Are chronic low back pain outcomes improved with co-management of concurrent depression?

Abstract

ObjectiveTo discuss the role of depression in chronic lower back pain and comment on appropriate methods of screening and co-management.Data SourcesThe current scientific literature was investigated using the online web databases CINAHL, Medline/PUBMED, Proquest, Meditext and from manual library searches.Data ExtractionDatabases were searched from 1980 to the present (2005). Articles were searched with the key words "depression" and "low back pain". Over three hundred articles were sourced and articles were then selected on their relevance to the chronic spinal pain states that present to manual therapy practitioners.Data synthesisPain is a subjective awareness of peripheral nociceptive stimulation, projected from the thalamus to the cerebral cortex with each individual's pain experience being mediated by his or her psychological state. Thus a psychological component will often be associated with any painful experience. A number of studies suggest (among other things) that the incidence of depression predicts chronicity in lower back pain syndromes but that chronic lower back pain does not have the reciprocal action to predict depression.ConclusionThe aetiology of chronic pain is multifactorial. There is sufficient evidence in the literature to demonstrate a requirement to draw treatment options from many sources in order to achieve a favourable pain relief outcome. The treatment should be multimodal, including mental and emotional support, counseling and herbal advice. While a strong correlation between depression and chronic low back pain can be demonstrated, an apparent paucity of literature that specifically addresses the patient response to chiropractic treatment and concurrent psychotherapy identifies the need for prospective studies of this nature to be undertaken. It is likely that multimodal/multidisciplinary treatment approaches should be encouraged to deal with these chronic lower back pain syndromes.

The association between depression and chronic lower back pain from disc degeneration and herniation of the lumbar spine

“…7 A study indicated that the incidence of depression predicts chronicity in lower back pain syndromes but that chronic lower back pain does not necessarily have the reciprocal action to predict depression. 8 Researchers have found shared neural mechanisms in these two disorders. 9,10 Molecules such as prostaglandin E2 (PGE2), interleukin (IL)-6, interferon (IFN)-γ, IL-1, and tumor necrosis factor (TNF)-α, among others, have been considered candidate markers of painful lumbar disc.…”

A Comprehensive Approach to the Patient at End of Life: Assessment of Multidimensional Suffering

“…30 Some of the psychological factors mediating the pain experience that have been identified include negative mood, anxiety, amount of social support, sense of self-efficacy and control, and adaptive coping strategies. 31–34 These factors still fail to completely explain the observed variability across individuals’ experiences with pain, however.…”

Relationship between depressive symptoms and acute low back pain at first medical consultation, three and six weeks of primary care

“…Unsuccessful treatment after consultation should be critically evaluated by taking depressive symptoms into consideration (Kroenke et al, 2011;Rush, Polatin, & Gatchel, 2000). To address depressive symptoms and pain, multimodal programmes including cognitive behavioural therapy (CBT) approaches appear to be promising in primary care (Middleton & Pollard, 2005;Williams et al, 2006). CBT includes a variety of treatments such as behaviour therapy, coping skills training, cognitive therapy, biofeedback, and relaxation (Morley, Eccleston, & Williams, 1999).…”