Coping with chronic pain, depression, and high blood pressure

Chronic pain makes everyday life more challenging, both physically and emotionally. Defined as pain that lasts for more than three months, chronic pain usually involves the muscles, bones, joints, or nearby tissues.

But this common condition - which affects at least a quarter of adults in the United States - may also be hard on your heart. New research suggests a link between pain and high blood pressure (hypertension), which may be driven in part by depression.

New evidence

Published in the January 2026 issue of Hypertension, the study included health data from more than 200,000 adults (average age 54) who were followed for about 14 years. Compared with people who reported no pain, those with chronic, widespread pain were 75% more likely to develop high blood pressure; those with short-term pain had a 10% higher risk. The study was an observational and cannot prove pain was the actual cause of hypertension.

However: "Chronic pain and depression often coexist, and both conditions are associated with physiologic stress responses that can contribute to elevations in blood pressure," says Dr. Danielle Sarno, assistant professor of physical medicine and rehabilitation at Harvard Medical School. The findings suggest that chronic pain is one more reason that adults should be routinely screened for both depression and high blood pressure.

Medications for chronic pain

Some medications can be effective for chronic pain, but it's important to note that oral anti-inflammatory drugs such as ibuprofen (Advil, Motrin) may raise blood pressure and have other side effects. For arthritis, topical anti-inflammatory medications such as diclofenac gel (Voltaren) applied directly to the joint often work well with fewer side effects than pills. Other medications such as gabapentin (Neurontin) and pregabalin (Lyrica) have less impact on blood pressure and are effective for nerve-related pain.

Antidepressant medications such as amitriptyline or duloxetine (Cymbalta) may be particularly helpful for people with both depression and chronic pain.

Drug-free ways to treat pain

Even when medications ease chronic pain, they may cause intolerable side effects or increase the risk for complications, especially when taken long term.

Nondrug therapies can help - on their own or in combination with other treatments. "Exercise is one of the most consistently beneficial treatments. For many people, it's helpful to work with a physical therapist, who can guide you in safely building your strength, mobility, and confidence and create an exercise program you can do at home," says Dr. Sarno. Other helpful lifestyle changes include a healthy diet, prioritizing restorative sleep, managing stress, avoiding risky substances such as tobacco and alcohol, and fostering positive social connections, she adds.

Psychological approaches

Psychological therapies that address negative thoughts and perceptions of pain also have proven benefits. One option is cognitive behavioral therapy for chronic pain, which teaches you to reframe your thoughts, emotions, and reactions to pain. That helps ease distress and improve function, especially in people with depression or other mood disorders.

Another option is mindfulness-based stress reduction (MBSR), a structured, eight-week program of meditation and mindfulness techniques that helps lower stress and emotional reactions related to pain. This approach enables people to take a more active role in caring for themselves and has been shown to dial down pain intensity and distress levels.

Growing evidence also supports pain reprocessing therapy, which focuses on how your brain interprets pain signals and helps reduce fear-based pain responses, Dr. Sarno says. This therapy can be particularly helpful for people with nociplastic pain conditions (such as fibromyalgia) that arise from altered processing of pain signals.

Other potentially helpful strategies include yoga, acupuncture, massage, and osteopathic manipulative treatment (a hands-on therapy performed by osteopathic physicians).

A multi-faceted approach

Creating an individualized plan that combines several types of nondrug therapies (along with medications, if needed) is an effective way to manage pain, says Dr. Sarno. You can also find pain management resources and educational sessions online through the virtual Functional Integrative Restoration (FINER) program, created by Dr. Jennifer Kurz, an assistant professor of physical medicine and rehabilitation at Harvard Medical School, in collaboration with Dr. Sarno.

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