Depression Worsens Low Back Pain

The connection between low back pain and depression has remained tenuous at best, but a new analysis has tied the two together.

Researchers from the University of Sydney recently looked at the two conditions as it pertains to twins. Now the team is back at it to make the relationship between low back pain and depression more clear. So in the first study of its kind, they evaluated depressive symptoms as a risk factor for the onset of low back pain.

“Previous reviews investigating the role of psychological variables in low back pain have shown evidence of depression as a predictor of poor outcomes, such as chronicity, disability, and work absenteeism. However, these reviews did not specifically focus on premorbid depression as a risk factor for new cases of low back pain,” the authors wrote in Arthritis Care & Research.

The investigators screened nearly 8,000 studies and narrowed it down to 16 consisting of 28,326 participants — none of which had low back pain at the time of enrollment. Although the studies used varying strategies to assess depressive symptoms, generally speaking, they used diagnostic interview, self-report screening questionnaires, and nonspecific screening questionnaires.

The results showed that symptoms of depression increased the risk of low back pain (95% confidence interval). In addition, this association held true whether patients were clinically diagnosed with depression or self-reported. Notably, the diagnostic interview and self-reporting screening questionnaires backed this up, but the nonspecific screening questionnaires did not show statistically significance.

“Individuals with symptoms of depression have an increased risk of developing an episode of low back pain in the future, with the risk being higher in patients with more severe levels of depression,” the authors summed up.

There are several theories for the connection. For one, it’s possible that the two share a pathway to the brain. Lifestyle factors, such as poor quality of sleep, are another possible explanation. However, further research is needed to verify the causal relationship.

This link is unfavorable for several reasons. For one, it was found that opioids don’t work as well in patients with depression or anxiety. It also presents the challenge of treating multiple conditions. But on the bright side, this analysis is another step in the right direction for better understanding pain as a whole.

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