Dr Sarah Brewer October 09, 2018

It’s easy to assume physical issues are the biggest concern when it comes to chronic pain. However, chronic pain can also have a large impact on mental wellbeing. Studies have shown that people with chronic pain can also experience higher levels of stress, (1) which may lead to a more vulnerable predisposition to mental health concerns like depression and anxiety. (2) 

While there is no magic pill when it comes to managing chronic pain, there are a number of ways you can support your mental wellbeing.

What is the link between chronic pain, stress and mental health?

Chronic pain, stress and mental health conditions are linked by the impact they have on quality of life. For example, pain, fatigue, the loss of social support and struggles with daily activities are just some of the issues that contribute to mental health issues in chronic pain and arthritis conditions.3

As a result, depression and anxiety are all too common in people with painful joints. In fact, in one study, the research showed that 70% of people felt anxious and 69% felt depressed.4 Not all of those involved in the study were diagnosed with a mental health condition, but their mental state may not have been optimal. Stress can also play a significant role in arthritis and mental health. 89% of people with arthritis report worrying about how arthritis affects their future independence. Unfortunately, stress can also increase the inflammatory load on the body, particularly in those with rheumatoid arthritis. This can lead to a flare-up of symptoms and more pain.5

When it comes to managing a chronic condition like arthritis, a plan that incorporates care for symptoms only goes so far. It's important to take an holistic approach and consider mental wellbeing, as well as physical.

Simple self-care interventions to support mental wellbeing

Self-care is an important aspect of managing any chronic condition and mental health. Even small changes can add up to significant benefits. These are just some of the interventions that can help boost your mental wellbeing:

Practice meditation and mindfulness

One intervention that continues to show benefits for both pain and mental health is mindfulness, or meditation. Practicing regular meditation, for instance, has been shown to reduce pain and other symptoms in arthritis.6 As a result, there’s also some suggestion that meditation could also improve symptoms of depression and aid in stress management.7, 8

Mindfulness and meditation can be practised almost anywhere. If you are new to meditation, the best place to start is using a guided service. There are plenty of free apps you can download, such as Headspace and Calm. Some of these apps will also have meditations to support specific issues, including anxiety, stress and even pain.

On the other hand, you can also practice mindfulness by yourself. Simply close your eyes and focus on your breathing. Every time you notice that your mind has wandered, bring it back to your breath. Start with a few minutes each day and build up as you feel ready to. It’s always worth remembering that a positive mindset can go a long way in helping you manage the various stressors in your life.

Diet

A balanced, nutrient-dense diet can support your overall wellbeing. However, there are a few dietary shifts you could consider to boost your mental health.

Following a diet that contains naturally anti-inflammatory foods could help you to manage your symptoms. Foods like fruits, vegetables, nuts, seeds, wholegrains and olive oil form the basis of an anti-inflammatory, Mediterranean-style diet. These foods are nutrient-dense and contain compounds, such as antioxidants, that may have protective effects for the joints and the brain.

A Mediterranean diet may also relieve symptoms in both osteoarthritis and rheumatoid arthritis.9, 10 Following a Mediterranean diet is also associated with better mental and physical wellbeing.11 Early studies suggest that this diet may even help to manage the symptoms of anxiety and stress.12

Another dietary change that may be beneficial is increasing your intake of oily fish. Research suggests that consuming fish 4 times per week can decrease inflammation, which could help with pain and related symptoms (13). However, fish intake may also be beneficial for mental health conditions such as depression.14 The British Dietetic Association recommends at least one serving of oily fish per week.15 For more information on how diet can help support mental health, you can learn more in our dedicated Gut Health resource.

Incorporating regular exercise

It can be common for people with chronic pain to avoid exercise for fear of aggravating their symptoms. However, regular exercise can actually be a vital intervention for joint health and mental wellbeing.16 Research suggests that engaging in regular exercise can improve depressive symptoms.17 In fact, one meta-analysis also found that exercise can significantly reduce the symptoms of anxiety.18

Stress management is another factor that exercise could assist with. Physical activity can go a long way to reduce tension, boost mood and improve sleep and self-esteem: all of these can aid with elevated stress levels (19). Yoga has also been shown to reduce stress in adults, although further research is needed to confirm the benefits.20

The good news is that regular exercise doesn’t need to be vigorous to have benefits. Studies have shown that even tai chi can improve symptoms of arthritis, balance and physical function.21 The most important thing is that you move your body safely and consistently.

Consider supportive supplements

Supplements are never a replacement for a balanced diet, but there are some options that may support your mental health and overall wellbeing.

Omega-3 fatty acid is one supplement worth considering if you are experiencing depressive symptoms and inflammation of any form. Research has shown that omega-3 can have potent anti-inflammatory properties. Omega-3s could also play a role in mental health, with many studies suggesting that it could have antidepressant effects.22

A dose of omega-3 fatty acids that is considered therapeutic for brain health is 250mg of DHA. You can get that and more with Healthspan's Opti-Omega 3, which contains 330mg of DHA. Vegetarians and vegans can get the same dose with the Vegetarian Omega-3.

What if it’s all too much?

Mental health issues, like any serious concern, are not to be taken lightly. If you are feeling overwhelmed and unable to cope with your symptoms, seeking help is vital. Don’t be afraid to speak to your GP about support options that are available to you.

If you are in a crisis, there are helplines you can call. The NHS website has several helpline options listed, including some that are available 24 hours a day. However, for more information on how you can support your joint health, just head across to our advice centre.


References
1Sharma, A., Kudesia, P., Shi, Q. and Gandhi, R., (2016). Anxiety and depression in patients with osteoarthritis: impact and management challenges, Open access rheumatology: research and reviews, 8, p.103
2National Rheumatoid Arthritis Society (2013). Depression and rheumatoid arthritis
3Arthritis Care (2017). Hidden impact: Arthritis and mental wellbeing
4Arthritis Care (2011). Arthritis Hurts: The emotional pain of arthritis
5Straub, R.H. and Kalden, J.R. (2009). Stress of different types increases the proinflammatory load in rheumatoid arthritis.
6Rosenzweig, S., Greeson, J.M., Reibel, D.K., Green, J.S., Jasser, S.A. and Beasley, D. (2010). Mindfulness-based stress reduction for chronic pain conditions: variation in treatment outcomes and role of home meditation practice. Journal of psychosomatic research, 68(1), pp.29-36
7Goyal, M., Singh, S., Sibinga, E.M., Gould, N.F., Rowland-Seymour, A., Sharma, R., Berger, Z., Sleicher, D., Maron, D.D., Shihab, H.M. and Ranasinghe, P.D. (2014). Meditation programs for psychological stress and well-being: a systematic review and meta-analysis, JAMA internal medicine, 174(3), pp.357-368
8Chiesa, A. and Serretti, A. (2009). Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. The journal of alternative and complementary medicine, 15(5), pp.593-600
9Forsyth, C., Kouvari, M., D’Cunha, N.M., Georgousopoulou, E.N., Panagiotakos, D.B., Mellor, D.D., Kellett, J. and Naumovski, N. (2017). The effects of the Mediterranean diet on rheumatoid arthritis prevention and treatment: a systematic review of human prospective studies. Rheumatology international, pp.1-11
10Dyer, J., Davison, G., Marcora, S.M. and Mauger, A.R. (2017). Effect of a Mediterranean type diet on inflammatory and cartilage degradation biomarkers in patients with osteoarthritis. The journal of nutrition, health & aging, 21(5), pp.562-566
11Munoz, M.A., Fíto, M., Marrugat, J., Covas, M.I. and Schröder, H. (2008). Adherence to the Mediterranean diet is associated with better mental and physical health. British Journal of Nutrition, 101(12), pp.1821-1827.
12Crichton, G.E., Bryan, J., Hodgson, J.M. and Murphy, K.J. (2013). Mediterranean diet adherence and self-reported psychological functioning in an Australian sample. Appetite, 70, pp.53-59
13Lankinen, M., Schwab, U., Erkkilä, A., Seppänen-Laakso, T., Hannila, M.L., Mussalo, H., Lehto, S., Uusitupa, M., Gylling, H. and Orešič, M. (2009). Fatty fish intake decreases lipids related to inflammation and insulin signaling — a lipidomics approach. PLoS one, 4(4), p.e5258.
14Sanchez-Villegas, A., Henríquez, P., Figueiras, A., Ortuño, F., Lahortiga, F. and Martínez-González, M.A. (2007). Long chain omega-3 fatty acids intake, fish consumption and mental disorders in the SUN cohort study. European journal of nutrition, 46(6), pp.337-346.
15British Dietetic Association (2017). Omega-3 Food Fact Sheet
16Wilcox, S., Der Ananian, C., Abbott, J., Vrazel, J., Ramsey, C., Sharpe, P.A. and Brady, T. (2006). Perceived exercise barriers, enablers, and benefits among exercising and nonexercising adults with arthritis: results from a qualitative study. Arthritis Care & Research: Official Journal of the American College of Rheumatology, 55(4), pp.616-627
17Rimer, J., Dwan, K., Lawlor, D.A., Greig, C.A., McMurdo, M., Morley, W. and Mead, G.E. (2012). Exercise for depression
18
Anxiety and Depression Association of America. (n.d.). Physical Activity Reduces Stress
19Chong, C.S., Tsunaka, M. and Chan, E.P. (2011). Effects of yoga on stress management in healthy adults: a systematic review. Alternative therapies in health and medicine, 17(1), p.32
20Chong, C.S., Tsunaka, M. and Chan, E.P. (2011). Effects of yoga on stress management in healthy adults: a systematic review. Alternative therapies in health and medicine, 17(1), p.32
21Song, R., Lee, E.O., Lam, P. and Bae, S.C. (2003). Effects of tai chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with Wipfli, B.M., Rethorst, C.D. and Landers, D.M., 2008. The anxiolytic effects of exercise: a meta-analysis of randomized trials and dose–response analysis. Journal of Sport and Exercise Psychology, 30(4), pp.392-410
22Lin, P.Y. and Su, K.P. (2007). A meta-analytic review of double-blind, placebo-controlled trials of antidepressant efficacy of omega-3 fatty acids. Journal of Clinical Psychiatry, 68(7), pp.1056-1061.

Nothing beats a healthy, balanced diet to provide all the nutrients we need. But when this isn't possible, supplements can help. This article isn't intended to replace medical advice. Please consult your healthcare professional before trying supplements or herbal medicines.

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