Healing Pain, Not Just Diagnosing Depression

Charlie, a 76-year-old retired manager, sat across from me, clutching a cane and fighting back tears. For decades, she had been told her disabling headaches, neck pain, and back pain were “just part of getting older” or a sign that she was depressed. That Friday, she wept in front of her husband and told me she felt “beyond saving.”

Story

In 2023, I first met Charlie, a now-retired 76-year-old middle manager, successful in her career, mother of two kids, and married. Her story, disabling headaches, neck pain, and back pain. Deeper story, she started addressing the long duration of childhood and adolescent sexual abuse, and she became deeply depressed, feeling helpless, and used a wheelchair to travel due to increasing back pain and dizziness, leading to imbalance.

On this first consult with her and her husband, she felt safe enough to cry and noted the despair that she is beyond saving. Counseling and antidepressants were not helping.

In May 2025, I went to get her from the waiting room, and she walked through the door with the largest smile.

In those two years, she worked with our whole team using physical rehab to gain muscle strength, undergoing medical procedures, which also led to radiofrequency lesioning of the spine and some pulse radiofrequency for her headaches in the occipital nerves. She followed with 100% compliance of nutritional changes, such as increasing protein, increasing creatinine, stopping processed foods, and increasing fiber.

Along the way, I had done a number of individual hypnotherapy sessions. My initial one was on the first consult. She could not, in fact, continue with the session because it spoke so deeply inside her inner child; she couldn't face it.

She joined the virtual group sessions we offered. These sessions deepen the knowledge around the neuroscience of pain and pain responses. She continued with this counseling support.

The combination of reduced pain intensity, physical conditioning, and mindset changes in the neurobiology was making inroads.

Path Block

Charlie’s story is all too familiar. Depression is often diagnosed when someone in relentless pain becomes withdrawn or hopeless. Many patients are handed antidepressants without anyone looking at the pain or trauma that underlies their despair. Chronic pain and depression often feed off one another; up to 70% of patients with depression or anxiety disorders have chronic pain, and persistent pain itself can drive mood changes and suicide risk. Yet, medications alone rarely solve the problem. We need to treat the whole person - body, brain, and context.

Mini-lesson:

Chronic pain and depression are intertwined. Severe pain increases the risk of depression and suicide. People with chronic pain often report fewer benefits from antidepressant medications. Labeling someone depressed without addressing their pain can deepen despair.

Diagnosis Journey

On our first consultation, Charlie cried openly as she recounted years of abuse and the hopelessness she felt. “I’m beyond saving,” she whispered. We talked about the science of pain: how trauma and long-term nociceptive input sensitize the nervous system and change the brain’s prediction of safety or danger. I explained that chronic pain is not simply damaged tissues; it is an interplay between the body (muscles, joints, and nerves), brain (thoughts, emotions, and coping), and context (social support and environment). Antidepressants can help some pain conditions, but the evidence is mixed. An international review found that only certain drugs, like duloxetine, have moderate evidence for specific conditions, while many antidepressants lack clear benefit for chronic pain. Non-drug approaches such as exercise, physiotherapy, and lifestyle changes can be equally or more effective.

We built a care plan focusing on layered, whole-person care:

Mini-lesson:

When pain coexists with trauma, focusing only on mood is insufficient. Evidence shows that chronic pain and depression are bidirectional, and that people with pain often derive less benefit from antidepressants than those without pain. Holistic approaches - movement, nutrition, interventional procedures, counseling, and education - address the body-brain-context triad.

Turning Point

The turning point was not a single injection or pill - it was Charlie’s willingness to confront her past and rebuild her body. During one hypnotherapy session, she revisited her childhood and connected with her vulnerable inner child; the emotional intensity forced her to pause. Later, in a group visit while discussing how pain pathways can be rewired, she suddenly understood she could change her brain’s predictions. She told the group, “I used to think I was beyond saving. Now I believe I have a say in this.”

Seeing her progress, we gradually tapered her opioids and antidepressants under supervision. As she regained muscle strength and learned to interrupt negative thoughts, her pain intensity fell. Compassionate communication was key: studies show that physician empathy and supportive context activate patients’ own healing mechanisms and produce better outcomes for chronic pain than some procedures. I made a point to listen, validate her experiences, and offer hope.

Resolution

By May 2025, Charlie walked into my clinic unassisted, smiling broadly. Two years earlier, she used a wheelchair; now she had gained muscle mass, improved her balance, and was using a cane only occasionally. She still had some pain, but it no longer dominated her life. She described feeling more energetic and hopeful. She continued counseling and hypnotherapy, but we had discontinued antidepressants. Her depression had lifted, not because of pills but because her pain and trauma were being addressed.

Mini-lesson:

Unrelenting pain can cause or worsen mental health symptoms. Accessible, layered pain care - combining physical, psychological, and social interventions - is critical to resolve depression linked to chronic pain.

Key Learnings

Charlie’s journey reveals several lessons:

• Depression is often over-diagnosed in people with chronic pain. Chronic pain frequently coexists with depression. Treating pain can improve mood, while ignoring pain perpetuates despair. Evidence suggests people with comorbid pain and depression derive limited benefit from antidepressants. Making muscle makes myokines, the body’s own powerful anti-depressant and anti-inflammatory molecules.

• A whole-person approach is essential. Effective care addresses the body (movement, procedures), brain (thoughts, beliefs, emotions), and context (social support, trauma history). Integrated care plans break the cycle of pain and hopelessness.

• Provider words and empathy matter. Research shows that supportive interactions change patients’ brain responses and improve outcomes. Clinicians who believe in their patients can ignite self-belief and agency.

• Medical therapies are bridges, not solutions. Interventions like nerve ablations or medications create windows of relief, but lasting change comes when patients build resilience, retrain their nervous systems, and reclaim their lives.

Takeaways for Patients & Clinicians

For Patients

• Ask about pain. If you are depressed and live with chronic pain, make sure your clinicians assess and address the pain, not just your mood. Speak openly about trauma and how pain affects your life.

• Engage in whole-person care. Look beyond pills. Participate in physiotherapy, exercise, nutrition changes, counseling, and education. Learn how your brain processes pain and practise skills to interrupt negative loops.

• Believe you are not beyond saving. Healing begins with acknowledging your story and believing change is possible.

For Clinicians

• Look beyond depression scores. Chronic pain can mimic or cause depressive symptoms. Evaluate physical and social factors and consider integrated pain management before escalating antidepressants.

• Provide layered care or refer appropriately. When evidence for antidepressants in chronic pain is limited, consider interventional procedures, physiotherapy, access to pain neuroscience education, physical conditioning, and counseling as part of the care plan.

• Communicate with compassion. Your belief and empathy can change a patient’s trajectory. Listen, validate, and offer hope; your words are as powerful as any procedure.

• Give patients foundations to build mental mastery by showing them how to interrupt, command, and act.

• Help patients understand the why and a path of options for pain, which will ultimately impact mental health.

• Unrelenting pain is a huge cause of mental health symptoms. Accessible layered pain care is critical to help resolve mental health.
  

• Lead with neuroscience to empower patients in rewiring the mind. Medical therapies on their own are NOT the solutions, but they buy the patient time to do this.

Brenda’s Path Forward Reflections

Charlie’s recovery reminds us that mental health cannot be separated from physical pain or social context. Depression is sometimes over-emphasized when the real culprit is unaddressed trauma and chronic pain. Our healthcare systems must recognize the bidirectional relationship between pain and mood and provide integrated, layered care for both. This means funding for physiotherapy and counseling, education on pain neuroscience, and training clinicians to use empathy and patient-centred language. Pills have a role, but they are not the answer.