Genetics and the environment affect the relationship between depression and low back pain

Abstract

Although the co-occurrence of low back pain (LBP) and depression is common, the nature of this association remains unclear. We aimed to investigate whether symptoms of depression are associated with LBP after adjusting for various confounders, including genetics. We used cross-sectional data from 2148 twins from the Murcia Twin Registry, Spain. All twins answered questions about lifetime prevalence of LBP (outcome variable) and symptoms of depression, collected through two instruments, deriving 3 measures: (1) self-report feelings of depression and anxiety; (2) state depression, and (3) trait depression. First, associations were investigated using logistic regression analysis of the total sample. We performed subsequent matched within-pair twin case-control analyses with all complete twin pairs discordant for LBP regardless of zygosity, and separately for dizygotic and monozygotic pairs. This sequential analysis allows for more precise estimates of the relationship between variables, as in each step, the impact of early shared environment and genetics is further considered. Symptoms of depression and anxiety were associated with higher prevalence of LBP in the total sample analysis (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.31-2.05), and this relationship was stronger in the subsequent case-control analysis (OR, 1.74; 95% CI, 1.13-2.69) and dizygotic case-control analysis (OR, 2.39; 95% CI, 1.39-4.08) but disappeared when the analysis was conducted for monozygotic twins (OR, 0.92; 95% CI, 0.42-2.05). A similar pattern was found for state and trait depression. The depression-LBP relationship disappears when high levels of control for confounding factors are applied and seems to be driven by genetic or environmental factors that influence both conditions.

Genetic and environmental influences to low back pain and symptoms of depression and anxiety: A population-based twin study

“…In light of the moderate to large effects of genetic factors on low back pain (Ferreira et al, 2013) and depression (Sullivan et al, 2000), our research group has recently investigated the relationship between low back pain and symptoms of depression and anxiety while accounting for genetic and environmental factors by employing a co-twin case-control design (Pinheiro et al, 2015a, Pinheiro et al, 2016. The findings from…”

Increased low back pain prevalence in females than in males after menopause age: evidences based on synthetic literature review

“…Population-based studies have shown that the prevalence of widespread pain increases with age, peaking in the seventh and eighth decades (20,21). Recently, it has been show that genetics also played a role in the development of LBP (1,22,23).…”

Insight into the genetic architecture of back pain and its risk factors from a study of 509,000 individuals

“…For instance, we observed strong positive genetic correlations between BP and depression related phenotypes, and between BP and obesity-related traits. These traits are known to often co-occur with BP and twin studies have suggested that they share underlying genetic factors 17 , with similar genetic correlations also seen for other pain phenotypes. [55][56][57] Our results confirm a recent twin report of genetic correlation of sleep disturbance with BP.…”

“…Importantly, not only is there a phenotypic association between LDD and LBP but a genetic correlation between the two has been reported in twin studies (11%-13%) 10,16 , suggestive of shared genetic background. Twin studies have demonstrated that BP also shares an underlying genetic predisposition with several of its risk factors including depression and anxiety 17 , educational attainment 18 , obesity 19 as well as with other pain conditions such as chronic widespread musculoskeletal pain 20 .…”