The depression connected with chronic back pain is termed as major or clinical depression. The type of depression that often accompanies chronic pain is referred to as major depression or clinical depression and is much more than what is termed normal sadness or feeling down. In order to diagnose this as major depression symptomatology it happens daily for at least two weeks and includes at least 5 of the following (DSM-IV): mood that is depressed, hopeless and includes crying spells, poor or increased appetite/weight loss or gain, too much or too little of sleep, fatigue or restlessness, decrease in interested in usual activities, lack of sex drive, memory issues and ideas of wanting to die, suicide. People with chronic back pain are known to be at increased risk of major depression and tend to seek treatments for the depression more often. There are triggers for the depression which include lack of sleep which makes a person more tired and irritated during the day. These patients tend to spend more time indoors due to the pain they are unable to enjoy they activities or spending time with others which does require travel outside the home. This can lead to lack of responsibility since someone else takes over/helps with chores, social isolation, loss of work and finance issues which tends to burden the entire family. Medications can lead to stomach upset and constipation and a feeling of mental fogginess from certain medications as well as trouble concentrating and sexual activity is diminished which in turn can cause stress on a relationship.
The focus in regards to depression and back pain is control. With back pain there is a decrease in activity on a daily basis which can include home or work chores, leisurely sports activities and other family interactions which leads to ‘physical and mental deconditioning’ which over time increased the control over a person’s life and pain is what controls life instead directing the person into major depression and it is not easy to change when a person is in such a situation. After surgery recovery a patient who is depressed may have more trouble getting motivated and could have harder time with physical rehabilitation and general motivation to recover at a quicker pace than others. It would be recommended that a patient delays their surgery until the depression is treated. It is important to note that many times patients with chronic back pain are not aware that they are also afflicted with major depression as well as their provider is not focusing on depression. Patients with chronic back pain state that their depression is related to just the pain and are less likely to see a mental health specialist than if they had no chronic pain. Thus, it is of major importance to screen patients for major depression.
It is best to treat clinical depression and pain at the same time with multiple providers involved. The treatment of clinical depression involved anti depressant medications as well as psychological interventions such as counseling. By not treating the chronic pain the improvement from depression maybe halted. Chronic pain treatment includes chiropractic care, physical rehabilitation, medication management. With the ability to treat both the chronic back pain and major depression the patient will have better awareness of control over the pain. The Depression Questionnaire is a self-administered test that allows patient to score the severity of their depression.