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It could easily be both, though there certainly is research indicating depression causes physical pain. However since many of these studies only found correlations it's only clear that they come together and not whether one causes the other. One way of isolating that issue would be to determine the rates of depression in people with unambiguously diagnosable chronic pain disorders due to a root physical cause vs both the population and the population of those who report chronic pain.



Chronic pain definitely negatively impacts mood.

Except for phantom pain, I think it's generally best to assume pain has a physical cause and pain negatively impacts mood, not the other way around.

And I've had phantom pain. I think even there, it's likely a physical cause, but mirror therapy is still known to help for some cases.




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