Chronic pain and mood

Chronic pain is pain that lasts longer than the normal time for healing, usually more than 3 to 6 months.² It might come from arthritis, a bad back, nerve damage, an old injury or surgery. Sometimes no clear cause is found.²

Pain that goes on and on wears people down. It can disturb sleep, limit what you do and change how you feel about yourself. Low mood can then make the pain feel worse. This page explains that cycle and the treatments that can help break it.

How common is chronic pain in later life?

In 2021, about 1 in 5 U.S. adults (21%) had chronic pain. About 7% had what experts call high-impact chronic pain, meaning pain that limits daily life or work on most days.¹

The numbers rise with age:¹

Source for the table: CDC, National Health Interview Survey, 2021 data.¹

Pain is common with age, but you do not have to simply accept it. Many treatments can help.

The pain and mood cycle

Experts have known for a long time that pain and depression often show up together. Depression is more common in people with pain than in the general public. Pain is also more common in people with depression.⁴ The link runs both ways:^3,4

• Pain can lead to depression. Pain that is severe, disabling or hard to treat is tied to more depression and a lower quality of life.⁴
• Depression can make pain worse. People with both tend to report more pain, have more trouble with daily tasks and have pain that lasts longer.⁴
• Each makes the other harder to treat. When both are present, both tend to be more severe.³

Here is how the cycle often works. Pain makes it hard to sleep, walk or see friends, so you do less. Doing less leads to stiff muscles and more time alone. You start to feel sad or hopeless. Those feelings can turn up the volume on pain and drain your energy. Then the cycle starts again.

Pain and depression also seem to share some of the same pathways and chemical messengers in the brain and body.⁴ That helps explain why some treatments help both at once.

Depression can hide behind pain. Many people, especially older adults, go to the doctor for aches and pains, not sadness. The depression may be missed.⁴ Aches and pains without a clear cause that do not get better with treatment can be a sign of depression.³ Learn more in depression with heart disease, stroke, diabetes and pain and depression in later life.

Signs that pain is affecting your mood

Watch for these signs, in yourself or someone you love. If several of these go on for weeks, talk with a doctor:³

• Feeling sad, empty, anxious or hopeless most days
• Losing interest in things you used to enjoy
• Feeling worthless or guilty, or like a burden
• Being cranky or restless
• Feeling tired all the time
• Trouble thinking or making decisions
• Big changes in sleep or appetite
• Thoughts of death or suicide

You can take a quick, private mood check-in on this site. Your doctor can also screen for depression during a regular visit. See getting checked for depression.

Talk therapies for pain: CBT and ACT

Talk therapy does not mean your pain is "all in your head." Pain is real. These therapies teach skills to lower the hold pain has on your life. Many people find that their mood, sleep and activity improve.

What to expect. These therapies usually mean weekly sessions for a few months, alone, in a group or by video, plus practice at home. If you have depression too, treating it directly also matters. Therapy, medicine or both can help, even when you have a long-term health problem.³

Start today with a small skill. Slow breathing and relaxation can ease the tension that comes with pain. Try cyclic sighing, a body scan or progressive muscle relaxation. If low mood keeps you on the couch, behavioral activation helps you plan small, doable activities that bring back a sense of reward.

Movement, tai chi and other body-based options

Rest helps after an injury. But for long-lasting pain, too much rest usually makes things worse. Exercise is one of the best-studied treatments for chronic pain. It helps low back pain, knee arthritis and fibromyalgia (a condition with widespread pain and tiredness).^5,8

Tai chi Moderate evidence is a slow, flowing practice from China that combines gentle movement, breathing and focus. Research suggests:¹⁰

• Knee arthritis: tai chi can help with pain, stiffness, function and balance. A national arthritis guideline strongly recommends it.
• Fibromyalgia: it lowered pain scores in a review of studies. It was also tied to less depression and better sleep.
• Low back pain: it may reduce pain and help daily function.
• Mood in older adults: a review found a small benefit for depressive symptoms in older adults with long-term health problems, though the studies had limits.
• Falls: it may lower the number of people who fall by about 1 in 5.

Side effects are usually minor, such as sore muscles. Instructors are not licensed, so ask about their training.¹⁰ Try our tai chi lessons or the short tai chi practice. Qigong and Baduanjin are related gentle options.

Other options with some evidence:²

• Yoga can help low back pain and may help neck pain. Its effect is similar to other exercise.
• Acupuncture works better than no treatment or fake (sham) acupuncture for back and neck pain.

Medicare and acupuncture. As of October 2026, Medicare Part B covers acupuncture only for chronic low back pain. That means back pain lasting 12 weeks or more with no known cause, such as cancer or infection. It covers up to 12 visits in 90 days, and up to 20 in a year if you are improving. You usually pay 20% after the Part B deductible. The provider must meet Medicare's license rules.¹²

Talk with your doctor before starting a new exercise or treatment, especially if you have heart disease, balance problems or weak bones. Don't use these practices to put off seeing a doctor about new or changing pain.^2,10 See strength and balance training for older adults and fear of falling.

Medicines: what to know

Medicines can be part of a pain plan. But for long-term pain, the CDC says treatments other than opioids are preferred.⁸ Your doctor may suggest other options first, depending on the kind of pain you have.

Medicines that may help both pain and mood. Some antidepressants also treat certain kinds of pain. For example, the FDA has approved duloxetine (Cymbalta) for depression and also for diabetic nerve pain, fibromyalgia and chronic muscle and joint pain.¹³ Like all medicines, it has risks. The label warns that older adults may be more likely to have low sodium in the blood, and that falls have been reported, with the risk appearing to rise with age.¹³ Older antidepressants called tricyclics can cause confusion and falls in older adults, so doctors decide case by case.⁸ Read more in antidepressant medicines.

Over-the-counter pain relievers. Medicines such as ibuprofen and naproxen (NSAIDs) need extra care in older adults. This is especially true with heart or kidney problems.⁸ Ask your doctor or pharmacist before taking them often. See medicines that can affect mood and memory.

Opioid cautions

Opioids are strong prescription pain medicines, such as oxycodone, hydrocodone, morphine and tramadol. They can help some people. But for long-lasting pain, the CDC says they should not be the first or routine choice.⁸ If an opioid is used, the doctor and patient should set clear goals for pain and function, and plan what to do if the benefits don't outweigh the risks.⁸

Things that raise the risk of harm include:^8,9

• Combining opioids with other sedating drugs. Taking opioids with benzodiazepines (anxiety or sleep pills such as lorazepam or alprazolam), other sedatives or alcohol can slow or stop breathing. The VA and Department of Defense guideline strongly recommends against using opioids and benzodiazepines together for chronic pain.⁹
• Falls. Sedating medicines raise the risk of falling. Doctors should keep this in mind when choosing them.⁸
• Kidney or liver problems can change how the body handles medicines.⁸
• Higher amounts. Higher doses carry more risk of breathing problems, overdose and death.⁸

Keep naloxone at home. Naloxone is a medicine that can quickly reverse an opioid overdose. Since 2023, Narcan nasal spray can be bought without a prescription at drugstores, grocery stores and online.¹¹ The CDC says doctors should offer naloxone to people at higher risk of overdose. Family members should know where it is and how to use it.⁸

Tips for living with pain and mood changes

• Keep a simple pain and mood diary. Note pain level, sleep, activity and mood each day. Bring it to visits. A memory notebook can hold this along with your medicine list.
• Pace yourself. On good days, avoid overdoing it. On bad days, do a little rather than nothing.
• Protect your sleep. Pain and poor sleep feed each other. See sleep in later life and CBT for insomnia.
• Stay connected. Isolation makes both pain and low mood worse. See ways to feel more connected.
• Watch alcohol. It can worsen mood and sleep and is dangerous with many pain and sleep medicines. See alcohol in later life.

Questions to ask your doctor

What is causing my pain, and what are my options?

• Is there a clear cause? Are there tests we should do?
• What treatments other than opioids could help my kind of pain?
• Would physical therapy, exercise or tai chi be safe for me?

Could depression or anxiety be part of this?

• Can you check me for depression or anxiety?
• Is there a medicine that could help both my pain and my mood?
• Can you refer me to a therapist who does CBT or ACT for pain?

Are my medicines safe together?

• Do any of my medicines raise my risk of falls, confusion or breathing problems?
• Should I have naloxone at home?
• If I want to cut back on a pain medicine, how would we do it safely?

When to get help

See your doctor if:

• Pain is new, getting worse, or changing in a way that worries you
• Pain keeps you from sleeping, moving or doing things you value
• You feel down, hopeless or anxious most days for two weeks or more
• You are taking more pain medicine than prescribed, or mixing it with alcohol or sleep pills

Ask about a referral to a pain specialist, physical therapist or a therapist trained in CBT or ACT for pain. Medicare Part B covers outpatient mental health care. See what Medicare covers for mental health and finding geriatric mental health care.

If you have thoughts of suicide, call or text 988. If someone is in immediate danger, call 911. A safety plan can help you prepare for hard moments.

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.