Connecting Back Pain to Depression and Anxiety

There is increasing evidence that chronic back pain can cause both physical and emotional distress. As researchers are learning more about the links between pain, depression and anxiety, they are also gaining insight into ways to break the cycle of pain and emotional distress.
Depressed woman sitting on a bed and holding her forehead.It is normal to have emotional reactions to back pain, such as fear and anxiety about what is causing the pain, how long it will last, and how much it will get in the way of your daily activities. Photo Source: is a complex experience that includes both physical and psychological factors. Pain can cause stress, which in turn may cause more pain. As pain worsens, a person may lose sleep, find it difficult to work, and feel irritable and helpless. All of this can lead to depression and anxiety.

It is normal to have emotional reactions to back pain, such as fear and anxiety about what is causing the pain, how long it will last, and how much it will get in the way of your daily activities. If your back pain lasts more than two to four months (considered a normal healing time for most back problems), it is more likely you may experience psychological distress.

Ask Your Doctor

To help reduce stress about your back pain, have a thorough discussion with your doctor about what you are experiencing. Having a clear picture of your condition can help reduce your anxiety and stress, which in turn may help reduce your pain. If you are not satisfied with your treatment, consider getting a second opinion.

Here are some questions to ask your doctor:

  • Is my back pain a sign of a serious disease or disability?
  • What are you looking for or ruling out? What have you found?
  • Can I remain active? If so, how can I do so safely?
  • How can I get around problems such as pain when I bend or lift?
  • What improvement can I expect in my back pain, and when is it likely to occur?

Can Depression Cause Pain?

While suffering from back pain can lead to depression, it is also possible that depression can cause pain. Some people suffer unexplained physical symptoms from depression, such as back pain or headaches. Scientists still do not fully understand how depression and chronic pain are linked.

People with more severe depression feel more intense pain, studies have found. They also have higher than normal levels of proteins called cytokines, which send messages to cells that affect how the immune system responds to disease and infection. Cytokines can trigger pain by promoting inflammation—the body’s response to injury or infection.

If you have pain, it can slow your recovery from depression. In turn, depression can make pain more difficult to treat. It can lead to isolation, which causes further depression. Pain can make a person reluctant to move and go about their daily activities for fear of making the pain worse; this can increase a person’s isolation.

Treating Pain, Depression and Anxiety

Different therapies may be recommended to help manage pain, depression and anxiety. These include:

  • Stress management, including exercise, meditation, journaling and other strategies.
  • Getting regular exercise may help reduce some symptoms of chronic pain, and can boost your mood.
  • Psychotherapy may help patients—and their family members—describe their experience of pain.
  • Biofeedback and hypnosis.
  • Cognitive-behavioral therapy, which helps you become aware of inaccurate or negative thinking, so you can view challenging situations more clearly and respond to them in a more effective way. Patients learn how to avoid fearful anticipation, stop discouraging thoughts, and adjust their routines.
  • Medications to treat sleep problems, anxiety and depression. Antidepressant medications may help relieve both pain and depression, because they share chemical messengers in the brain.

One study of patients with low back, hip or knee pain for three months or longer and at least moderate depression were helped by a combination of medication and behavioral treatment. Patients who received 12 weeks of antidepressant therapy, followed by six sessions of a pain self-management program over 12 weeks, and continuing therapy for six months, reported moderate improvements in both their depression and pain.

Don’t suffer in silence from pain, depression and anxiety. Talk with your health care provider about treating these conditions at the same time, to increase the chance you will start to feel better both physically and emotionally.

Updated on: 04/22/19
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