Back pain, sore knees, arthritis, nerve pain and headaches become more common as we move through midlife. When pain lasts for months, it wears on more than the body. It can disturb sleep, limit work and family life, and drain your mood and hope.
Pain and depression often travel together, and each makes the other harder to treat. The good news is that many treatments help both at once, and most of them do not involve opioids. This guide is part of our midlife guide. For later-life issues, see chronic pain and mood in older adults.
Key points
- In 2023, about 29% of U.S. adults aged 45 to 64 had chronic pain. For about 11%, pain limited daily life or work most days.1
- Depression is common in people with chronic pain, from about 1 in 5 in the general population to about half of people seen in pain clinics.4
- Pain can hide depression, so doctors may treat the pain and miss the low mood.4
- Exercise, CBT, mindfulness, yoga, tai chi and acupuncture can improve pain or function for some common conditions.2,5
- U.S. guidelines say nonopioid treatments are preferred for long-lasting pain.7
Signs that pain is affecting your mood
Chronic pain usually means pain on most days or every day for at least 3 months.1 Living with it can slowly change how you feel. Signs that mood is also involved include:
- Feeling hopeless about the future, or that nothing will help
- Losing interest in people and activities you used to enjoy
- Staying in bed or at home more, even on better days
- Feeling irritable, tearful or numb
- Sleeping poorly or much more than usual
- Worrying constantly about the pain getting worse or about injury
- Using alcohol, sleeping pills or extra pain pills to get through the day
- Thinking that others would be better off without you
If these sound familiar, take our free depression test and share the results with your doctor.
Why pain and mood are linked
They share pathways. Pain and depression use some of the same brain pathways and chemical messengers.4 That helps explain why each can make the other worse, and why some treatments help both.
Pain shrinks your life. When pain keeps you from work, hobbies, exercise or time with friends, you lose many of the things that keep mood steady. Less activity can then mean weaker muscles, more stiffness and more pain.
Depression turns up pain. People with depression and pain tend to have more pain complaints, more disability and pain that lasts longer.4 Depression also makes it harder to keep up healthy habits and get medical care.3
Midlife stress adds weight. Work, caregiving and money worries are often at their peak in these years. See our guides on work and caregiving.
How common it is
A national survey found that chronic pain rises with age:1
| Age | Chronic pain | Pain that limits daily life or work |
|---|---|---|
| 18–29 | 12% | 3% |
| 30–44 | 18% | 5% |
| 45–64 | 29% | 11% |
| 65 and older | 36% | 14% |
Women were somewhat more likely than men to have chronic pain. People in rural areas were more likely than people in big cities.1
Depression is common alongside pain. In a well-known review, rates ranged from about 27% in primary care to about 52% in pain clinics, and about 18% in community surveys.4
What helps
The best results usually come from combining approaches: staying active, learning skills to manage pain and mood, and treating depression when it is there.3,4
Exercise and physical therapy
Strong evidenceExercise improved pain or function for at least a month after treatment for low back pain, neck pain, knee and hip arthritis, and fibromyalgia.5 A physical therapist can build a safe plan that starts where you are.
CBT for chronic pain
Moderate evidenceCognitive behavioral therapy helps you set realistic goals, become more active and change unhelpful thoughts about pain.6 It improved pain or function in low back pain and fibromyalgia.5 See CBT.
Mindfulness
Moderate evidenceMindfulness programs and CBT both reduce pain intensity and improve function, with no big difference between them.2 Mindfulness-based stress reduction gives a small improvement in chronic low back pain.2 Try the body scan or see MBSR.
Yoga and tai chi
Moderate evidenceYoga helps low back pain and neck pain. A guideline strongly recommends tai chi for knee or hip arthritis.2 Classes can also add social contact.
Acupuncture
Moderate evidenceAcupuncture helps back and neck pain more than no treatment or sham acupuncture, and has some support for knee arthritis and fibromyalgia.2
Treating depression
Strong evidenceDepression can be treated even when you have a chronic illness, with talk therapy, medicine or both.3 Some antidepressants are also used for certain types of pain, such as nerve pain, arthritis and low back pain.7 Ask about collaborative care, where your medical and mental health care are linked.3
About opioids. CDC guidelines say nonopioid treatments are preferred for pain that lasts beyond a few months. Opioids are started only if the expected benefits for pain and function outweigh the risks.7 If you already take opioids, do not stop suddenly. Talk with your doctor about any changes.
About supplements. "Natural" does not always mean safe. Some products marketed for arthritis or pain have been found to contain hidden prescription drugs, and some supplements interact with medicines.2 Check with your doctor or pharmacist first.
Steps you can take
- Track pain and mood together for two weeks. Each day, rate pain and mood from 0 to 10, and note sleep and activity. Patterns help you and your doctor.
- Ask for a mood check at your next visit, not just a pain check. Pain can hide depression.4
- Ask about physical therapy and a home exercise plan.
- Ask about CBT for pain or a mindfulness course.2,6
- Pace yourself. On good days, do a bit more than usual but not everything. On bad days, do a little rather than nothing.
- Move gently every day. A short walk, stretching or tai chi counts. See our walking plan and strength and balance.
- Protect your sleep. Pain and poor sleep feed each other. See sleep in midlife.
- Use calming skills during flare-ups. Try the cyclic sigh, progressive muscle relaxation or a body scan.
- Keep one thing you value. Pick one meaningful activity and adapt it so you can keep doing it. See ACT.
For partners, family and friends
Pain is invisible, and people living with it often feel doubted. Believe them. Ask what helps on bad days instead of guessing. Encourage activity in small, doable steps rather than pushing too hard or doing everything for them. Notice signs of depression, such as withdrawal, hopelessness or giving up on things they love, and encourage them to tell their doctor. Join a walk or a class together.
If you are the main helper, look after your own rest and support. See caregiver burnout.
Special situations
Alcohol and pain. Some people drink to dull pain or to sleep. Over time, alcohol can make sleep and mood worse.8 It can also interact with medicines, including some pain medicines, so ask your pharmacist. See alcohol in midlife.
Rural areas. Chronic pain is more common outside cities, where specialists can be harder to reach.1 Ask about telehealth therapy or online CBT programs. See online therapy and apps.
Pain and heart or other illness. Depression often comes with several chronic conditions at once.3 See depression with heart disease, stroke, diabetes and pain and heart, brain and mood.
Common questions
Is the pain "all in my head" if therapy helps?
Should I rest until the pain goes away?
For most long-lasting pain, staying active helps more than rest. Exercise is one of the best-studied treatments.5 Start slow and build up with guidance.
Can an antidepressant help my pain even if I am not depressed?
Some antidepressants are used for certain kinds of pain, such as nerve pain and some arthritis or back pain.7 Your doctor can tell you whether one fits your situation. Do not start or stop any medicine on your own.
Will I always have this pain?
Many people find their pain improves, or that they can live a fuller life even with some pain. Treatment aims to reduce pain and help you get back to what matters.6
When to get help
See your doctor if pain lasts more than a few months, if it keeps you from work or daily life, or if your mood has been low for two weeks or more. Get prompt care for new pain with fever, weight loss, weakness, or loss of bladder or bowel control.
People with chronic pain have a higher risk of suicidal thoughts.7 You do not have to wait until things get worse to ask for help.
If you have thoughts of suicide, call or text 988, the Suicide & Crisis Lifeline, any time. If you are in danger now, call 911.
Call 911 for sudden chest pain, sudden severe headache, or new weakness or numbness.
Sources
- Lucas JW, Sohi I. Chronic pain and high-impact chronic pain in U.S. adults, 2023. NCHS Data Brief No. 518, National Center for Health Statistics, 2024. CDC
- National Center for Complementary and Integrative Health. Chronic pain: what you need to know. NIH. NCCIH
- National Institute of Mental Health. Understanding the link between chronic disease and depression. NIMH. NIMH
- Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med, 2003. JAMA Network
- Skelly AC, Chou R, Dettori JR, et al. Noninvasive nonpharmacological treatment for chronic pain: a systematic review. Agency for Healthcare Research and Quality, 2018. AHRQ
- U.S. Department of Veterans Affairs. Cognitive behavioral therapy for chronic pain (CBT-CP): for Veterans. VA Pain Management. VA
- Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC clinical practice guideline for prescribing opioids for pain — United States, 2022. MMWR Recomm Rep, 2022. CDC
- National Institute on Alcohol Abuse and Alcoholism. Mental health issues: alcohol use disorder and common co-occurring conditions (Core Resource on Alcohol). NIAAA. NIAAA
Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.