Can your Low Back pain be caused by Depression?

We know that chronic low back pain can cause depression. In the same way, depression can cause low back pain. Body pain is a common symptom of depression and depression actually worsens the way we feel about the pain. Depression causes a feeling of tiredness and fatigue and a lack of interest. This prevents you from exercising and strengthening your back muscles.

This does not mean that the back pain in ‘imagined’ in the head, it physical and chemical effects of depression worsens the severity of the low back pain.

There is enough evidence in the medical literature that depression can lead to the increased production of chemicals that cause pain and inflammation. These chemicals are proteins called ‘cytokines’ These are seen in higher levels in depressed patients. These can cause inflammation of the muscles, joints and tissues in the lower back causing muscle pain, fatigue and low back spasm and stiffness.

It appears that emotional stress plays a major role in causing low back pain. Stress can lead to your muscles tightening for most of the time. This can produce pain and is called ‘muscle spasms’ of the back. Back spasms are common in low back pain. It also can cause stiffness of the back muscles and decreases the movement of the spine. This makes the back muscles to tighten up further. Worry due to this pain can cause even more stress that results in more pain.

When we are anxious, we tend to breathe rapidly and our breathing patterns change. All the muscles around our chest and lower back becomes tense. This will affect our posture and flexibility of our chest and back muscles. It soon becomes a cyclical pattern and more the anxiety, more the pain and more the pain, worse does the anxiety gets. We also exercise less during periods of anxiety.

Our emotions drive our activity. We lose interest if we are sad and this can significantly decrease our energy and activity levels. Lack of activity will cause tiredness and fatigue as we do not exercise our muscles as much as we could and this can lead to low back pain. We expect the worse about our pain and the worse we think that our pain will be, the worst it gets. It affects our perceptions, feelings and thoughts.

We need to manage our emotions as well as the effects that has on our low back pain. Emotional distress can lead to pain as well as pain causing emotional distress. The more difficulty we have in dealing with emotional distress, the more likely it is that we will experience pain. This is a cycle and it can lead to fear-avoidance. This means that we avoid any activity out of fear that it will cause back pain.

The first step in the treatment will be to break this cycle with a ‘supervised exercise program’ This will help reduce our anxiety, fear, and avoidance of movement. Eventually, this program will strengthen our back and help us handle our everyday activities of daily living like lifting and bending.

This is done with the surgeon, physiotherapist, pain specialist and psychologist. A ‘pain dairy’ usually helps to see when the pain occurs and what triggers it.

Behavioural therapy can help to cope with the pain and deal with the emotions and anxiety associated with it. Relaxation techniques like deep breathing exercises and progressive muscle relaxation (PMR), Guided imagery, Biofeedback therapy and Mindfulness meditation are all effective in easing the muscle spasms. These interventions can help manage low back pain and our emotions effectively. Antidepressant and anti-inflammatory medications can both be necessary.