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  • Dr. Mark Freund

Can Chronic Back Pain Be Caused by Depression?

chronic pain and depression

Chronic Back Pain and Depression

If you are currently experiencing back pain, you understand the debilitating effects back pain can have on your physical and mental health. Suffering from chronic back pain sometimes means sitting on the sidelines of life and missing out on the activities you love. While there is no definitive link made, many researchers believe that there is a significant correlation between depression and muscular back pain.

Pain, especially chronic back pain, is an emotional condition as well as a physical sensation. It is a complex experience that affects thought, mood, and behavior and can lead to isolation, immobility, and drug dependence.

In those ways, it resembles depression, and the relationship is intimate. Pain is depressing, and depression causes and intensifies the pain. People with chronic pain have three times the average risk of developing psychiatric symptoms — usually mood or anxiety disorders — and depressed patients have three times the average risk of developing chronic pain.

Is There a Link Between Back Pain and Depression?

Though not all patients who suffer from back pain will develop depression, there is a significant risk of developing depression after several months or years of back pain. Some of the reasons for this correlation include:

  • Chronic neck or back pain can make sleep impossible for patients, leading to irritability and less predictable moods.

  • Patients struggling with severe pain may not be able to leave the house or interact with others as they are used to, leading to a feeling of isolation.

  • Those with chronic back pain are often unable to work, placing financial stress on individuals and families alike.

  • Many pain medications prescribed to assist with chronic back pain jeopardize patients' mental health

  • Chronic back pain makes it difficult to concentrate and hard to remember basic elements of day-to-day life.

  • Chronic back pain may diminish a patient's sex drive, placing increased stress on their relationships.

How Depression Can Lead to 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.

man suffering from chronic back pain at the gym
  • 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 the 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 major depression or clinical depression.

How to Cope with Chronic Back Pain and Depression

There are many different approaches to treating chronic back pain and the psychological troubles associated with it. Here are some pain relief strategies to help cope and alleviate back pain and depression.


Not every therapy works for every person, and the best treatment is often a combination of techniques. Psychotherapy—particularly talk therapy—can help treat both physical and emotional pain. One of the best-supported, most-researched forms is cognitive-behavioral therapy (CBT).

Cognitive-behavioral therapy can be effective for both back pain and mental health issues.

During CBT, you learn to identify your negative reactions to chronic back pain and work to change them into positive thoughts. The idea is that if you can alter your initial response, you can better manage how the pain affects you. CBT is directed by a therapist and can be done individually or in a group setting.

For many people, medication is an effective way to manage mental health issues linked to chronic pain—and some drugs even help to relieve the pain itself. For people with depression, for example, antidepressants such as serotonin and norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants (TCAs) are often prescribed to address both issues.

While these drugs can be helpful, however, many may come with side effects. Antidepressants, for example, can cause:

  • Blurry vision

  • Drowsiness

  • Dizziness

Enrolling in a chronic pain rehabilitation program is another option for some. During pain rehab, a team of doctors from different disciplines works together to address the medical, physical, and mental issues related to your pain.

Each program is personalized to the patient, and treatments are often conducted at a medical center. The goals of pain rehab often include addressing your underlying medical conditions, improving your physical function, reducing your reliance on pain medication, and helping you cope with your stress, anxiety, depression, and more.

Complementary Health Practices

Many people find that alternative health approaches help control their back pain and ease their minds. And while there isn't much scientific proof for some practices, such as cupping and dry needling, research has shown that certain other practices actually work to relieve patients.

There's low- to moderate-quality evidence that the following pain management and relief therapies may lessen chronic lower back pain.

  • Acupuncture

  • Low-level laser therapy

  • Mindfulness-based stress reduction, such as breathing exercises and guided imagery

  • Progressive muscle relaxation

  • Spinal manipulation (chiropractic therapy)

  • Tai chi

  • Yoga

Complementary practices such as yoga, which has a strong mental health component, can help many patients with their back pain.

acupuncture treatment on back for pain relief

Electromyography biofeedback, during which electric signals are used to help you gain control over muscle movement, has also been successful for patients in some studies. And though the scientific proof is lacking, some patients find journaling, massage, prayer, and other relaxation techniques to be helpful in coping, as well.

While these alternative practices are widely considered to be safe when done correctly, there may be risks for certain patients, including pregnant women and others with pre-existing conditions. Speak with your doctor if you have questions or a health issue that may be affected by complementary chronic back pain treatments.

Lifestyle Changes

One of the most effective and most widely recommended methods of relieving stress, anxiety, depression, and chronic pain—and improving physical function—is getting regular exercise. Low-impact workouts like stretching, walking, swimming, and yoga are often helpful for people with chronic back issues. Speak with your doctor about physical activities that are safe for you, though, as over-exerting yourself can lead to further injury.

Prioritizing good sleep can help, as well, as poor sleep and sleep deprivation can increase stress, leading to more pain. Most adults should shoot for between 7 and 9 hours nightly. To foster good sleep, try to wake up and go to bed at the same time each day and remove electronic distractions from your room.

A Healthy Diet

Eating a healthy diet can boost your mood and help relieve back pain, partly by fostering weight loss. Aim for well-rounded meals full of lean proteins, whole grains and produce—and limit your intake of processed foods, added sugars, and saturated fats. Try to avoid excess alcohol, as well, and if you smoke—quit; both habits are linked to chronic back pain.

Above all, try to go easy on yourself. Learning about your chronic back pain and searching for successful treatment can be a long and frustrating process in itself.

Food can play a significant role in physical as well as mental and emotional health. When struggling with depression, it can be extremely beneficial to incorporate specific foods into a daily diet. For example, walnuts have been shown to support overall brain health, being one of the highest plant-based sources of omega-3 and a great source of protein.

Also, a high source of omega-3s like chia seeds can pack a punch when looking for small ways to improve diet and mood. Beans are also a great addition to any diet as they're a great source of protein and fiber. These are both excellent ways to minimize blood sugar spikes which can affect mood. Folate, which is also found in beans, can help the body use vitamin B12 and amino acids, helping detox cells and create new cells.

Chicken and turkey are both great sources of lean protein that can help to stabilize blood sugar levels which can help to keep mood well balanced during the day. These trusted sources of lean protein are also known to provide high amounts of tryptophan. This beneficial amino acid can help to create serotonin which assists in maintaining healthy sleep and a balanced mood.

When looking for healthy alternatives to help fight depression, look no further than vegetables. Fiber, folate, and other key nutrients make vegetables a wonderful choice when looking for foods to help improve and stabilize mood.

healthy eating food selection for good nutrition

Leafy green vegetables are great sources of alpha-linolenic acid (ALA) which is one of the three main types of omega-3 fatty acids. While there are many foods that should be added to a daily diet to help with depression, there are also just as many that should be avoided. There is a clear link between alcohol and mental health problems, making this one of the most important dietary changes necessary when battling depression.

Convenience foods such as fast food and junk food should also be avoided when battling depression. They are often high in calories and low in nutrients. Studies have suggested that processed foods, especially those high in sugar and refined cards, cause the body's energy levels to increase rapidly but then crash. Therefore, it is always best to opt for fresh, nutrient-dense, whole foods that can provide a steady source of energy over time.

Refined and saturated fats must also be avoided when consuming foods for depression treatment. These harmful fats can trigger inflammation and may also impair brain function and worsen the symptoms of depression.

With mounting evidence against caffeine, it is best to stay away from that morning cup of coffee. Research has found that caffeine may increase feelings of anxiety, stress, and depression. So next time you need a boost, try going for a walk instead of grabbing a cup of joe.

Identify Stress Triggers

Identifying stress triggers or emotional triggers that affect the pain is the first step in helping manage pain—at least in part—by avoiding or eliminating specific stress triggers.

For example, a person does not plan ahead for appointments causing s/he to be habitually late due to traffic and other unforeseen problems. This "stress" results in increased pain. Developing a behavioral strategy for being early to appointments, and relaxing beforehand once there, can go a long way toward resolving this stress and the pain exacerbation. This is an effective time and pain management.

Another example could be that a couple develops a pattern of bringing up and discussing stressful issues just before bed. The individual with chronic pain gets "stressed," sleeps poorly, and wakes up in increased pain. A simply behavioral prescription of prohibiting these types of discussions in the evening (e.g., the finances) could help avoid this trigger.

suffering from lower-back pain and depression

Patients can monitor how their own stress and anxiety affect their back pain by keeping a diary of when their back pain changes and what kinds of stress could be triggering the pain. This exercise can provide an identification of the elements in one's life that affects the pain.

Recognizing how stress affects pain provides the ability to lessen pain without pain medications and some level of empowerment over chronic pain.

Managing Chronic Back Pain and Depression

If you're suffering from chronic back pain and depression simultaneously, there are a number of health professionals that can treat your conditions. A multidisciplinary approach is often the best way to treat chronic back pain and depression. Natural Care Chiropractic can provide holistic solutions such as manual therapy and chiropractic treatments to help alleviate the back pain, which can also help to aid in depression, especially if the symptoms are coming from physical pain. Schedule an appointment with us today!


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