benefits are modest. CBT has the largest evidence base. ACT is widely used, but research is still developing. Movement-based care and pain education also play a big part.
Psychological support for living with pain aims to reduce distress and help you return to the things that matter.
CBT for Chronic Pain
Cognitive behavioural therapy (CBT) has the largest evidence base of any psychological therapy for chronic pain. A 2020 Cochrane review of 59 CBT trials found small or very small average improvements in pain, distress and disability. CBT can help people develop practical ways to manage pain, although individual results vary.
In practice, CBT for chronic pain and depression focuses on pacing, goals and the thoughts that make pain harder to live with. It often includes:
- pacing activity so you avoid both “push and crash” and complete rest
- setting small, realistic goals
- noticing and softening unhelpful thinking, such as expecting the worst
- a gradual return to activities you value
Acceptance and Commitment Therapy for Pain
Acceptance and Commitment Therapy helps people live meaningfully alongside pain rather than waiting for it to disappear. It is widely used. However, the 2020 Cochrane review found only five ACT trials, and the evidence was very low quality. Research is growing, but higher-quality trials are still needed. ACT may suit some people well, and your psychologist can talk you through the options.
Movement, Physiotherapy and Pain Education
A physiotherapist or exercise physiologist can guide graded activity, meaning you increase movement slowly and steadily. Pain education (“understanding pain”) explains why persistent pain can continue after tissues have healed. Many people find that knowing how pain works moves feel less frightening.
What Support Can a GP Organise? The GP Chronic Condition Management Plan
A GP can prepare a GP Chronic Condition Management Plan (GPCCMP) for a condition that has lasted, or is likely to last, more than six months. The plan can open access to Medicare-subsidised allied health visits, such as physiotherapy, exercise physiology and psychology. Your GP will check what suits your situation.
Medicare rules as at November 2026. Here is what changed and how it works:
- From 1 July 2025: The GPCCMP replaced the GP Management Plan and Team Care Arrangements.
- Up to five visits: Eligible patients can access up to five Medicare-subsidised individual allied health services per calendar year. These visits can be shared across different allied health professionals.
- 18-month plan requirement: The GPCCMP must have been prepared or reviewed within the previous 18 months to maintain access to allied health services under the plan.
- Referral validity: New allied health referrals are generally valid for up to 18 months, unless the referring practitioner specifies otherwise.
- Until 30 June 2027: Existing GP Management Plans and Team Care Arrangements can continue to support eligible services. From 1 July 2027, a GPCCMP or eligible multidisciplinary care plan will be needed for ongoing access.
Note: Medicare rebates do not necessarily cover the full cost of allied health appointments. You may need to pay a gap fee, depending on the provider.
Ask your GP whether you are eligible. GP chronic condition management plans can connect you with physiotherapy, exercise physiology and psychology.
Separately, a Mental Health Treatment Plan under the Better Access initiative may provide Medicare-subsidised mental health treatment if your GP assesses that you have an eligible mental disorder, such as depression or an anxiety disorder. Eligible people can access up to 10 individual and 10 group sessions per calendar year, subject to the relevant referral and review requirements. This is separate from the GPCCMP
Breaking the Cycle: An Integrated Approach to Pain and Mood
The cycle is easier to break when several people work on it together. Each plays a different part:
Who | How they Help |
GP | Coordinates care, reviews pain medicines, checks mood and sleep, and sets up the GPCCMP |
Psychologist | Uses CBT or ACT to support coping, mood and sleep |
Physiotherapist or exercise physiologist | Guides graded movement and strength |
Psychiatrist | Helps when depression is moderate to severe, complex, or not responding, and reviews medicines |
Pain specialist or pain management program | Supports complex or high-impact pain |
Research shows that people with pain and depression or anxiety are often left out of specialised pain services and clinical trials. Joined-up care helps close that gap. If depression is severe or not improving, a psychiatric review when depression and pain overlap can look at diagnosis and medicines together.
Elyséa HEALTH is one example of this model, bringing GP, psychology and psychiatry care together in Adelaide.
Practical Steps You Can Start Now
Small, steady steps usually work better than big changes:
- Pace yourself. Aim for a middle path between “pushing through” and resting completely.
- Move a little each day. Short, gentle movement counts.
- Keep a sleep routine. Regular wake times help most.
- Stay connected. Short contact with friends or family protects mood.
- Track mood alongside pain. A simple daily note can show patterns for your GP.
- Tell your GP about low mood, not just pain. Both are worth treating.
Frequently Asked Questions
Can chronic pain cause depression?
Yes, chronic pain can raise the risk of depression, though most people with chronic pain do not develop it. Constant pain, poor sleep, lost activities, and isolation can build into persistent low mood. If low mood lasts most days for two weeks or more, tell your GP.
Why does depression make pain worse?
Mood and pain share pathways in the nervous system, and low mood can lower your pain tolerance. Depression also affects sleep, energy, and activity, which can increase stiffness over time. Treating mood, sleep, and pain together usually works better than treating one alone.
Can antidepressants help chronic pain?
Some can, but a large Cochrane review finds the strongest evidence for only one: duloxetine. Evidence for most others is uncertain, and most trials excluded people with low mood. Antidepressants may still be used to treat depression itself. Do not stop or change any medicine without your prescriber.
What therapy helps chronic pain?
CBT has the largest evidence base, with small average benefits for pain, distress, and disability when delivered by a trained psychologist. ACT is widely used, but the research is still developing. Graded movement, exercise physiology and pain education can also help many people.
Is chronic pain “all in my head” if I’m referred to a psychologist?
No. A referral to a psychologist does not mean your pain is imagined or caused by your mind. Pain and mood affect each other through the nervous system, and psychological skills can help with stress, poor sleep, and fear of movement. Your pain is real.
What support can a GP organise for chronic pain?
Your GP can review your pain and medicines, check your mood and sleep, and prepare a GP Chronic Condition Management Plan. They can refer you to allied health, such as physiotherapists, exercise physiologists and psychologists, and, if needed,d to a pain specialist or psychiatrist.
How many Medicare-subsidised allied health sessions can I get?
Under a GP Chronic Condition Management Plan, eligible people can access up to five Medicare-subsidised individual allied health services a calendar year, shared across all allied health types. A Mental Health Treatment Plan is separate and may give access to up to 10 psychology sessions a year. Gap fees may apply.
When should I see a psychiatrist for pain and depression?
Consider a psychiatrist if depression is moderate to severe, complex, or not improving, or if you want your medicines reviewed with both pain and mood in mind. If you are having thoughts of suicide, seek help straight away: call Lifeline on 13 11 14, or 000 in an emergency.
If pain is making life feel unbearable, or you are having thoughts of suicide: Lifeline 13 11 14 | Suicide Call Back Service 1300 659 467 | In an emergency call 000.
Peer support: Chronic Pain Australia [reviewer to confirm resource and contact details].
This article is general information and does not replace advice from your doctor.
