The link between depression and chronic back pain

According to the DSM-IV (1994), a diagnosis of major depression requires the presence of the following symptoms occurring daily for a minimum of two weeks, with at least five of the following being experienced:

• Persistent mood characterized by feelings of depression, sadness, hopelessness, low mood, or irritability, which may be accompanied by occasional episodes of crying.
• Significant change in appetite resulting in either noticeable weight loss or gain, or a noticeable increase or decrease in appetite.
• Disturbances in sleep patterns, which may manifest as excessive sleep (hypersomnia) or insufficient sleep (hyposomnia).
• Restlessness (agitation) or feeling of being slowed down (fatigue or low energy).
• Loss of interest or pleasure in activities that were previously enjoyable or engaging.
• Decreased sexual desire.
• Feelings of worthlessness and/or guilt.
• Difficulty concentrating or experiencing problems with memory.
• Recurrent thoughts of death, suicide, or a desire to be deceased.

It is important to note that these symptoms must be consistently present and significantly impairing an individual’s daily functioning in order to meet the criteria for a major depressive episode.

Health professionals frequently encounter chronic pain and depression, yet only a limited number of studies have explored the relationship between these conditions in the general population (Currie and Wang, 2004) [2].

Individuals with chronic back pain are believed to be four times more likely to experience major depression compared to the general population (Sullivan, Reesor, Mikail & Fisher, 1992) [3]. Moreover, research conducted on chronic low back pain patients seeking treatment at pain clinics reveals even higher rates of depression. Between 32 to 82 percent of patients exhibit some form of depression or depressive symptoms, with an average prevalence of 62 percent (Sinel, Deardorff & Goldstein, 1996) [4].

Recent findings demonstrate a direct correlation between pain severity and the incidence of major depression, with a progressively higher rate of depression observed as pain intensity increases (Currie and Wang, 2004) [2]. Furthermore, the combination of chronic back pain and depression is associated with greater disability compared to experiencing either depression or chronic back pain alone.

Depression is a common occurrence among individuals dealing with chronic back pain compared to those with acute, short-term pain.

The development of depression in such cases can be attributed to a range of symptoms frequently experienced by individuals with chronic back pain or other spine-related discomfort.

Firstly, the pain itself often disrupts sleep, resulting in fatigue and daytime irritability. Additionally, the limitations imposed by back pain make patients move cautiously and slowly, leading to reduced social interaction and a lack of engagement in enjoyable activities, which can contribute to feelings of social isolation.

Furthermore, the inability to work due to chronic back pain may cause financial difficulties that impact not only the individual but also their entire family. Additionally, the use of anti-inflammatory medications can lead to gastrointestinal distress, while pain medications can induce a general sense of mental dullness, further exacerbating the challenges faced by individuals.

The persistent pain also serves as a distraction, making it difficult to concentrate and affecting memory function. Moreover, the decreased interest in sexual activity due to the pain adds additional stress to the patient’s relationships.

Understandably, these symptoms accompanying chronic back pain or neck pain can lead to feelings of hopelessness, despair, and other symptoms associated with major or clinical depression.

A recent study conducted by Strunin and Boden (2004) [5] examined the family consequences of chronic back pain. The findings revealed that patients experienced various limitations in their family and social roles. Physical constraints hindered their ability to perform household chores, take care of children, and engage in leisure activities with their spouses. Consequently, spouses and children often assumed the responsibilities previously handled by the individual with back pain. These changes in family dynamics frequently led to depression and anger among the individuals experiencing back pain and resulted in stress and strain within family relationships.

At Advanced Pain Diagnostic & Solutions, we can help with your chronic back pain and with your depression. Contact us to learn more!