Physical and mental health is interrelated and distress in one can cause distress in others. Chronic back pain and depression is an example of one such case.1 Living a life with chronic back pain is burdensome and frustrating. Experiencing depression along with back pain, acts like a salt to the sore. Chronic back pain is a kind that’s lasts for more than 6 months or even years together. There can be specific reasons for cause of back pain such as an injury or trauma, overuse, ageing, or a serious disease or disorder. However, at times it might happen without a definite cause.
How Back Pain Can Cause Depression?
People experiencing chronic back pain can have hormonal abnormalities, low energy, mood changes or disorders, altered physical and mental abilities and muscle pain. Back pain patients often have difficulty sleeping and frequent awakenings leading to feeling drowsy or fatigue in day time and thus lower their productivity.2 This in turn along with the ongoing pain increases irritation making it difficult to deal with people around. The overwhelming feelings can thus cause depression with symptoms like low mood, loss of interest in activities, inability to experience pleasure in activities which was once pleasurable. Interestingly, the depression itself could worsen the chronic pain making a vicious circle which is difficult to breakthrough! The situation gets even worse if he/she has a child to look after or a full-time work.
Type Of Depression And Its Symptoms Linked To Back Pain
The type of depression which is generally associated with chronic back pain is Major Depressive Disorder (MDD), which is commonly known as clinical depression or major depression. It is usually characterized by symptoms like:
- Depressed mood on most of the days
- Increased or loss of appetite 3
- Losing or gaining weight 3
- Loss of pleasure in daily activities
- Decreased sex drive 4
- Feeling worthless or hopeless
- Difficulty concentrating
- Poor memory
- Suicidal thoughts or thoughts of being dead
- Somatic sensations.
Research Findings – Studies To Support The Link Between Back Pain And Depression And Its Statistical Correlation
Studies conducted by Sullivan et. al. (1992) found that the risk for major depression in patients with chronic pain is four times higher than that in the general population. Siel et. al. (1996) found that as high as 32 to 82 percent of people taking a treatment in a pain clinic show symptoms of depression. An interesting research conducted by a team from Saint Louis University Medical Center confirmed that even drugs prescribed by physicians to relieve pain can also trigger depression. The study concluded that patients using opioid drugs for 90-180 days have an increased risk of 25% of developing depression, while those using the drugs for 180 or more days have a 53% increased risk of developing the major depressive disorder.
Treatment For Back Pain and Depression Linked To Back Pain
Often depression in patients with chronic back pain remains undiagnosed and thus untreated. Physical pain and its complaints remain the major concern in every visit to the physicians. The result is lack of proper sleep, loss of appetite, decreased physical activity due to back pain and depression and the worst being in depression itself increases the pain. Thus an integrative and collaborative approach is required to treat the back pain and depression associated with back pain.
Treatment for Back Pain
- Non-invasive Non-drug Management of Back Pain: These include physical therapies like exercise, water therapy, aerobic exercise, stretching’s, etc; Manual therapy by applying pressure on the affected areas; using of cold and hot packs; Electrotherapy, most commonly TENS, ultrasound or laser treatments.
- Non-invasive Pharmacologic Management of Back Pain:The most common types include
- Analgesics for reducing pain
- Antidepressants and Anticonvulsants for treating neuropathic pain
- Neuromodulating medications for treating muscular and neuropathic pain
- Non-steroidal anti-inflammatory drugs (NSAIDs) for reducing inflammation
- Muscle relaxants for soothing or releasing muscle spasms caused by prolonged pain.
- Invasive Treatment of Back Pain:This type of management plan includes the following:
- Injections: With this type, steroids or analgesics are directly injected into the ligaments, muscles or joints to give a temporary relief from pain.
- Radiofrequency radioablation: This involves pricking a painful nerve with a small pre-heated needle for deadening it. It usually gives a relief for months to years.
- Surgically implanting Electrotherapy devices: These include implanting a spinal cord stimulators or a peripheral nerve stimulator surgically. Typically it is found to be useful for hand and leg pain but not for spinal cord related pain.
Treatment for Depression Linked To Back Pain
- Antidepressants For Treating Back Pain Induced Depression: Depending on the level of depression, the psychiatrist might prescribe you antidepressants to reduce the symptoms of depression.5 The antidepressants also help in reducing the chronic back pain.
- Counseling: It helps in patients being able to describe their current emotional state, difficulties faced in socializations due to back pain, etc.
- Cognitive Behavioral Therapy For Treating Back Pain Induced Depression: It is a type of psychotherapy used to treat both pain and depression. The focus is on the thought processes which tend to maximize or minimize a pain. The errors or negative thought or a thought block is tried to modify which helps in changing the perception of the present problem in hand.
- Relaxation Techniques For Treating Back Pain Induced Depression: It helps in relaxing the mind and the body including the muscles thus aids in reducing depression and relieving pain to a great extent. The techniques included are breathing exercises, progressive muscle relaxation therapy, meditation etc.
- Alternative Therapies: Alternative therapies include acupuncture, massage, shiatsu, yoga, dance movement therapy.
Self Help and Prevention of Back Pain and Depression
- Exercise: A regular exercise keeps the mind and body fresh, alive, strengthens the back muscles, reduces back spasms, and increases flexibility of the spine which helps overcome and prevent back pain. It increases and deepens the connection between with mind and body.
- Being Active: Staying active and engaged in activities helps in keeping back pain and depression away. It keeps the individual socially engaged thus preventing isolation due to back pain.
- Diet: A healthy diet provides all the necessary proteins, vitamins, fibers and minerals which help in treating both the conditions. People with chronic back pain and depression should try to avoid or limit the intake of caffeine and alcohol. Certain foods which are thought to increase inflammation or musculoskeletal problems are dairy products, gluten, and starchy food like potatoes, tomatoes, eggplant, etc. and thus the intake should be limited. However, consult the physician before planning a diet as there might be specific deficiencies in the body which needs to be checked beforehand.
- Sleep: A good and sound sleep is the key to good health. It relaxes the body in the best possible way and reduces pain and depression symptoms.
- Stress-free Life: Living a life free of stress is though difficult in today’s world, however finding ways to reduce it is very important when the life is surrounded by pain and depression. Identifying the stressors can help a lot in finding out what aggravates the pain in the back and depression linked to back pain. Relaxation techniques can do wonders in reducing the stress and eliminating back pain induced depression.
- Communicating: Talking to physician in details about the symptoms of depression is very important. If depression is left untreated, many a times the treatment directed at pain only might not help in giving relief since depression also increases the back pain. Thus to get an effective treatment, the physician needs a detailed knowledge of the problems experienced. Moreover, communicating to family and friends is also important to stay fresh and emotional healthy. It might also help if some of your work could be handled by others and you can get some more rest which is required for your effective healing process.
Chronic back pain along with depression is often too difficult to deal with and usually takes a long time to be treated completely. However, if the symptoms of depression is neglected and thought that it would subside if the back pain reduces, then the situation might become even worse. Thus to get the most effective treatment and the maximum relief, communicate with the physician and update him/her with all the details that you notice and ensure an integrative treatment plan which will help you to live life better and happily.
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