Chronic back pain and depression often go hand in hand, and one can lead to the other.
The cause and effect relationship is not always obvious, but like most things, there’s an even more important question:
What can we do about it?
To find out, we’re going to combine scientific evidence with real personal experience, clinical insights and practical solutions.
Back Pain Can Cause Depression
A study that looked at 5001 people over ten years, showed that both pain and depression can lead to the other condition. The authors state “the need to assess the presence of both disorders given the presence of one”.(1)
It showed that people with chronic pain are more likely to develop ‘dysthmic disorder/dysthmia’, a type of depression described by the Merriam-Webster dictionary as “a mood disorder characterized by chronic mildly depressed or irritable mood often accompanied by other symptoms (such as eating and sleeping disturbances, fatigue, and poor self-esteem)”. Other symptoms include loss of interest in life, feelings of guilt, anger, poor concentration and decision making, and loss of productivity.
In addition, a study of over 118,000 Canadians showed that “The rate of major depression increased in a linear fashion with greater pain severity” (More pain, more likelihood of depression). (2)
So that’s pretty clear.
How can back pain cause depression (and what can we do about it)?
On the surface, there are some obvious ways that back pain can cause depression, which we’ll look at first.
1. Pain can cause stress and anxiety. Especially when you don’t know why it’s there, if it’s something ‘serious’ or how long it’s going to last. The most important thing here is to get an assessment from a health professional who can give you an accurate diagnosis and tell you what your options are. I recommend going to see your doctor and a good chiropractor/osteopath/physio, because they play different roles in helping you recover.
2. Then there’s the frustration of not being able to do the things you normally do. From losing your hobbies and social life, to the fear (or reality) of not being able to work, play golf or pick up your kids. Getting back to normal life as soon as you can is very important. The likelihood of someone going back to work decreases the longer they spend off, so getting ‘back in the saddle’ is the priority.
3. If exercise is your main source of endorphins (feel-good chemicals) and you can’t do it, that can also have a big effect on how you feel. One of my current patients Paula, 50, who’s had chronic back pain since her early 20’s, followed by depression, says:
“Back pain took my happiness away. I used to exercise three hours every day, and (my) depression comes from not having the endorphins I used to get from exercise.”
Exercise makes everyone feel better. But for some people, it’s a crutch that helps them deal with underlying stress, depression or anxiety, and taking it away has a big impact on them. With Paula, I recently suggested that although she can’t walk very far, she tries a recumbent exercise bike at home. She finds that it really helps her mood, and she can do a lot more than she thought when she gets going with it.
So try to find something you can do, even if it’s in a limited way. Like 5 minutes of gentle stretches, walking around the garden, cycling, swimming or even dancing on your own in the living room. Walking is often the best and most accessible exercise, but if that’s a struggle then try to find something you can do.
4. For some people, there’s also the sense of feeling useless or helpless, if they can’t contribute, support or look after their family in the same way. This can be hard because it’s linked to your sense of identity and self-worth. Even if people around you are supportive and understanding (which they may not always be) it’s still such a deep part of you that it’s hard to ignore.
Paula says “Before my back was bad, I used to do all the housework, gardening, cooking, and feel accomplishments through doing all these things. When I could no longer do them I felt/feel impotent, lost, useless, jealous of people who can do what they want… I think the main feeling is definitely of impotence/completely useless. Which leads to depression and not wanting to do anything because of fear of damaging my back more”.
Getting more active can certainly help lift your spirits. But sometimes there’s just no easy quick fix for these feelings, and it can be helpful to talk to a professional psychologist or counsellor about it. You are a unique person and your experiences are unique to you, but a lot of people have been through a similar situation, and an experienced professional can do a lot to help you through it.
CBT (cognitive behavioural therapy) is another popular option for helping with stress, anxiety and depression. It involves talking through your thoughts, feelings and physical sensations, but unlike counselling, it focusses ion the present and not the past, so doesn’t have to involve digging up painful or unpleasant memories, that some people understandably don’t want to do.
The NHS (National Health Service in the UK) website states this:
“CBT aims to help you deal with overwhelming problems in a more positive way by breaking them down into smaller parts. You’re shown how to change these negative patterns to improve the way you feel. Unlike some other talking treatments, CBT deals with your current problems, rather than focusing on issues from your past. It looks for practical ways to improve your state of mind on a daily basis.”
For more information on CBT you can check out the Mind.org website here.
5. Back pain can interfere with sleep.
And ongoing sleep disturbances are linked to the development of mental health issues like depression. Missing out on sleep makes everything worse, both physically and mentally. So anything that can help you get a good (or better) night’s sleep is worth its weight in gold.
Doctors may prescribe sleeping tablets or drugs like amitriptyline, which can be helpful. But some people want to limit the amount of medication they’re taking, or don’t like the side effects. There are natural sleep remedies which can work very well, and often worth trying before resorting to the pharmaceutical options. Like valerian or magnesium for example.
Magnesium Gets a Special Mention!
I personally recommend magnesium to a lot of my patients, and I take it myself every night. Partly because it’s very safe compared to medication, but also because magnesium deficiency is very common, and is linked to both depression and physical aches and pains.
A study of 457 patients with chronic depression or chronic pain with depression stated that “Virtually all significantly depressed patients are deficient in magnesium”. (3)
Another study presented case histories showing rapid recovery (less than 7 days) from major depression using magnesium supplementation (125–300 mg as glycinate and taurinate) with each meal and before bed. (4)
The authors go on to say:
“The possibility that magnesium deficiency is the cause of most major depression and related mental health problems including IQ loss and addiction is enormously important to public health and is recommended for immediate further study”.
The recommended daily amount for magnesium supplements is around 300mg for women and 400mg for men. The best time to take it is half an hour before bedtime. Here is the one I am currently recommending.
The main causes of magnesium deficiency are refined and processed foods, caffeine & alcohol, diuretics (‘water tablets’ given for high blood pressure), calcium tablets (given for osteoporosis), and chronic stress.
Foods that are high in magnesium include leafy greens like spinach and swiss chard, wild fish like herring, mackerel, halibut and pollock, edamame beans and sweet potatoes (with the skin on), dark chocolate (yes you heard that right) and pumpkin seeds.
Can depression cause back pain (and what can you do about it)?
It can work the other way around as well, which implies that they can feed into each other in a vicious circle.
Research shows that people who score in the highest 25% of depression scores have four times the risk of experiencing neck or low back pain. To quote the study from the scientific journal Pain: “Depression is a strong and independent predictor for the onset of an episode of intense and/or disabling neck and low back pain”. (5)
Again the causes aren’t always clear, and in some cases, it could be linked to sensitization of the nervous system for example. But as before, some reasons are pretty obvious.
Depression can make you less active. And inactivity is a big factor behind many cases of back pain, and physical aches and pains in general. Your body is built to move around, and when it doesn’t, it complains. I believe that a lot of physical (musculoskeletal) discomfort is the body protesting that it’s not being used the way it’s meant for. Such as walking and running, bending and lifting, pushing and pulling, and moving things around.
Being active is so important. Even though you don’t feel like it. Especially as you don’t feel like it. It doesn’t mean running 10 miles, just getting out the house and walking around the block. Anything that gets your body moving. Walking is so great for the back because it gets all the muscles working, pumps fluid around the joints and the spinal discs, and the rhythmic movement (when you walk with your arms swinging, no bag or hands in pockets) helps loosen everything up. Again though, if walking isn’t your thing then it’s worth finding something you can do.
There are antidepressants of course, and some studies have shown that tricyclic antidepressants might also help reduce low back pain.(6)
But those medications might not be suitable for everyone, and it’s up to your doctor to decide if it’s right to prescribe them.
Inflammation: The Common Thread
We’ve established by now that back pain can lead to depression, and vice versa. But what’s often overlooked is that, in many cases, the main underlying cause of both of these conditions is the same thing. Systemic (body-wide) inflammation.
Inflammation is a factor in both chronic pain and depression. In fact, reducing systemic inflammation helps literally everything in the body to work better. Chronic, ongoing inflammation is at the root of most diseases, from depression to heart disease, Alzheimer’s to cancer. Anything that helps quench inflammation in the body is a good thing.
And the ways to do it that you have the most control over, are what you eat and how you move.
How to Reduce Inflammation
Less sugar, more greens
Your body produces inflammation in response to a challenge. It’s like rallying the troops.
Sugar, grains, alcohol, caffeine, processed foods (and generally most of the things we like) are common causes of inflammation. Whereas vegetables generally help reduce inflammation.
So, an easy way of reducing systemic inflammation is to just have less of the above, and eat more of these foods:
- Green beans
- Collard greens
Start with breakfast
Have you heard of the 80/20 rule?
Basically, 20% of your actions give you 80% of the results. And switching up your breakfast to a more nutritious and less inflammatory meal is one of the simplest ways to feel better for the rest of the day.
If you generally go for the western default options of toast or processed cereal, or nothing at all, then you’re missing a trick.
Those ‘foods’ are practically worthless nutritionally, and a high carbohydrate/low protein meal like that first thing is likely to cause more inflammation in the body, and also spike your blood sugar leading to a crash later on. Which is definitely not what you want if you’re prone to any sort of mood disturbances like depression or anxiety.
In contrast, eating a meal based around protein and fat within an hour of waking up not only fills you up for longer, but it also helps to regulate your blood sugar better throughout the day, which actually makes you more resilient to stressful situations.
Eggs (however you like em) are a great breakfast option. Instead of toast, you can have them with tomato, cheese, bacon, turkey or beans. And don’t worry about eggs causing high cholesterol, that’s just not true. (7)
But the quickest and easiest way to get protein, fat and a ton of nutrients in the first thing, is a protein shake. I have one for breakfast every day. You can just put protein powder and almond/coconut milk in a handheld shaker, but for maximum nutrition (and flavour) all you need is a blender/extractor and the following ingredients (aside from the protein powder everything is optional so just experiment to find what works for you):
- A high-quality protein powder (either whey, made from milk, or there are vegan options too)
- Unsweetened almond or coconut milk
- A handful of spinach (high in magnesium)
- Berries of some kind (blueberries are high in vitamin C)
- A tablespoon of coconut oil
- …and anything else you like the taste of!
Just Wizz it up for 20 seconds and you’re good to go.
Sorry to keep going on about it, but it’s true.
“Interventions that include exercise prescription have been shown to reduce both abdominal fat and systemic inflammation. Furthermore, exercise is also known to reduce pain perception and improve mental health and quality of life that also improves pain outcomes.” (8)
Once again it comes down to being more active. Especially if you don’t feel like it.
I’m not saying it’s easy, it’s not. But when you make yourself do it, you will feel the benefit for sure.
Back pain and depression can often go hand in hand. One can lead to the other, and it’s important to think about the factors involved, because by doing so you might, one step at a time, be able to improve the quality of your own or your client’s life.
(1) Schmaling, Karen B., and Zachary A. Nounou. “Incident Chronic Spinal Pain and Depressive Disorders: Data From the National Comorbidity Survey.” The Journal of Pain 20.4 (2019): 481-488.
(2) Currie, Shawn R., and JianLi Wang. “Chronic back pain and major depression in the general Canadian population.” Pain 107.1-2 (2004): 54-60.
(3) Cox, Richard H., et al. “Significant magnesium deficiency in depression.” J Neurol Orthop Med Surg 1996 17 (1996): 7-9.
(4) Eby, George A., and Karen L. Eby. “Rapid recovery from major depression using magnesium treatment.” Medical hypotheses 67.2 (2006): 362-370.
(5) Carroll, Linda J., J. David Cassidy, and Pierre Côté. “Depression as a risk factor for onset of an episode of troublesome neck and low back pain.” Pain 107.1-2 (2004): 134-139.
(6) Verdu, Bénédicte, et al. “Antidepressants for the treatment of chronic pain.” Drugs 68.18 (2008): 2611-2632.
(7) Gray, J., and B. Griffin. “Eggs and dietary cholesterol–dispelling the myth.” Nutrition Bulletin 34.1 (2009): 66-70.
(8) Paley, Carole A., and Mark I. Johnson. “Physical activity to reduce systemic inflammation associated with chronic pain and obesity.” The Clinical journal of pain 32.4 (2016): 365-370.