Chronic pain and poor mental health often show up together, and each can make the other worse. Here's what the research says, and what tends to help. Please note, this blog mentions mental health conditions, anxiety and suicide. Need support now? If you're struggling, call Lifeline on 13 11 14 (24/7) or Beyond Blue on 1300 22 4636. In an emergency, call 000.
Blog made Jan 2022, updated Nov 2026Chronic pain and poor mental health are both common, and they turn up together far more often than chance would explain. Most Australians will have back pain at some point, and about two in five Australians aged 16–85 have experienced a mental health disorder in their lifetime.
The research suggests the relationship runs both ways. Persistent pain raises the risk of depression and anxiety. Depression and anxiety raise the risk of developing pain, and of it sticking around. Plenty of the people we see at our clinic in Cromer with long-running back, neck or shoulder pain are dealing with some version of this, whether they've named it or not.
This post covers what's going on in the nervous system, what the evidence says about the link, and what tends to help.
What counts as chronic pain?
Chronic (or persistent) pain is pain that lasts or keeps coming back for more than three months. There are plenty of causes. This post focuses on musculoskeletal pain: backs, necks, shoulders, hips and the like.
Chronic pain rarely stays in its lane. It tends to affect sleep, mood, work, relationships and how much you move. A common pattern is fear avoidance: you avoid movements that hurt, you get less capable, normal activity starts to feel more threatening, and the avoidance grows.
People living with chronic pain are also at higher risk of depression, anxiety, substance use problems and suicide. That's not a reason for alarm. It's a reason to take the mental health side of pain seriously from the start.
Pain is produced by the brain, not just the body
There's no single "pain centre" in the brain. When you feel pain, a network of regions lights up, including:
Somatosensory cortex: where the pain is and how intense it is.
Thalamus: a relay station that routes signals from the spinal cord to the rest of the brain.
Insula: pulls together physical sensation, emotion and thinking.
Anterior cingulate cortex: the unpleasantness and distress of pain, plus attention to it.
Prefrontal cortex: decision-making, memory and emotional regulation.
This network used to be called the "pain matrix". The more recent view is that these regions aren't pain-specific at all. They respond to anything the brain judges important or threatening.
That's the key point. The same machinery that processes pain also processes threat, stress, attention and emotion. So mood, sleep, stress and past experience can turn the volume of pain up or down. None of this means the pain is imagined. Pain is always real. It means the signal is being processed by a system that's also listening to everything else going on in your life.
The link between chronic pain and mental health: a two-way street
The research consistently shows higher rates of depression and anxiety in people with chronic pain, and the more severe the pain, the higher the rate tends to be.
It works in the other direction too. In a Canadian population study of around 800 adults without significant neck or back pain, people with the highest levels of depressive symptoms were about four times as likely to develop intense or disabling neck or low back pain over the following year as those with the lowest levels.
Brain imaging studies also show overlapping changes in regions that handle both emotional and pain processing in people with chronic pain and depression.
In plain terms: pain can wear down mood, and low mood can make pain more likely and harder to shift. Each can keep the other going. That's why treating only one side often stalls.
What helps
There's no single fix, and anyone promising one should make you suspicious. What the evidence supports is a combination of approaches, matched to the person.
1. Treat the whole person, not just the sore spot. Look at sleep, stress, workload, alcohol, diet and social support alongside the physical side. For some people that means seeing a chiropractor or physio and a psychologist at the same time, with both in the loop.
2. Get support for the mental health side. Psychological therapies such as cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) have evidence for reducing distress and disability in chronic pain. They should be delivered by a qualified professional, usually a psychologist. Your GP can set up a Mental Health Treatment Plan, which gives you access to Medicare-subsidised psychology sessions.
If we suggest you see a psychologist, it's not because we think the pain is in your head. It's because the evidence says it's one of the levers that helps, and we'd rather use all of them.
3. Keep moving, progressively. Exercise is one of the best-supported treatments for persistent low back pain. The aim is graded: start with what you can do confidently, then build load and range over weeks. It also helps mood and sleep, which feeds back into pain. (See [How to return to exercise safely and avoid injury].)
4. Use mind-body techniques. Slow breathing, mindfulness, relaxation and yoga nidra are things you can do yourself, without relying on a practitioner. Free apps such as Insight Timer have plenty of guided sessions to start with. (See [How belly breathing reduces pain].)
5. Stay connected. Isolation makes both pain and low mood harder to manage. Training partners, a surf crew, a walking group, family: social connection matters more than it gets credit for.
6. Focus on what you can do. Constantly checking what hurts and what you can't do keeps attention locked on the threat. Rebuilding what you can do, and adding to it, is a core part of most chronic pain rehab.
How we approach persistent pain at our Cromer clinic
At Movement Health & Wellness, upstairs at Surfers Gym in Cromer, we see people from across the Northern Beaches with pain that has hung around longer than it should.
Our approach starts with a proper assessment and a clear explanation of what we think is going on, including how pain works. From there, care is built around exercise-led rehabilitation, with hands-on treatment where it helps. Both chiropractic and physiotherapy are available at the clinic, and we can refer you to resources, GPs and psychologists when the mental health side needs more support than we can give.
If pain has been affecting your training, work or mood, book an assessment and we'll work out a plan together.
Need support now? If you're struggling, call Lifeline on 13 11 14 (24/7) or Beyond Blue on 1300 22 4636. In an emergency, call 000.
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Chronic pain is linked to a higher risk of depression, and the risk tends to rise with pain severity. The relationship runs both ways: depression also increases the risk of developing persistent pain.
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Yes, they can. The brain regions that process pain also process threat, stress and attention, so stress, poor sleep and anxiety can amplify how much pain you feel. That doesn't make the pain any less real.
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Pain that lasts or keeps returning for more than three months is generally classed as chronic or persistent pain.
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Often more than one. A chiropractor or physio can assess the physical side and guide an exercise-based rehab plan, while a psychologist can help with the mental health side. On the Northern Beaches, our Cromer clinic offers both chiropractic and physiotherapy and works with local GPs and psychologists.
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