Low Back Pain, Chronic Pain and Depression

Clinical depression and back pain

Depression and chronic back pain are closely correlated conditions. Depression can lead to the onset of or worsening of back pain , and conversely, chronic back pain can lead to depression. The type of depression that often accompanies chronic pain is referred to as major depression or clinical depression. This type of depression goes beyond what would be considered normal sadness or feeling "down for a few days" and is a condition that needs treatment just as the back pain needs treatment.

Chronic pain and depression are two of the most common health problems that health professionals encounter, yet only a handful of studies have investigated the relationship between these conditions in the general population (Currie and Wang, 2004).

Research has found that clinical depression is up to four times higher in those with chronic back pain than in the general population (Sullivan, Reesor, Mikail & Fisher, 1992). In research studies on depression in chronic low back pain patients seeking treatment at pain clinics, prevalence rates are even higher. 32 to 82 percent of patients show some type of depression or depressive problem, with an average of 62 percent (Sinel, Deardorff & Goldstein, 1996). In a recent study it was found that the rate of major depression increased in a linear fashion with greater pain severity (Currie and Wang, 2004). These findings were recently confirmed in a June 2007 survey conducted on Spine-health.com, which found that 61% of those with chronic back pain also suffer from depression (N=642).

Depression is more commonly seen in patients with chronic back pain problems than in patients with pain that only lasts for a few days or weeks. A review of the host of symptoms typically experienced by the person with chronic back pain illustrates how this happens:

• The pain often makes it difficult to sleep, leading to fatigue and irritability during the day.
• During the day, patients with chronic back pain often spend most of their time at home. Often, since they are unable to work and have difficulty with most movement, they don’t get out and about with others. This pattern leads to social isolation and a lack of enjoyable activities.
• Due to the inability to work and often large health care expenses, there may also be financial difficulties that cause stress and may impact the entire family. • Beyond the pain itself, there may be gastrointestinal distress caused by anti-inflammatory medication, and a general feeling of mental dullness from the pain medications.
• The pain is distracting, leading to memory and concentration difficulties. • Sexual activity is often the last thing on the person’s mind and this causes more stress in the patient’s relationships.
• Other family members may need to take over household chores and other responsibilities that were previously handled by the person with back pain, which in turn can lead to depression and anger for the individual with back pain and to stress and strain in family relationships.

The above are just some of the typical consequences that develop when one has low back pain. Quite understandably, these symptoms accompanying chronic back pain may lead to feelings of despair, hopelessness and other symptoms of clinical depression.

The issue of lack of control can also play a major role in the development of depression for those dealing with chronic back pain. As discussed previously, chronic back pain can lead to a diminished ability to engage in a variety of activities such as work, hobbies and enjoyable activities, and normal interactions with family and friends. This situation leads to a downward physical and emotional spiral that has been termed "physical and mental deconditioning" (See Gatchel and Turk, 1999). As the spiral continues, the person with chronic back pain feels more and more loss of control over his or her life. The individual ultimately feels totally controlled by the pain, leading to major depression. Once in this depressed state, the person is generally unable to change the situation even if possible solutions to the situation exist.

Depression can lead to chronic back pain

For quite some time, clinical researchers have known that chronic back pain can lead to major depression, as discussed previously (See Worz, 2003 for a review). Newer studies are now looking at how psychological variables such as depression and anxiety may be linked to the onset of a back pain problem. For example: in a review of relevant research, Linton (2000) found that in 14 of the 16 reviewed studies, depression was found to have increased the risk for developing back pain problems.

Source: Spine-health.com – www.spine-health.com 
Last updated: August 31, 2007

This information and the information on Spine-health.com is not intended as a substitute for medical professional help or advice but is to be used only as an aid in understanding back pain and neck pain.

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