The Science Behind Back Pain and Depression

According to current research, up to 85% of persons living with chronic pain also suffer from depression (Sheng, Lui et al., 2017). This is not a coincidence. Both are forms of stress on the body: a phenomenon regulated by a structure in the brain called the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis controls endocrine factors that release hormones into the bloodstream in response to stress.

Stress activates cortisol: the hormone that triggers fight-or-flight reactions in an emergency. It’s a survival mechanism. However, chronic stress lasting three months or more causes the HPA axis to become dysregulated. Imagine driving your car at wide-open-throttle for an entire 500-mile road trip. By the end of the drive, your engine would likely need some attention.

Abnormal cortisol levels amplify the perception of pain and trigger depressive episodes, with one perpetuating the other (Sickmann, Mork et al., 2014). Addressing the depression can break the cycle and reduce the amount of pain perceived.  This explains why cognitive behavioral therapy (CBT) can be an effective strategy for reducing pain. CBT is based on the work of Dr. Aaron Beck (1979), who noticed that many of his patients who lived with depression had distorted perceptions about themselves and their environment which he described as maladaptive thinking.

Examples of maladaptive thought patterns include:

* All-or-nothing thinking, viewing everything in absolutes

* Overgeneralization, using “always” or “never” a little too frequently

* Catastrophizing, magnifying a small event to the exclusion of everything else

* Discounting the positive

* Mind reading, predicting someone is going to react to you in a certain way

* Fortune telling, predicting that events will unfold in a certain way without any evidence

* Magnification, making mountains out of molehills

* Self-blaming

* Emotional reasoning, letting your emotions overtake your sense of reason

* Should statements, fixating on things you should or must do

Being aware of maladaptive thought patterns is the first step towards reframing them in a more positive light. A useful strategy is to keep a diary for a week and list each incident in which you find your thinking distorted. Reconsider a couple of the situations. Were your perspectives based on observation, or more on emotional reactions? Maladaptive thinking is a habit, and habits take time to break. It may take weeks or even months of being attentive to your thought patterns to gain a more realistic outlook and start to feel better.

Physical activity can help by refocusing attention away from the thoughts that are triggering depression. Something as simple as a five-minute walk can make a difference. In addition, make sure that you are getting adequate sleep, since lack of sleep can have a significant impact on emotions. For more information, check out the back pain book available as a free download on this website.



One thought on “The Science Behind Back Pain and Depression

  • You might enjoy looking at work done by Dr. Jim Keelan on stress. I worked with him in Denver, he did a lot work on trying to reduce stress.

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