Many people say, “I’m not depressed – I’m in pain,” or “You’d be depressed too if your back hurt all the time and you couldn’t do the things you used to do.”
Our response is a resounding: “YES – We agree!”
…However, there are links between pain, in particular low back pain, and mood. We have observed that over 20% of older adults with low back pain have symptoms of clinical depression. This figure illustrates how we view the cycle of low back pain and depression. Table 1 is a list of some published studies showing a link between pain and depression in people 60 and older.
|Table 1. Published Studies Documenting Relationship Between Pain and Depression in Older Adults|
|Bradbeer et al., 2003.||65+||People with pain had higher depression scores.|
|Bruce, 2002.||65+||Pain increased the odds of major depression.|
|Carrington-Reid, 2003.||70+||Depression increased odds of developing chronic disabling back pain.|
|Chou and Chi, 2005.||65+||Pain predicted depression.|
|Croft et al., 2005.||65+||Prevalence of depression increased with number of painful sites.|
|Ferrell et al., 1990.||~89||Pain measures correlated with inability to participate in enjoyable activities.|
|Finne-Soveri +Silvis, 1998||65+||Depression increased the odds of daily pain.|
|Harris et al., 2006.||65+||Moderate-to-severe baseline pain predicted onset of depression.|
|Hein et al., 2003.||60+||Lifetime history of joint pain increased risk of late-onset major depression.|
|Jakobsson et al., 2004.||85+||Depressed mood is more common in those with pain.|
|Jongenelis et al., 2004.||55+||Pain increased the risk of major depression.|
|Karp et al., 2005.||69+||Pain may be associated with a more difficult to treat depression|
|Lamb et al., 2000.||65+||Depression is more common with moderate and severe pain.|
|Magni and Frisoni, 1996.||75+||Depression severity increased with number of painful sites.|
|Meyer et al., 2007.||65+||Depression increased the risk of disabling low back pain after two years and vice versa.|
|Parmelee et al., 1991.||60+||Pain intensity and extensity higher in those with major depression.|
|Wang et al., 1999.||65+||Headache frequency, severity, and chronicity associated with higher depression severity.|
|Won et al., 1999.||65+||Daily pain for 1+ week had higher odds of “impaired mood.”
We view depression as a medical condition with psychological symptoms. Pain may increase the risk of becoming depressed because:
- Pain is an unpleasant experience
- Pain can be frightening
- Pain interferes with sleep
- Pain interferes with activities
- Pain interferes with relationships
- Pain medications can have effects on mood.
- People with low back pain are often concerned that their symptoms will “flare up” or cause permanent damage. This often leads to inactivity, physical weakness, and worse pain.
What does depression look like in people 60 and older with low back pain?
While symptoms can come and go, many people with low back pain and the blues describe the following:
- Not enjoying previously pleasurable activities
- Problems falling asleep, staying asleep, or waking up too early
- Fatigue (mental and/or physical)
- Low energy
- Poor concentration and memory problems
- A desire to be alone or isolate (some people say “I can’t be bothered”)
- Feeling worried or anxious
- Guilty that they can’t manage at home as well as they could before or that they are letting their family or spouse down
- A feeling that life is not worth living or they would be better off dead.