The Relationship Between Depression and Back Pain

Depression and back pain are often related. As you can see, those with this kind of chronic pain also have a greater risk of being emotionally unstable at some point. Why, though?
The Relationship Between Depression and Back Pain
Valeria Sabater

Written and verified by the psychologist Valeria Sabater.

Last update: 15 November, 2021

There’s a direct relationship between depression and back pain. In fact, the former tends to appear along with the latter. It’s common for a person experiencing chronic low back pain to develop a mood disorder. You may not be aware of it but these are quite debilitating and often alter the quality of life of those afflicted by them.

Thus, these are the most common and recurrent in regard to those conditions that cause the most pain at the work level. For example, it’s clear that back pain has a great impact on absenteeism and that this is a global problem. In fact, estimates indicate that almost 80 percent of people have had or will experience this problem at some time in their lives.

The same thing happens with depression. The psychological, social, occupational, and personal impact of this disorder is enormous and will be even more so in the future. Therefore, it’s a relevant problem that continues to accumulate more research decade after decade. Living with pain, be it physical or emotional, is incapacitating and affects many areas of people’s lives. Thus, it’s important to clarify the causes and improve the mechanisms of approach.

“I didn’t want to wake up. I was having a much better time asleep. And that’s really sad. It was almost like a reverse nightmare, like when you wake up from a nightmare you’re so relieved. I woke up into a nightmare.”

-Ned Vizzini-

A depressed woman.

Factors that determine the relationship between depression and back pain

Depression, major depression in particular, is usually followed by intense physical symptoms. In addition to back pain, there are contractures, neck discomfort, headaches, joint pain, gastrointestinal alterations, etc. This isn’t new and, in fact, there are accounts of many people who experience post-traumatic stress disorder and have all sorts of physical pain.

Atkinson, Slater, Patterson, Grant, and Garfin (1991) noticed that depression and back pain often afflict veterans who return from missions in scenarios where there’s armed conflict. Thus, studies such as those conducted at the Jilin University in China, which specializes in genetic research, provide compelling information regarding the relationship between these two dimensions. In other words, mood disorders and chronic pain are often two sides of the same coin.

The greater the severity of the depression, the greater the back pain

People are facing a major depression when low back pain is either psychological or emotional. It’s the most serious mood disorder and usually the result of a psychological entity that’s either neglected or not properly addressed.

What scientists observed through X-rays and CAT scans in these situations is that the brain regions linked to depression are the same as those related to the physical perception of pain.

One could say they experience emotional pain in the same way as physical pain. Likewise, they were able to discover that depressive states increase the production of a type of protein, pro-BDNF. This molecule releases in the spinal cord, elevating the perception of pain, especially in the back area.

Chronic states of neglected emotional and physical pain

Freie Universität Berlin and the German Health Service conducted a study of more than 43,000 people over a year. They wanted to understand the link between depression and back pain. One thing they observed is that this reality is more common among women, especially after the age of 50. Likewise, they also observed it affected people who received less emotional, social, and psychological support.

Thus, sometimes, people can spend long periods of time neglecting this mental state. This depression makes a dent and worsens their emotional state. Finally, the psychosomatic symptomatology elevates and mostly affects the back.

Similarly, it’s evident that people with chronic low back pain also have a greater risk of developing a mood disorder. The pain, the limitation in carrying out basic tasks, of being able to work normally, and a diminished daily routine eventually affect their state of mind.

A man with back pain.

How to treat depression and back pain

Medical professionals advise using an interdisciplinary approach when dealing with depression and back pain. It’s important, above all, to make an adequate diagnosis and detect the possible presence of other physical or psychological conditions. The following approaches are generally useful:

  • Pharmacological therapy in the form of antidepressants, analgesics, anti-inflammatories, etc.
  • Cognitive-behavioral therapy allows you to work on a person’s dysfunctional thoughts and introduce more adjusted behaviors.
  • Stress reduction techniques, such as moderate physical activity, relaxation, deep breathing, meditation, and learning coping techniques for managing emotions.
  • Programs for pain rehabilitation, such as medical and psychological units specialized in pain management. Also, the collaboration of physiotherapists, doctors, and psychologists usually gives good results in these cases.

Professionals are still developing exciting programs. In fact, research such as that conducted by Gatchel, RJ, and Turk indicates the need to achieve “mental deconditioning” in patients. What this means is there are times when a person feels completely conditioned by pain and subordinate to their own suffering. Thus, they fail to manage to advance and their depression intensifies.

Finally, it’s necessary to work on that perception and reality in order to achieve small daily advances.

All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

  • Srivastava, S., Yadav, P., Panchal, B. N., Vala, A. U., Ratnani, I., & Khania, P. (2018). Association of depression and chronic lower-back pain. Archives of Psychiatry and Psychotherapy20(4), 37–46.
  • Pinheiro, M. B., Ferreira, M. L., Refshauge, K., Maher, C. G., Ordoñana, J. R., Andrade, T. B., … Ferreira, P. H. (2016, January 1). Symptoms of depression as a prognostic factor for low back pain: A systematic review. Spine Journal. Elsevier Inc.
  • Martini, L., & Hoffmann, F. (2018). Comorbidity of chronic back pain and depression in Germany: Results from the GEDA study, 2009 and 2010. Zeitschrift Fur Evidenz, Fortbildung Und Qualitat Im Gesundheitswesen137138, 62–68.

This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.