Can Depression Cause Back Pain?

While it's common for patients with chronic pain to suffer from clinical depression, it's a lesser-known medical fact that depression can also cause and exacerbate neck and back pain. This article chronicles the reasons behind back pain found in sufferers of clinical depression and examines some of the possible solutions.

Symptoms

• Depression can be a pain in the neck---literally.
  The American Pain Foundation says that 65% of people who suffer from clinical depression also experience some kind of chronic pain in the back or neck. It turns out that chronic low back pain caused by strain, injury or disease can also lead to depression---or vice-versa. It's a which-came-first story featuring the chicken and the egg, a vicious, self-fueling cycle that can cause serious physical and mental damage if left untreated.

Causes

• How does the cycle begin?
  In a 2004 study published in the journal Pain, University of Alberta professor Dr. Linda Carroll discovered that, out of a study composed of 800 adult men and women, participants with clinical depression are four times as likely to suffer debilitating, chronic pain in their neck and back than those without.
  According to the study, every human being experiences mild pain on a daily basis, but patients who suffer from clinical depression cope passively--instead of actively--with those experiences, which "may increase the likelihood that pain will become a problem in someone's life," Carroll said. Her observations were backed up by a 2006 study at the University Medical Center in Nijmegen, the Netherlands, where doctors discovered that "helplessness was the only significant predictor" for a higher pain level in all kinds of conditions.
  It's a medical fact: The more you suffer from clinical depression, the worse your back pain will be.

Medicine Not The Answer

• Unfortunately, there is little evidence that antidepressants will help a patient's back pain, or that serious pain medicine will improve the mental condition of a back pain sufferer who is already clinically depressed.
  While California-based rheumatologist Dr. Mark Borigini sometimes prescribes anti-depressant drugs to his back-pain patients because of their "sedating effects" and low-dose pain reliever content, he cautioned in a February 2009 blog on Psychology Today that "it appears that patients with chronic low back pain do not experience a reduction in depression with the use of anti-depressants."

Treatment

• Instead, studies say, the answer to back pain may lay in the patient's mind and attitude.
  Carroll recommends that patients who suffer from both back pain and depression work with their therapists and doctors to adopt a more active way of dealing with pain through exercise, work, and lifestyle changes. She seems to be on the right track: Dr. Kurt Kroenke, a doctor at the Indiana University School of Medicine, published a May 2009 study in the Journal of the American Medical Association that touted better recovery rates for patients who went through an individualized regimen that touted therapeutic pain management alongside anti-depressants and painkillers than those who dealt with the problem in the usual way--by popping pills and hoping they work.
  "It is possible that pain improvement in our trial reflected a main effect of improved mood ... and that as depression lifts, patients may experience pain as being less intense and less disabling. Conversely, it is also possible that the improvement in depression was mediated by an improvement in pain ... or that both depression and pain lessened as a result of treatment effects on a common pathway," Kroenke wrote.

Prevention

• One thing's for certain: if clinical depression or back pain strikes, get help right away.
  "It's important to try to deal with these conditions before they become troublesome and lead to a vicious cycle," Carroll said.