Depression Hurts but so Does My Lower Back

Prolonged pain "appears to set up a pathway in the nervous system that sends pain signals to the brain, even in the absence of an underlying anatomical problem."(Deardoff, 2005). Deardoff also states, "depression and pain share common limbic pathways in the emotional (limbic) region of the brain." This explains why chronic pain is frequently associated with depression. Depression may increase the response to pain or at least increase the suffering associated with pain.

While studies and research may confirm these facts, that do not mean a person, stable on antidepressants, does not have real back pain. One patient suffered a herniated disc in an automobile accident and opted not to have the dreaded surgery because the neurosurgeon could not guarantee pain relief. He suffered from depression but, according to his psychiatrist, was stable on his medication regime.

The patient spent the next 2 years attempting to persuade physicians the pain was real, even with MRI test results in hand. Many physicians could not get past the mental illness diagnosis. Some worried that analgesics and antidepressants may be incompatible or may cause unwanted effects.

There is also an underlying belief and fear that depressed persons are more prone to addiction on narcotics and/or suicide.

The adage "depression hurts" may cause more people with mental illness to continue hurting despite having verifiable physical back pain. There must be a meeting of the minds so everyone can receive unbiased treatment.

An informed physician can suggest a "treatment plan early on that treats the patient's mental state as well as their physical pain, minimizing the chances of the patient developing a chronic pain problem. Getting simultaneous back pain treatment and depression treatment will give the patient a better chance of a full recovery" (Boyles, 2004).

According to Hall-Flavin, more often, the chronic pain has no clear anatomical cause, as in failed back surgery syndrome or chronic back pain without an identified pain generator. In such cases, the pain is itself the disease" (Oct. 2006).

A multidisciplinary team approach to back pain is a tenet of pain management clinics. This team may consist of a physician, nurse practitioner, psychiatrist, and psychologist. The patient is evaluated for coping skills and stress management in addition to medications such as opiates.

"It is important to recognize that physical symptoms like pain can be part of the picture of depression," researcher Kurt Kroenke, MD, tells WebMD. "Even though the physical symptoms may be related to or aggravated by the depression, they can linger longer than
the emotional symptoms." (Boyles, 2004).

References:

Boyles, Salynn. (8/26/2004). Study links depression and pain: Pain Severity Predicts Treatment Outcome.
http://www.webmd.com/depression/news/20040826/study-links-depression-pain

Deardoff, William. PHD. (8/12/2005). 4 Tips to Help Cope with Chronic Pain and Depression: Chronic Pain and Depression Cycle.
http://www.spine-health.com/conditions/depression/4-tips-help-cope-chronic-pain-and-depression

Flavin-Hall, Daniel M.D. (10/13/2005). Pain and Depression: Is There a Link?
http://http://www.mayoclinic.com/health/pain-and-depression/AN01449