Anxiety and Depression in Chronic Back Pain
Understanding the Connection Between Anxiety and depression in chronic back pain
Anxiety and depression in chronic back pain patients is a significant concern that affects quality of life and treatment outcomes. Research has recognized that the anxiety chronic back pain patients experience is influenced by the intensity of the pain they have, the level of disability it causes, and the subsequent feeling of helplessness that anxiety and depression in chronic back pain can spiral patients into.
The Research Behind Anxiety and Depression in Chronic Back Pain
A November 2022 paper[1] highlighted important findings about anxiety and depression in chronic back pain patients: “Quality of life is a very important outcome of low back pain patients, which is affected by multiple dimensions, primarily mobility, followed by anxiety or depression. Patients who have chronic musculoskeletal pain combined with psychosomatic factors (anxiety and depression) were correlated with more severe pain and greater daily activity limitations than those who experienced pain alone. Chronic low back pain patients with psychological disorders (mood and/or anxiety disorders) are highly associated with more severe pain and disability.”
These findings suggest that anxiety and depression in chronic back pain create a complex cycle where psychological factors can intensify physical symptoms and limit recovery.
Is Anxiety and Depression Causing or Worsening Back Pain?
The relationship between anxiety and depression in chronic back pain remains somewhat controversial. While some research points out that it is not entirely clear whether anxiety and depression cause or worsen back pain, patients commonly suffer from all three conditions simultaneously. The research concludes that even though the relationship between symptoms of low back pain and anxiety may be complex, the problem still commonly exists in patients with chronic back pain.
The Need for Integrated Treatment
According to the research on anxiety and depression in chronic back pain: “Although the relationship between symptoms of low back pain and anxiety is very weak in addition to quality of life and quality of sleep, the problem still commonly exists in patients with low back pain. In view of this, psychotherapy should be an integral part of multidisciplinary rehabilitation training strategies, with psychological consultation for patients with anxiety and other negative emotions control strategies to improve their psychological state.”
Mental Health and Orthopedic Treatment Outcomes
A December 2022 paper[2] examining anxiety and depression in orthopedic patients found critical insights: “Across virtually all orthopedic subspecialties, symptoms of depression, anxiety, and unhelpful thinking are associated with worse patient-reported satisfaction with orthopedic treatment and increased postoperative complications. Most patients with orthopedic conditions expressed they would like their mental well-being to be acknowledged, if not addressed, as part of a thoughtful orthopedic care plan.”
This research emphasizes that addressing anxiety and depression in chronic back pain is essential for better surgical outcomes and patient satisfaction.
The Inflammation Connection: Anxiety and Depression in Chronic Back Pain
Research on osteoarthritis reveals an important mechanism linking anxiety and depression in chronic back pain to inflammation. A December 2022 paper[3] discusses accumulating evidence suggesting that about one in five osteoarthritis patients are diagnosed with depression and/or anxiety disorder. The study found that “greater pain scores, joint dysfunction, stiffness, and two or more comorbidities are associated with a higher incidence of depression among osteoarthritis patients.”
How Inflammation Triggers Anxiety and Depression
The research on anxiety and depression in chronic back pain points to a biological mechanism: “It is evident that there is a tendency for the coupling of the pathologic processes of osteoarthritis and neuropsychiatric disease. A higher prevalence of mood disorders in osteoarthritis patients that experience more pain suggests chronic pain as the mediating mechanism of pathogenesis. Chronic pain itself has been shown to promote higher risks of developing depression, anxiety, and dementia.”
What is causing this connection between anxiety and depression in chronic back pain? According to the research: “Molecular and cellular changes in the brain, recognized in the presence of chronic peripheral inflammation—chronic low-grade inflammation.”
A Multidisciplinary Approach to Anxiety and Depression in Chronic Back Pain
At Joint Rehab, we understand that anxiety and depression in chronic back pain require more than traditional physical therapy alone. Our comprehensive approach to treating anxiety and depression in chronic back pain includes:
- Physical therapy to reduce pain and improve mobility
- Education about the mind-body connection
- Coordination with mental health professionals when appropriate
- Gradual return to activity to rebuild confidence and reduce catastrophic thinking
- Strategies to break the cycle of pain, anxiety, and depression
By addressing both the physical and psychological aspects of anxiety and depression in chronic back pain, we help patients achieve better outcomes and improved quality of life.
Contact Joint Rehab today to schedule a consultation and learn how we can help you manage chronic back pain alongside anxiety and depression for lasting relief.
References
1 Jiang Y, Wang Y, Wang R, Zhang X, Wang X. Differences in pain, disability, and psychological function in low back pain patients with and without anxiety. Frontiers in Physiology. 2022:2328.
2 Cheng AL, Leo AJ, Calfee RP, Dy CJ, Armbrecht MA, Abraham J. What Are Orthopaedic Patients’ and Clinical Team Members’ Perspectives Regarding Whether and How to Address Mental Health in the Orthopaedic Care Setting? A Qualitative Investigation of Patients With Neck or Back Pain. Clinical Orthopaedics and Related Research®. 2022 May 10:10-97.
3 Naumovs V, Groma V, Mednieks J. From Low-Grade Inflammation in Osteoarthritis to Neuropsychiatric Sequelae: A Narrative Review. International Journal of Molecular Sciences. 2022 Dec 16;23(24):16031.