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  • Writer's pictureDr. Bonnie Verhunce

What's the Link Between Chronic Back Pain and Depression?

Over the past few decades, healthcare researchers and clinicians have come to recognize that physical, psychological and emotional well-being are very closely linked and that they can influence each other in very complex ways. Some refer to this general idea as the "mind-body" or "brain-body" connection. While science doesn't fully understand all of the relationships and feedback mechanisms involved, we have learned a great deal about some patterns-including a link between chronic pain and depression.

Back pain can be crippling. It's difficult to get out of bed, you can't take part in the activities you used to enjoy, and you may feel like you're trapped. Depression can present the same types of symptoms. And it's obviously even more challenging to suffer from both simultaneously. Yet this is what often occurs. In fact, depression is the emotion most frequently reported by people suffering from back pain. Statistics illustrate the seriousness of this issue: Close to 31 million Americans suffer from lower-back pain at any given time. Nearly half of all people who suffer from chronic back pain also report symptoms of depression, and some researchers suggest that this number may be as high as 85%.

With chronic pain, it's not unusual for heightened levels of tension and anxiety to become constant. As time passes, this unrelenting stress can trigger a wide variety of symptoms often associated with depression. Patients may experience exhaustion, sharp mood swings, reduced self-esteem, and relationship problems as well as general physical decline, sleep disorders, and weight gain (or loss).

And while the healthcare community generally recognizes that chronic back pain can cause depression, there is also some evidence that it can happen the other way around, too-that depression can cause chronic back pain. Physical symptoms are actually quite common in people who suffer from depression. A study conducted by the World Health Organization (WHO) found that of the 1,146 patients surveyed and diagnosed with depression, 69% reported that physical symptoms were the only reason for their visit to the doctor. Given this fact, it's not surprising that false diagnoses are also quite common.

Writer Dr. Marc Browner, a chiropractor and co-owner of Windmill Health Center in Weston, Florida, "This link between back pain and depression is believed to be caused by a shared neurological pathway. The brain moderates pain stimuli by releasing serotonin and norepinephrine, which also play a role in affecting mood. People with a neurotransmitter deregulation may also exhibit an imbalance of serotonin and norepinephrine, which can lead to a heightened sensitivity to pain. This suggests that there may be a chemical reason why people diagnosed with depression also complain of physical pain, especially in their joints, neck, and back."

So what can patients do to end this vicious cycle of chronic back pain and depression? And how can their support networks (family, friends, coworkers and healthcare providers) be as helpful as possible? When dealing with both depression and back pain, it is important to:

* Recognize that that the two problems-pain and depression-are often inextricably linked. Many healthcare professionals believe that you cannot reliably address both conditions by treating only one. "Rather, it is best to treat both conditions simultaneously for the most effective results," notes Dr. Browner. He continues, "A study published in the Journal of the American Medical Association found that combining antidepressants with a pain management program was an effective way to relieve both depression and pain." You and your doctor (or doctors) must create a treatment plan that targets both issues simultaneously. * Use all the tools at your disposal. Depending on your specific situation, this may include chiropractic adjustments, spinal decompression, massage therapy or laser pain relief treatments. It may also include supervised stretching, exercise or nutritional programs. Finally, your healthcare team may recommend stress management or relaxation techniques as well as counseling sessions and/or antidepressant medications. * Try to normalize your life as much as possible. Says "Multidisciplinary treatment of the chronic back pain and major depression will ultimately give the patient more of a sense of control over the pain and start a 'positive spiral' toward physical and mental re-conditioning."

If you're dealing with chronic back pain and depression (whatever the underlying cause), having a multidisciplinary healthcare team to guide your recovery may be your best option. However, seeking holistic treatment like this may seem like a very tall order.

Don't be afraid to consult with your general practitioner and Dr Bonnie about your condition and to ask for their advice and help in coordinating care. The sooner you get the treatment you need, the sooner you can get out of pain and start living your life again!

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