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Back Pain and Depression: What’s the Connection?

POSTED BY: Florida Hospital

Sufferers of chronic back pain often exhibit signs of depression, and it’s not hard to understand why. After all, severe and unrelenting pain can wear you down by keeping you from sleeping and eating well, adding to your daily stress, preventing you from being physically active, and discouraging you from participating in hobbies or social activities that you enjoy.

All of these take a toll on your emotional well-being – even more so if you’ve previously received treatment for a spinal condition only to have your pain return in full force. And keep in mind that some medications for controlling back pain may also contribute to depression symptoms.

Studies have concluded that the more severe back pain a person has, the more likely they are to experience depressive symptoms – so you’re not alone if you feel like your back problems are keeping you down in more ways than one.

While chronic back pain can cause depression, depression can also cause back pain.

In fact, body aches (including backaches) are a common symptom of depression, and research has shown that people with severe depression actually feel pain more intensely than others. Some studies have suggested that depression causes increased pain and inflammation via proteins known as cytokines, which are known to affect immune system responses to infection and disease and appear to be present in higher levels in depressed patients.

Moreover, not unlike chronic pain, depression itself can cause the kind of fatigue that prevents you from exercising and strengthening your core muscles, which in turn puts added stresses on the disks, joints and ligaments in your back, making you more susceptible to low back pain, muscle strains and other injuries.

So when we say that depression can actually cause back pain, we don’t mean that the pain is all in a patient’s head. We mean that the chemical processes and physical effects associated with clinical depression can contribute to the presence and/or severity of a person’s very real back pain.

Depression may have an adverse effect on patients recovering from spine surgery.

Research indicates that depression, anxiety, negative thought patterns and even certain personality traits can have a negative effect on patient outcomes following spine surgery. This is believed to be due to the impact that such psychological factors have on motivation, sleep quality, adherence to a physical rehabilitation program and the ability to perceive improvements – all of which play a role in the healing process. So it’s important to talk to your doctor about depression signs and symptoms that you may have noticed in addition to your back pain. These include feelings of sadness, hopelessness, irritability, and overwhelming fatigue, along with sleeping problems, difficulty concentrating, loss of appetite, overeating or thoughts of death and suicide.

Treating patients with chronic back pain and depression requires a comprehensive approach.

Depressed patients who seek treatment for chronic back pain usually think of their condition in terms of “If I can just get rid of this pain, I’ll feel fine again,” – and to some extent, they may be right. However, when you understand how thoroughly pain and depression are interrelated, it makes sense to treat both conditions as part of your overall plan of care. That’s particularly true of patients who may be considering spine surgery, in order to give them the greatest potential for optimal postoperative results and rehabilitation.

Treatments for spine patients who display signs of depression may include psychological counseling, relaxation training, and behavioral therapy, as well as the use of low-dose antidepressants. Such medications can reduce depressive symptoms as well as back pain because of the way they work to inhibit the reuptake of neurotransmitters within the brain (serotonin and norepinephrine) that are associated with a person’s mood and pain perceptions.

Another key to treating depression and low back pain is regular aerobic exercise, which stimulates serotonin levels in the brain and spurs the release of feel-good endorphins to relieve both depression and pain. While you should always check with your doctor prior to beginning a new exercise program, the benefits that proper exercise offers in terms of reducing stiffness and pain, strengthening core and back muscles, improving flexibility and boosting a person’s mood and self-esteem are indisputable.

The multidisciplinary team at the Spine Health Institute provides integrated pain management including the services of a licensed clinical psychologist.

At the Spine Health Institute, orthopedic surgeon Dr. Chetan Patel, MD, frequently see patients who have endured years or even decades of chronic back pain without relief, along with mild to severe depression symptoms.

Understanding that one of the most common symptoms accompanying chronic back pain is depression, Dr. Patel's approach to patient care includes the services of licensed clinical psychologist Charles Lammers, Ph.d. Dr. Lammers specializes in helping patients with pain and other complex medical issues to effectively manage their response to their pain so that they can focus on their overall rehabilitation plan and reduce their need for medical intervention in the future.

The Spine Health Institute's medical staff also includes physicians specializing in pain medicine and injection therapies designed to provide short-term physical relief from inflammation and pain in order to allow patients to engage in physical rehabilitation that is essential to the overall healing process for both depression and back pain. In every instance, their focus is on restoring patients’ ability to feel and function better through the least invasive and most comprehensive, effective medical care.

Click here to find out more about the Spine Health Institute's pain management programs and arrange for a consultation with one of our spine health specialists.