Chronic pain and mood disorders can often go hand-in-hand. In fact, as many as 50% of people with chronic pain also have depression. It seems that one particular pair of conditions – depression and back pain – may be particularly widespread. Considering how often chronic pain and mood disorders can co-occur, this isn’t very surprising. After all, back pain is one of the most commonly-reported pain conditions, and depression is one of the most common mood disorders.
How many people are affected by depression and back pain?
Both depression and back pain afflict a large number of people. Over 26 million people in the United States suffer from back pain, making it the leading cause of disability among people in the U.S. under the age of 45. People who have low back pain are commonly in poorer physical and mental health than people without low back pain.
Around 20.9 million people in the United States suffer from some sort of mood disorder. Out of these people, a whopping 14.8 million have depression. Depression can (and often does) co-occur with other mood disorders, as well as with illnesses, pain, and medical conditions.
Why do they occur together?
Back pain and depression often co-occur, largely because it’s possible for each condition to cause (or worsen) the other.
Dealing with chronic back pain can cause a lot of stress. Back pain can even affect a person’s ability to work, interfere with relationships, and chip away at self-esteem. Sleep can be disrupted by back pain, and the ensuing fatigue can further decrease quality of life.
Back pain can also make physical activity difficult or unappealing. Even if, in the long run, physical activity might help with back pain, it can initially be hard to get started or cause some aches and pains. Lessened physical fitness can further reduce self-esteem and interfere with relationships.
Aside from the effects of back pain, the pain itself can increase the risk of depression. It’s easy to focus on pain, which can magnify its effects. The higher the perception of pain is, the more likely it is to cause depression. Once depression has set in, it can cause emotional interpretations of pain, which lead to increased perception of pain. In other words, pain worsens depression, and depression worsens pain, which further worsens pain. As is obvious, the cycle can go around and around, worsening steadily over time if there is no intervention.
Just as back pain can lead to depression, depression can lead to back pain. Sleep disturbance, social withdrawal, difficulty at work, lowered self-esteem, and withdrawal from activities can all occur with depression. Additionally, many people experience physical symptoms, like pain, as a result of depression. Indeed, for some people, physical pain may be the primary symptom of their depression.
Also, some overuse or abuse of some medications can lead to depression. Opioids, for instance, are a pain medication, but they carry a high risk of abuse, addiction, and depression. Unfortunately, when depression is causing or contributing to back pain, treating the back pain is unlikely to work unless paired with treatment for depression.
This can lead to feelings of hopelessness about ineffective treatment, which can further exacerbate depression and the risk for overuse of pain medications.
Recent research suggests there may be deeper reasons for the common co-occurrence of back pain and depression.
A study carried out by researchers at UC Irvine and UCLA examined the brains of rodents with chronic pain. They found that chronic pain can cause brain inflammation. This pain-derived brain inflammation causes faster growth and activation of a type of immune cell, called microglia. Microglia cells trigger chemical signals that restrict dopamine release. Dopamine aids in controlling the reward and pleasure centers of the brain, but it’s also involved in pain responses. As noted on Scientific American’s blog, it’s also involved in depressive behavior:
“[D]opamine could also be important in major depressive disorder. People with depression often exhibit reduced motivation, anhedonia (a decrease in pleasure from usually enjoyed things), sometimes motor decreases as well. All of these are linked with dopamine.”
Opioid pain medications also work by triggering the release of dopamine. However, the pain-derived brain inflammation and its resultant increased microglia cells mean that opioids can fail to trigger a dopamine response. This explains why opioids are often ineffective in treating chronic pain. If further research can continue to explain the mechanisms behind the relationship between chronic pain and depression, a targeted, more effective therapy can be developed.
Researchers are also considering the possibility of genetics playing a role. Data concerning over 2,000 twins was analyzed to look for genetic factors relating to both back pain and depression. Interestingly, the group with the strongest association between back pain and depression was the non-identical twin group. When identical pairs of twins were considered, the association disappeared.
Treating depression and back pain
Just as the development of back pain and depression can go hand-in-hand, treatment for these conditions can work together, too.
Treating a person’s pain while ignoring his or her depression can prove ineffective, and treating his or her depression while ignoring his or her pain can be ineffective, too. However, just because treating one or the other may not solve both issues completely doesn’t mean it can’t help, as explained at Everyday Health:
“What’s interesting about back pain and depression is that they seem to be so closely tied that getting depression relief may actually lead to back pain relief… On the flip side of the coin, getting back pain relief can also help the depression improve.”
Therefore, treating one or the other is much better than treating neither.
The best case scenario, though, is undergoing treatment for both back pain and depression. The first step in getting treatment is discussing all issues, physical, mental, and emotional, with a primary care physician. From there, the physician should be able to suggest specialists and coordinate treatment for both conditions.
But, one of the first steps to treating it is actually knowing if you have depression to begin with. Here’s how to diagnose this condition.
How to diagnose depression
You find yourself snapping at your kids. Maybe your temper flares more often in traffic. You don’t seem to have as much patience as you normally do, or small things get under your skin more than they used to. On top of that, your back has started hurting right around your shoulders, so much so that it can be hard to fall asleep at night. The signs of depression don’t always show up on a billboard; you may be suffering from depression and not realize it. One in four people suffer from some form of mental illness in their lives, but we still have a hard time bringing this “hidden illness” into light. Here are a few ways to do that.
What to watch for
Depression can manifest itself in sometimes hidden ways. The most common signs of depression are:
- Changes in appetite
- Changes in sleep habits
- Low energy or fatigue
- Withdrawal or social isolation
- Feelings of worthlessness
Some people may experience these common signs in uncommon ways, such as:
- Increase in anger or irritability: You may be short-tempered or quick to anger or snappish
- More mood swings: You may find yourself going from one extreme to another in a flash
- Anxiety in social situations: You may experience anxiety in situations where you previously felt none
- Physical pain not related to injury: Pain in the hips, lower back, and shoulders indicate chronic clenching or stress
Some of these may be triggered by traumatic events. Some may be as a result of treatment for another condition. Regardless, it is important to talk to your doctor if these symptoms persist. Consider this first meeting a fact-finding session more than a diagnosis, and go in with an open mind (and heart).
Talk about it
If you have suffered from periods of depression or anxiety, it can be helpful to others going through a similar experience to know they are not alone. Depression can be socially isolating. The depressed person often feels alone and may question if anyone cares about them. Remind them that they are loved, you get it, and you are here for them. Often a person suffering from depression is plagued with the idea that they are their illness.
National Institue of Mental Health director Thomas Insel believes we should discuss mental illness in the same way we discuss things like cardiovascular disease, noting:
“We need to talk about mental disorders the way we talk about other medical disorders. We generally don’t let having a medical illness define a person’s identity, yet we are very cautious about revealing mental illness because it will somehow define a person’s competence or even suggest dangerousness.”
Don’t ignore it
Ninety percent of people who commit suicide suffer from mental illness, often undiagnosed. If you or someone you love is showing signs of depression that are persistent and lasting longer than two months, it is important to not ignore it.
There are ways to ease into conversations about sadness and depression, but sometimes we feel awkward and uneasy, especially when the depression may be related to grief or a traumatic event. When someone has died, we may hesitate to bring up that person for fear of “triggering” depression, but chances are good that talking about it may be just the thing that encourages someone to seek help.
Depression and back pain are a complicated and often related set of conditions. If you suffer from these conditions, head to the comments to share how you’ve dealt with them in your own life.