The link between physical and emotional pain has been well documented. One study showed that depression is 3-4 times more prevalent among those who suffer chronic back pain than among those who don't (Sullivan et al, 1992).
One theory that attempts to explain this correlation acknowledges that symptoms of both pain and depression become signals in the brain that travel via the same neurotransmitters. Serotonin and norepinephrine transmit both physical and emotional signals, creating a mind-body link. Altered levels of these neurotransmitters can be caused by pain, and this alteration affects emotional states.
There is hope for those who suffer chronic pain and depression. A variety of therapies, both medicinal and physical, are available.
What is Depression?
Depression is set apart from normal sadness by severity and duration. Generally, clinical depression is not purely situational. It lasts long after a stressful situation's occurrence and often has unknown causes. Symptoms of depression include:
-Feeling low, helpless, guilty and/or worthless for a prolonged period of time
-Disturbance of appetite
-Agitation or lethargy
-Disinterest toward things one used to enjoy
Experiencing a number of these symptoms for a prolonged period of time merits the diagnosis of clinical depression.
The Relationship Between Pain and Depression
Alongside the idea that shared neurotransmitters cause depression among sufferers of chronic pain is the common-sense connection between the two.
Chronic pain can lower the quality of one's life, thereby posing as a situational cause of depression. Though clinical depression is often not purely situational, a constant negative situation can cause a constant negative emotional reaction.
Back pain can be felt as a piercing sensation, a dull ache, or a burning sensation. It can be located in the upper back, lower back or neck. For some with back pain, the unpleasant sensation extends from the back to the neck and arms or to the legs and feet.
Chronic back pain is present when any of the symptoms above recur regularly or are experienced constantly. Pain can limit one's ability to participate in activities that once brought enjoyment. It can also interfere with healthy sleep. The combination of limitation, fatigue and pain itself may be enough to induce a state of depression.
The Good News
A number of treatment options exist for those with chronic back pain and depression. Since the two are biologically and environmentally linked, an improvement of one side is likely to be reflected in the other.
Several medications are used to alleviate back pain. These range from over-the-counter medications like acetaminophen and ibuprofen to muscle relaxants and anti-convulsion. Anti-depressants have also been used to some extent to treat pain. If an individual chooses anti-depressant medication, it is recommended that the one chosen targets serotonin and norepinephrine.
Since medication often comes with safety and dependency risks, many are seeking alternative treatment plans for pain management. Fortunately, many exist. Some drug-free treatments involve movement:
Exercise can be done to target particular muscle groups and strengthen specific areas.
Water aerobics has emerged as a promising component of physical therapy.
Massage therapy and chiropractic care are passive manipulation techniques available to correct problems and ease pain.
Other forms of treatment target one's reception of the pain rather than the pain itself:
Relaxation and meditation therapies cause changes in neurotransmitter activity in the brain. These therapies, also used for those with depression alone, change the way negative sensations are processed by the brain and therefore the degree to which they are experienced.
For those who take medications for chronic back pain and would like to come off of them, a plan is necessary. Consulting with a doctor is the first step, since pain medications come with the risk of dependency. Second, an alternative treatment plan must be set in place to take over the role that medicine used to play. A combination of the above techniques is recommended.