Depression
and Chronic Back Pain
Depression is
common for those with
chronic back pain
Depression is
more commonly seen in
patients with chronic
back pain problems
than in patients with
pain that is of an
acute, short-term
nature. How does
depression develop in
these cases? This can
be understood by
looking at the host
of symptoms often
experienced by the
person with chronic
back pain or other
spine-related pain.
- The pain
often makes it
difficult to
sleep, leading
to fatigue and
irritability
during the day.
- Then, during
the day, because
patients with
back pain have
difficulty with
most movement
they often move
slowly and
carefully,
spending most of
their time at
home away from
others. This
leads to social
isolation and a
lack of
enjoyable
activities.
- Due to the
inability to
work, there may
also be
financial
difficulties
that begin to
impact the
entire family.
- Beyond the
pain itself,
there may be
gastrointestinal
distress caused
by
anti-inflammatory
medication and a
general feeling
of mental
dullness from
the pain
medications.
- The pain is
distracting,
leading to
memory and
concentration
difficulties.
- Sexual
activity is
often the last
thing on the
person’s mind
and this causes
more stress in
the patient’s
relationships.
Understandably,
these symptoms
accompanying chronic
back pain or neck
pain may lead to
feelings of despair,
hopelessness and
other symptoms of a
major depression or
clinical depression.
A recent study
investigated the
family consequences
of chronic back pain.
Patients reported a
wide range of
limitations on family
and social roles
including: physical
limitation that
hampered patients’
ability to do
household chores,
take care of the
children, and engage
in leisure activities
with their spouses.
Spouses and children
often took over
family
responsibilities once
carried out by the
individual with back
pain. These changes
in the family often
led to depression and
anger among the back
pain patients and to
stress and strain in
family relationships.
Clinical
depression and back
pain
Depression is by
far the most common
emotion associated
with chronic back
pain. The type of
depression that often
accompanies chronic
pain is referred to
as major
depression or
clinical depression.
This type of
depression goes
beyond what would be
considered normal
sadness or feeling
"down for a few
days". The symptoms
of a major depression
occur daily for at
least two weeks and
include at least 5 of
the following
(DSM-IV, 1994):
- A
predominant mood
that is
depressed, sad,
blue, hopeless,
low, or
irritable, which
may include
periodic crying
spells
- Poor
appetite or
significant
weight loss or
increased
appetite or
weight gain
- Sleep
problem of
either too much
(hypersomnia) or
too little (hyposomnia)
sleep
- Feeling
agitated
(restless) or
sluggish (low
energy or
fatigue)
- Loss of
interest or
pleasure in
usual activities
- Decreased
sex drive
- Feeling of
worthlessness
and/or guilt
- Problems
with
concentration or
memory
- Thoughts of
death, suicide,
or wishing to be
dead
Chronic pain and
depression are two of
the most common
health problems that
health professionals
encounter, yet only a
handful of studies
have investigated the
relationship between
these conditions in
the general
population (Currie
and Wang, 2004).
Major depression
is thought to be four
times greater in
people with chronic
back pain than in the
general population
(Sullivan, Reesor,
Mikail & Fisher,
1992). In research
studies on depression
in chronic low back
pain patients seeking
treatment at pain
clinics, prevalence
rates are even
higher. 32 to 82
percent of patients
show some type of
depression or
depressive problem,
with an average of 62
percent (Sinel,
Deardorff &
Goldstein, 1996). In
a recent study it was
found that the rate
of major depression
increased in a linear
fashion with greater
pain severity (Currie
and Wang, 2004). It
was also found that
the combination of
chronic back pain and
depression was
associated with
greater disability
than either
depression or chronic
back pain alone.
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