Depression & Chronic Back Pain: Symptoms & How to Treat It

A lot of people with chronic pain report feeling depressed. For many people, it’s a “chicken or the egg” scenario. For instance, "did I start feeling depressed or anxious because of my chronic pain?" or "is my back pain a physical manifestation of my depression?". Regardless of how your back pain and depression came to be, what often goes unspoken is the known link between depression and back pain. Pain and depression are positively interconnected.

People with depression are much more likely to experience back pain and people with back pain are more likely to be depressed. People with depression also feel pain more intensely than others. As such, back pain and depression can feel like a vicious cycle where depression is both a symptom and cause of back pain.

Read on as we break down depression and chronic back pain. We will answer “what is depression?”, share back pain and depression symptoms, explain how back pain and depression are connected, and share how you can work through these physical and mental setbacks.

What is Depression & How Do I know if I’m Depressed?

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For a lot of people, it’s tough to admit to themselves and others that they’re not feeling their best. It’s hard to reach out for help and sometimes can be tough to recognize the symptoms. The National Institute of Mental Health describes depression as causing “severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working.”

In order to be diagnosed with this mood disorder, the feelings of sadness, anxiety, exhaustion and other physical factors must last for at least two weeks. In other words, a bad day at work, temporary sadness (like not getting the job you wanted), or feeling anxious about a new situation would not be considered depression. There are various types of depression, but all forms of depression carry symptoms lasting a couple of weeks or more.

Symptoms of Depression

If you’re experiencing some of these symptoms, for a prolonged time period (more than two weeks), for some or most of the day, you may be depressed. Always remember to talk to your doctor if you have depression and back pain symptoms.

  • Feeling sad or anxious.
  • Feeling empty, hopeless, or negative about the future.
  • Feeling irritable or short-tempered with small things that may not have annoyed you before.
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest in the activities, friends, or hobbies that you used to enjoy. Everything feels “meh”.
  • Lack of energy and feeling fatigue. You don’t have the energy to do things.
  • Physically moving slowly or talking quietly/slowly (a lack of enthusiasm).
  • Feeling restless or having trouble sitting still
  • A hard time making decisions, focusing, or remembering plans, facts etc.
  • Change in sleeping. You may have trouble sleeping, waking up, you’re sleeping too much.
  • Appetite changes. You may have a lack of appetite or are overeating. This could affect your weight.
  • Suicidal thoughts or attempts at suicide.

Here’s a link to the Hospital Anxiety and Depression Scale (HADS), a clinical test used to determine a patient’s level of anxiety and/or depression. You can run the test yourself to see roughly where you would rank.

*If you think you’re depressed or are having suicidal thoughts, talk to your care provider or a medical professional immediately.

Depression and Back Pain/ Chronic Pain

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Generally, when it comes to depression and back pain, the types of depression associated are “major depression” or “clinical depression”. Depression is associated with chronic back pain and lower back pain (less with injury). As discussed above, chronic back pain is both a symptom of depression and a cause. This means that the two are interconnected and one can “kickstart” the other into action.

42% of patients experienced the onset of depression prior to the onset of pain, whereas 58% experienced depression after the pain began.”

Experiencing mostly just lower back pain? Learn about the symptoms, treatments, and what to look out for.

Back Pain and Depression: What's the Connection?

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  1. Lack of sleep: Poor sleep, insomnia, and oversleeping can lead to feelings of depression. If you’re experiencing pain, you will naturally have a more challenging sleep. Studies have found that “clinical insomnia” is very common in patients with chronic back pain. Fatigue from lack of sleep and other sleep disorders is linked to physical diseased and psychiatric disorders.
  2. It’s Isolating/ Lonely: When you’re experiencing chronic pain for a prolonged period, you will eventually not be able to do all of the activities you used to enjoy. This includes social outings, hobbies, and other activities. Withdrawing from the people and things you love is depressing in and of itself but is also a symptom of depression. Feelings of loneliness, isolation, and not being able to/ wanting to participate are common in depressed people and those with back pain.
  3. Cannot work: Similar to feeling isolated and lonely, if you’re in moderate or severe pain, chances are you cannot work normally. This can cause financial stress and in some, muster up feeling of worthlessness, helplessness, and guilt for not doing your best for yourself and/or your family. Worthlessness, helplessness and guilt are also feeling shared with those who suffer from depression.
  4. Medication: Side effects of pain medication taken for lower back pain (LBP), spinal pain, sciatica, spondylosis, or chronic pain diagnosis can cause depression. A known and common side effect of narcotic pain medication (not over the counter) is depression.
  5. Poor Sex Drive: A lower sex drive can be frustrating, painful, and confusing for both you and your partner. Both pain and depression are proven to lower your sex drive. This can cause a strain on romantic relationships, create tension, resentment and feelings of guilt—a solid recipe for depression.
  6. Bad Eating Habits: Eating too much? Too little? Both pain and depression can mess with your appetite. Some people who are in pain and taking narcotics will lose their appetite altogether. Others who are feeling depressed turn to food for comfort. An unhealthy diet can lead to weight gain or weight loss—both of which are signs of depression, and can spur other comorbidities, diseases or conditions (like diabetes, high blood pressure etc.).
  7. Feeling Helpless: When you’re in chronic pain, much like depression, the future can look grim with no relief in sight. However, it’s important to know that both of these conditions are curable. This may be easier said than done, but feeling helpless is your depression and pain talking!

With this said, there are things you can do to manage your depression and/or chronic pain. Keep reading and we’ll talk it out.

Back Pain Treatment & How to Treat Depression From Chronic Pain

Since both depression and back pain are closely linked, if you’re able to address one, the other will be affected too. In other words, if you’re able to better manage your pain, you may notice a mood, behaviour and emotional shift as well. The same goes with treating your depression or anxiety—sort out the psychological and notice the physical resolve itself too.

Here are 5 ways to improve and manage your depression and pain.

1. Reach Out for Professional Help

When it comes to back pain and depression, you may need a two-pronged approach to best treat your condition. It’s important that you don’t just focus on your depression or pain, but look at them as a whole that are connected. Speak to your physician about your depression AND back pain. You doctor may recommend a variety of treatment options to aid with both your physical and emotional ailments.

From a physical treatment point of view, this could mean working with health care professionals like: a physical therapist, occupational therapist, massage therapist, chiropractor, acupuncturist etc.

For treating your depression or anxiety, this could involve: seeing a therapist (some specialize in chronic pain), meeting with a counsellor, introducing meditation, taking yoga, working with a nutritionist etc.

Sometimes, a diagnosis of depression can be empowering. Learn more.

2. Take Your Medication

A lot of people hate taking medication and this is totally understandable. It sucks to have to rely on medication to feel physically or mentally better. However, if your physician has recommended medication—whether it be anti-inflammatories, NSAIDs, pain medication, anti-depressants, or other mood stabilizers, take them as prescribed. If you find the right medications for you and your symptoms, you may notice a drastic improvement.

With that said, narcotics for pain can have downsides with prolonged use and when doses are increased. Read more about the dangers and alternatives to narcotic pain medication.

3. Exercise and Eat Well

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Yeah, yeah, yeah. You’ve heard it all before, but we’re going to say it again: food is medicine. Healthy foods are packed with vitamins and nutrients that promote healing, reduce inflammation (a leading cause of pain), and make us feel good. If you focus on eating better and seeing food as something that has the potential to help with your pain and depression, you can naturally cut your symptoms.

Paired with cleaner eating, exercise (specifically, cardio) will also stabilize your mood and reduce anxiety and depression. When you’re working out (even if this means walking, water aerobics, or cycling on a stationary bike) your body releases chemicals that break up the negative thought loop you’re in. Exercise increases the “production of BDNF (brain-developed neurotrophic factor), a protein that helps neurotransmitters perform their function, and which may help depressed people emerge from their rut.” This same article describes exercise as “Miracle-Gro for the brain."

Here are foods that boost your healthy and healing potential.

4. Monitor Your Symptoms

It’s important to keep track of how you feel, the medicine you’re taking, and monitoring any symptoms you may experience. Record your exercise, the medication you take (both prescribed and over-the-counter), pain levels, how you’re feeling, and if you’re really a go getter, what you’re eating. You can even rank your pain from 1-10 and your mood for 1-10 too. By keeping track of your day and logging everything, you may be able to pinpoint what triggers flare-ups, what makes you feel better, and uncover helpful patterns. Sharing your findings with your care team can also get you better, individualized treatment and help "crack the code" on your depression and pain.

5. Reach Out to Friends and Family

Isolating yourself from family and friends is dangerous and perpetuates feelings of emptiness and hopelessness. You are not alone in having back pain, chronic pain, or feeling depressed or anxious. Millions of Americans, people you know, and people you look up to have gone through what you’re going through.

Bring your family and friends in. They want to help you and support you. Almost everyone has experienced some form of depression in their lifetime, so don't be ashamed of talking it out. Your loved ones want to help you and are in the best position to do so.

For more ways to treat depression, specifically post-op depression after surgery, read this popular post.


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Hi, I'm Grace. I write and research about hip and knee replacements, PreHab before orthopedic surgery & ReHab. Content advised or co-authored with physicians (MD) and orthopedic surgeons (OS).

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