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Depression or anxiety secondary to chronic pain

Do you need a nexus letter for depression, anxiety or another mental health condition which is secondary to your already service connected physical condition(s) that cause chronic pain? Dr. Finnerty would be happy to help by reviewing your medical evidence and the associated scientific research.

Sample nexus letter statements/research related to depression and/or anxiety due to chronic pain that Dr. Finnerty may use:

It is well-known that chronic pain leads to depression. This is supported by the research literature. Sheng, et. al. (2017) [see The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain; Neural Plasticity; 2017: 9724371] noted “Chronic pain, as a stress state, is one of the critical factors for determining depression, and their coexistence tends to further aggravate the severity of both disorders.” The authors note that “In recent years, studies have found considerable overlaps between pain- and depression-induced neuroplasticity changes and neurobiological mechanism changes. Such overlaps are vital to facilitating the occurrence and development of chronic pain and chronic pain-induced depression.” The authors note that “pain and depression are closely correlated from the perspectives of both brain regions and the neurological function system, whereby chronic pain may lead to depression. One of the important causes for chronic pain leading to depression appears to be the crucial effect of common neuroplasticity changes on the occurrence and development of the two disorders in question.”

Different aspects of pain negatively affect several depression outcomes. Increasing pain severity, pain that interferes with daily activities, frequent pain episodes, diffuse pain, and pain that is refractory to treatment are all associated with more depressive symptoms and more severe depression. Additionally, as pain severity worsens, other depression outcomes such as functional limitations, health-related quality of life, and work function are adversely affected. Pain with comorbid depression also appears to be additive in terms of an increased number of medical visits and higher health care costs. The prognosis of comorbid depression and pain is poor compared with the prognosis for individuals with depression without pain. Depression complicates the management of patients with pain and is associated with poorer outcomes. In patients with pain, depression is associated with more pain complaints, greater pain intensity, longer duration of pain, and greater likelihood of nonrecovery. Additive impairments in social function, work function, and functional limitations (eg, limited mobility and restricted activity) are seen when depression and pain coexist. Depression also predicts increased health care utilization, poorer adherence to treatment, worse patient satisfaction, and future episodes of pain. The combination of depression and pain is associated with worse clinical outcomes than either condition alone [see Bair, et. al. (2003) Depression and Pain comorbidity: a literature review; Archives of Internal Medicine; 163(20)2433-2445].

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You can reach out to Dr. Finnerty by completing this form here: Free Consultation – Nexus Letters from a Psychologist