Depression and Back Pain – How Back Pain Can Ruin Your Life

how back pain can ruin your life depression chronic painMost people are free of daily chronic pain such as can occur with spinal stenosis and so don’t understand how back pain can ruin your life, affecting your work, relationships, family, and recreation. Chronic pain of any kind is associated with an increased rate of depression, with back pain found to increase the likelihood of a patient also being depressed by six times. Around 6% of pain-free people suffer from major depression according to a rigorous community health survey conducted in Canada in recent years. The rate of major depression in those with chronic back pain? Nearly twenty percent. Yet only a small number of studies have looked at the relationship between back pain and depression and patients often receive little help for either condition.

Back Pain and Depression – A Common Combination

A study done by Currie and Wang in 2004 used data collected from 118,533 household residents in Canada with information on their lifestyle, medical conditions, and demographics available for analysis. Chronic back pain (lasting 6-months or more and diagnosed by a health professional) was identified in 9% of those providing information, and rates of major depression were 5.9% for pain-free individuals, and 19.8% for those with chronic back pain. What’s more, the more severe the back pain the greater the associated rates of major depression. Back pain was the strongest predictor of depression in patients even after adjusting for confounding factors such as other medical conditions and socioeconomic status. Those with both depression and chronic back pain had higher rates of disability than those with either condition alone. So how is it that chronic back pain can cause such suffering?

Pain Intensity, Duration, and Depressive Symptoms

Research by Von Korff, et al (1998) found that symptoms of depression were more common in those with chronic pain than those free of pain, with the incidence of depression correlated with the degree of interference the pain caused and the number of pain sites rather than the intensity of the pain as such. The World Health Organization (WHO) also looked at the psychological ramifications of chronic pain and found that 32% of those with somatoform pain disorder also met criteria for a depressive disorder (Von Korff and Simon, 1996).

how back pain can ruin your life

The seemingly never-ending cycle of back pain and depression.

Symptoms of Depression

Signs of depression include loss of interest in previously enjoyed activities, fatigue, sleeping problems and difficulties concentrating, weight gain, weight loss, feelings of worthlessness, suicidal thoughts, and depressed mood. For those with chronic back pain it might be easy to see why depression is easily missed in such patients. Many of these symptoms overlap as chronic back pain can reduce the ability to engage in previously enjoyed activities, can make you feel a burden to those around you, often disrupts sleep, may lead to weight gain through reduced activity, and could cause weight loss if you are unable to adequately provide for yourself due to problems shopping and cooking. You may have even experienced an accident or trauma of some kind that resulted in your back pain and, later, in depression, anxiety, and even post-traumatic stress disorder. The difference, perhaps, between those suffering from these symptoms of depression due to a chronic medical condition, and those diagnosed with major depression alone is that the latter condition is much more likely to be addressed and attempts made to resolve the problem.

Causes of Depression and Back Pain

Oftentimes, patients with chronic pain feel unable to mention their struggles with the pain to their physician. After all, it is perfectly reasonable that a major change in your lifestyle, your ability to work, your capacity to go hiking, cycling, play with your kids, or dance, may result in feelings of despair and sadness. In some ways we may even see those who don’t despair at their diagnosis of a chronic pain condition as being in denial, or not fully comprehending their situation. Why then would a doctor bother with diagnosing depression in a patient who could be said to have a reason to be depressed?


Misdiagnosis of Depression with Back Pain

One of the major issues here is that not all patients with chronic back pain are depressed, meaning that it is not an inevitable consequence of the condition. Secondly, where depression does arise it may not even be related to the chronic back pain at all. Just as those with fibromyalgia may have a new symptom of intense fatigue dismissed as part of their condition, those with chronic back pain may simply have their depressed mood chalked up to their chronic pain. The patient with fibromyalgia may go years without having the real cause of their fatigue identified and it could be as simple as iron-deficiency anaemia, or a problem with their medications. This may also be true of the patient with chronic back pain and depression; the depression may be a sign of an imbalance in neurotransmitters, a side-effect of their own pain medication, or a consequence of a major life event that is dismissed or ignored as a potential cause of their symptoms.

Why Does It Matter?

Clearly it is important to try to reduce the incidence of depression wherever possible and it matters particularly in those with chronic back pain because it can also adversely affect their back health and even make both conditions worse in the long run. Depression can be worsened by pain and the perception of pain is also often worsened by depression. Chronic back pain can ruin your life by tipping you into a cycle of depression and pain and increased perception of pain as well as affecting your motivation to take care of your general health, nutrition, exercise, and attendance at medical appointments and pain-management clinics.

What to Do if Back Pain is Ruining Your Life

back pain and depression support group

Join a support group to meet others suffering from back pain and depression.

Talk to people about your pain, whether this means friends, family, doctors, fellow patients in a support-group, or a private therapist. Don’t simply accept that you should be depressed because back pain has changed your life and limited your options. It is a far cry from accepting the reality of your situation to reaching a point of despair where nothing seems worth doing. Know that your symptoms of chronic back pain may actually feel worse when you’re depressed and that feeling better within yourself could actually mean you need less pain medication, fewer hospital visits, and that you get more out of your life. One of the major concerns of those with chronic back pain is that admitting that they are in pain will make them appear weak and unable to do their job or look after their family. Admitting that you need help is not a sign of weakness, asking others to support you through a difficult time is a display of strength and it also helps you avoid having to make excuses at work or when missing social engagements. People are much more understanding of someone who comes clean about their chronic pain than someone who simply appears flaky, irresponsible, and secretive.

Dealing with Depression and Chronic Back Pain

Depression is not an inevitable consequence of chronic back pain, you may have other things going on in your life that have caused you to feel depressed. Talking your situation over can help you identify the source(s) of your feelings and maybe even highlight opportunities to change things for the better. It may be that antidepressants can help, or that a change in diet, exercise, and even the simple act of getting outside in the sunshine more regularly makes a big difference to how you feel. Patients suffering from chronic pain often impose strict limits on themselves and go from being sociable and active to reclusive and reluctant to engage in previously enjoyed fun. Many things may now not be unrealistic but the importance of interacting with others, being part of a community, having close friends, loving family, and feeling needed, wanted, and useful are all still relevant even with chronic back pain. Yes, back pain can ruin your life, but realizing that it doesn’t have to is a major step back to happiness.

References


Currie, S.R., Wang, J.L., (2004), Chronic back pain and major depression in the general Canadian population. Pain, Vol.107, pp.54–60.

Von Korff, M., Simon, G., (1996), The relationship between pain and depression. Br J
Psychiatry, Vol. 168, (Suppl. 3), pp.101–8.

Von Korff, M., Dworkin, S.F., LeResche, L., Kurger, A., (1998), An epidemiologic
comparison of pain complaints. Pain, Vol.32, pp.173–83.

3 replies

Trackbacks & Pingbacks

  1. […] to developing feelings of sadness, fatigue, and isolation. More recent research even suggests that depression can actually lead to some forms of back pain. But what is the exact link between psychological and physical ailments, and what separates […]

  2. […] problems of self-esteem and motivation, poorer physical health through reduced exercise, and depression, anxiety, and stress that can then create a vicious cycle with regards to back pain. Richard A. […]

  3. […] may be that sleep deprivation is also a trigger for the condition, as can be chronic infection and depression. Spinal stenosis itself may result in myofascial pain syndrome through radiculopathy and muscular […]

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *