Mind-body Relationship

The mind and body work together -- they cannot be separated. The way your mind controls thoughts and attitudes affects the way your body controls pain.

Pain itself, and the fear of pain, can cause you to avoid both physical and social activities. Over time this leads to less physical strength and weaker social relationships. It can also cause further lack of functioning and pain.

Stress

Stress has both physical and emotional effects on our bodies. It can raise our blood pressure, increase our breathing rate and heart rate, and cause muscle tension. These things are hard on the body. They can lead to fatigue, sleeping problems, and changes in appetite.

If you feel tired but have a hard time falling asleep, you may have stress-related fatigue. Or you may notice that you can fall asleep, but you have a hard time staying asleep. These are all reasons to talk with your health care provider about the physical effects stress is having on your body.

Stress can also lead to the emotions of anxiety and depression and a dependence on others. It can also lead to an unhealthy dependence on medications.

Depression

Depression is very common among people who have chronic back pain. Pain can cause depression or make existing depression worse. Depression can also make any pain worse.

If you or your family members have or have had depression, there is a greater risk that you could develop depression from your chronic back pain. You should seek help at the first sign of depression. Even mild depression can affect how well you can manage your pain and stay active.

Signs of depression include having:

• Frequent feelings of sadness, anger, worthlessness, or hopelessness
• Less energy
• Less interest in doing things or less pleasure from your activities
• Difficulty falling asleep or staying asleep
• Decreased or increased appetite that causes major weight loss or weight gain
• A hard time concentrating
• Thoughts about death or suicide

What to Do About Your Emotions

A common type of therapy for people with chronic back pain is called cognitive behavioral therapy. Seeking help from a therapist can help you:

• Learn how to have positive thoughts instead of negative ones.
• Reduce your fear of pain.
• Make important relationships stronger.
• Develop a sense of freedom from your pain.

If your back pain is the result of an accident or emotional trauma, your health care provider should assess you for a condition called post-traumatic stress disorder (PTSD). Many people with PTSD are not able to fully deal with their back pain until they deal with the emotional stress that their accident or trauma caused.

If you think you may be depressed or if you are having a hard time controlling your emotions, talk with your health provider. You should get help sooner rather than later. Your health care provider may also suggest medicines to help with your feelings of stress or sadness.

Alternate Names

Nonspecific back pain - depression; Backache – chronic - depression; Lumbar pain – chronic - depression; Pain - back – chronic - depression; Chronic back pain – low - depression

References

Henschke N, Ostelo RW, van Tulder MW, Vlaeyen JW, Morley S, Assendelft WJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev. 2010;(7).

Smeets RJ, Vlaeyen JW, Hidding A, et al. Chronic low back pain: physical training, graded activity with problem solving training, or both? The one-year post-treatment results of a randomized controlled trial. Pain. 2008;134:263-276.

Kroenke K, Bair MJ, Damush TM, Wu J, Hoke S, Sutherland J, Tu W. Optimized antidepressant therapy and pain self-management in primary care patients with depression and musculoskeletal pain: a randomized controlled trial. JAMA. 2009;301(20):2099-2110.

Update Date: 10/21/2011

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.