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Chronic Pain & Mental Health

Updated: Feb 5, 2020

First of all, let me thank Clarinda Brandão for asking me to write this blog post.

My name is Dr. Donald Littlewood and I am a chiropractor at Liberty Clinic at Yonge & Bloor.

What does that mean? It means I treat the muscles, joints & nerves of the body. While I treat mostly headaches, neck pain and back pain, any part of the body can benefit from chiropractic care.

I also have a focus in treating the LGBTQ+ community. We as a community are often stigmatized and judged when it comes to our health, and that simply isn’t fair. A lot of LGBTQ+ people want their healthcare provider to be understanding of their unique issues, and a bonus if they are part of the community as well. That’s where I come in!

Enough about me, let’s talk chronic pain and mental health. For this blog I focused on depression and chronic stress, mainly because that is where the research lies.

Some Definitions

Okay, so we need to define a couple of things here:

Stress is a challenging emotional or physiological event(s) that results in adaptive changes to regain the body’s optimal state.

Pain is a collection of emotions and sensations (and their accompanying movements) resulting in response to a harmful stimulus.

Both pain and stress are adaptive processes and are here for your protection. If either of the two become chronic it can lead to some changes in your physiology as well as your behaviour.

Interestingly enough, post-traumatic stress disorder and chronic pain are considered conditions where the brain fails to extinguish a negative memory. In PTSD, the inability to unlearn fear manifests emotionally, whereas in chronic pain it manifests physically.

Chronic Pain

1 in 10 suffer from chronic pain whether it be cancer, nerve disorders, arthritis, back/neck pain that lasts more than three months, etc. 80% of that pain is treated with prescription medication (and some of it should be)

As I said above, pain is a protective measure, and is good in the short term (think a sprained ankle). If that pain becomes chronic other sensations start to kick in.

  • Hyperalgesia is an abnormal increase in the amount of pain felt with a stimulus. It is generally correlated with a sharp burning sensation.

  • Allodynia: the sensation of pain where pain is usually not felt.

Chronic Pain & Depression

Newer studies are showing that ~50% of people suffering from chronic pain also express clinical symptoms of depression. There are five hypotheses on how these two are linked.

  1. Antecedent – depression precedes the development of chronic pain

  2. Consequence – depression is a consequence of chronic pain

  3. Scar – bouts of depression before the chronic pain predispose the patient to a depressive episode after pain

  4. Cognitive mediation – poor coping skills mediate the reciprocal interactions between chronic pain and depression

  5. Independent – the two share some common pathology but remain distinct conditions without causal interaction. As my AP Psychology teacher used to make us repeat: Correlation is not causation!

Studies are showing that those with depression are more likely to score their pain as more severe than those without depression. This has led researchers to think that there is a link with depression and the lowering of one’s pain tolerance.

Mental Health in the LGBTQ+ Population

The LGBTQ community has a disproportionately higher burden of mental health issues especially in the transgender community. For many trans individuals, feelings of shame, isolation, sadness, anger, loss & rejection can lead to depressive symptoms.

This can also be associated with higher sexual behaviour, which inherently increases the risk of STI contraction, which can further compound these feelings.

Final Thoughts

It’s pretty clear to me that mental illness and chronic pain are intimately linked in some fashion whether one is causative of the other or not. Those who experience chronic pain are more likely to have a diagnosis of depression, and vice versa.

In my practice, this has implications in the LGBTQ+ community due to the increased likelihood of mental health disorders, especially in youth & young adults.

Are you having chronic pain with or without depression-like symptoms? I would love to chat about specifics on how I can help!


Dr. Donald Littlewood is a chiropractor in downtown Toronto. His passion in practice lies in headaches and helping the LGBTQ+ community life full and authentic lives. As an avid skiier, the only thing Dr. D doesn't love about Toronto is that there are no mountains, however he makes up for it by playing volleyball and searching for the city's best charcuterie board!

416.591.1123 |

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